Fonsecaea monophora所致着色芽生菌病1例及其相关实验研究

目的 报道1例由Fonsecaea monophora所致的着色芽生菌病.方法 患者女,60岁,主因左手背皮损1 a余就诊,取皮损痂屑进行真菌直接镜检和培养,取皮损组织进行组织病理学检查和真菌培养.对培养获得菌株进行形态学和分子生物学鉴定,并进行药物敏感性检测.结果 真菌直接镜检阳性,可见较多圆形、厚壁、棕色的硬壳细胞.组织病理学显示为慢性肉芽肿样改变;HE和PAS染色均可见到圆形、厚壁、棕色的硬壳细胞.真菌培养阳性,菌落生长缓慢,呈橄榄色到黑色.小培养及扫描电镜检查可见枝孢型和喙枝孢型产孢,分生孢子单细胞性,呈椭圆形或卵圆形.ITS区序列分析鉴定为Fonsecaea monophora.药敏试验显示伊曲康唑对F.monophora的最低抑菌浓度（minimal inhibitory concentration,MIC）为1.0 μg/mL,特比萘芬的MIC为0.015 6μg/mL.给予患者口服特比萘芬250 mg/d治疗,皮损缓慢好转;6周后加服伊曲康唑200 mg/d治疗,14周后皮损消退呈瘢痕化修复.结论 依据临床及实验室检查确诊该病例为Fonsecaeamonophora所致着色芽生菌病,伊曲康唑联合特比萘芬治疗本病例显示较好疗效.     

Fonsecaea monophora所致着色芽生菌病1例CSCD

患者,男,63岁,因“左手腕结节斑块半个月”为主诉就诊我科门诊。左手腕肥厚性的肉色斑块,结节,表面疣状增生,病理活检见真皮及多核巨细胞胞浆内褐色厚壁圆形硬壳小体。PAS染色(+),真菌培养见暗棕至黑色菌落生长;经测序,最终确诊为Fonsecaea monophora所致着色芽生菌病。予口服伊曲康唑治疗,但由于患者原发矽肺症状加重,后因矽肺引发并发症死亡。     

Fonsecaea monophora致皮肤着色芽生菌病1例

报告重庆地区1例由Fonsecaea monophora感染引起的皮肤着色芽生菌病。患者,男,81岁,因左上臂内侧皮肤被铁片划伤后出现溃疡伴疼痛1年余到我院就诊。对患者皮损组织行组织病理学检查和真菌培养,将培养出的菌落做形态学和分子生物学鉴定。真菌培养获得菌落形态,小培养乳酸酚棉兰染色得到镜下特征形态,菌落形态：可见暗棕色和黑色菌落生长;镜下形态：可见枝孢型和喙枝孢型产孢;皮损处组织病理学检查结果：可见慢性肉芽肿样改变。ITS(internal transcribed spacer)区域测序鉴定结果为Fonsecaea monophora。根据实验室培养结果和临床资料分析确定该例为Fonsecaea monophora感染引起的着色芽生菌病。口服伊曲康唑200 mg, 2次/日,联合药物涂抹和光动力学治疗有效。     

着色真菌monophora引起皮肤着色芽生菌病1例

目的报道1例由着色真菌monophora引起的皮肤着色芽生菌病。方法取皮损皮屑标本进行真菌直接镜检和培养,同时取活检进行真菌培养和组织病理学检查。对真菌培养阳性菌株进行形态学鉴定、温度试验和放线菌酮耐受试验,PCR扩增测序。结果KOH涂片检查可见较多圆形厚壁棕色硬壳细胞。组织病理学显示为慢性肉芽肿样改变;PAS和银染色可见到圆形厚壁的硬壳细胞。真菌菌落生长缓慢,呈橄榄色到黑色。小培养可见大量棕色菌丝、分支分隔,分生孢子梗主要为喙枝孢型,分生孢子棕色,椭圆形或卵圆形,单细胞。温度试验37℃生长,38℃不生长。0．01％、0．05％和0．1％放线菌酮均能耐受。扩增真菌rDNA的ITS区得到645bp的片段,经序列分析与裴氏着色真菌monophora变种ITS区比对,100％一致。结论据真菌学形态结构特征以及DNA序列分析菌种被鉴定为着色霉monophora。     

伊曲康唑联合特比萘芬治愈着色芽生菌病1例

报告1例由卡氏枝孢瓶霉引起的着色芽生菌病。患者男性,43岁,因右上臂局限性红色斑块性皮损5 a就诊。皮损组织病理为慢性炎性肉芽肿改变,可见硬壳细胞。真菌培养鉴定为卡氏枝孢瓶霉。给予伊曲康唑(200 mg/d)和特比萘芬(250 mg/d)联合治疗12周痊愈。     

伊曲康唑治愈着色芽生菌病1例

着色芽生菌病（chromoblastomycosis）是由暗色真菌引起的皮肤及皮下组织的慢性肉芽肿性疾病。致病真菌常通过皮肤的微小外伤侵入,损害好发于四肢远端的暴露部位。临床表现为疣状增生性斑块或结节,病程持久,迁延不愈。最近我们用伊曲康唑治愈1例着色芽生菌病患者,报告如下。     

裴氏着色芽生菌病1例

1临床资料 患者男,60岁,农民。左下肢皮肤瘢痕、斑块11 a。11 a 前,不慎跌倒擦伤左膝下方皮肤,局部溃烂长期不愈。口服抗生素,外用碘伏,红霉素软膏治疗后无效,当地医院按真菌感染先后予口服伊曲康唑,氟康唑,特比萘芬不规则治疗,期间皮损大部分愈合形成瘢痕。其后瘢痕逐渐扩大并时有疼痛。后又在当地医院按“瘢痕疙瘩”予复方倍他米松注射液局部封闭治疗2次,瘢痕未缩小却在边缘渐出现红色斑块,肿胀并有浸润。遂来我院就诊。     

孢子丝菌病致睑外翻1例

1 临床资料 患者女,36岁,河北省张家口市农民.主因右下眼睑部皮损6 a,于2011年1月5日就诊.6 a前患者无明显诱因右下眼睑部位出现一个结痂性皮损,有少许脓液外渗,缓慢增大,导致右下眼睑外翻.1.5a前在外院给予局部皮损手术切除加右下眼睑外翻修复术,术后皮损组织病理显示为"急性炎症反应",给予抗菌药物口服处理,患者右下眼睑外翻明显好转,但术后不久在原部位处皮损再发.     

伊曲康唑联合全厚皮片移植术治愈着色芽生菌病1例

患者男,47岁.颈部皮损5a,皮损直接镜检可见多个棕色硬壳小体,皮损组织真菌培养为卡氏枝孢瓶霉,皮损组织病理PAS染色可见棕色厚壁孢子.诊断为着色芽生菌病,给予患者口服伊曲康唑胶囊治疗8个月,皮损形成瘢痕,之后采取全厚皮片移植术切除瘢痕,术后继续口服伊曲康唑治疗2个月,皮损痊愈.     

裴氏着色霉致着色芽生菌病1例并文献复习

报道1例裴氏着色霉致左手背及腕部着色芽生菌病,通过文献复习统计并分析该病在我国的流行病学及临床特点.患者男,48岁,左手背部红斑、疣状增生伴瘙痒10 a.皮损组织病理检查示真皮中下层有炎细胞及多核巨细胞,PAS染色见硬壳小体.经真菌培养和分子鉴定为裴氏着色霉.经伊曲康唑600 mg每日口服,治疗3个月后好转.     

蜡螟-单梗着色霉Fonsecaea monophora感染模型的构建及其血淋巴功能的变化

暗色真菌单梗着色霉Fonsecaea monophora侵犯皮肤及皮下组织,引起着色芽生菌病;其所引起的皮肤疣状改变或溃疡严重影响患者生活质量,重者可致残甚至发生癌变。近年来,无脊椎动物构建感染模型逐渐兴起,应用范围逐渐扩大。本研究利用蜡螟成功构建了F. monophora体内感染的动物模型,绘制了被感染蜡螟幼虫的生存曲线,观察记录了感染过程中蜡螟幼虫体表及体腔内的变化情况。在此基础上,进一步探索蜡螟幼虫对F. monophora的免疫防御应答,初步研究发现由病原体感染所诱发的血淋巴改变具有一定的抑真菌性,可抑制白念珠菌的生长。     

Chromoblastomycosis due to Fonsecaea pedrosoi and F. monophora in Cuba

We report two cases of chromoblastomycosis due to Fonsecaea pedrosoi and F. monophora in otherwise healthy Cuban males. Direct microscopic examination of biopsies revealed muriform cells, the hallmark of chromoblastomycosis. The suspected agents were recovered in culture, identified on the basis of morphological criteria and confirmed by sequencing of the internal transcribed spacer regions of rDNA. Final treatment consisted of surgical excision. The patients were successfully cured since there was no relapse after a follow-up of more than a year. In vitro antifungal susceptibility testing of both isolates showed that itraconazole and posaconazole had potent activity. High MICs of amphotericin B (2 μg/ml), fluconazole (>64 μg/ml), anidulafungin (8 μg/ml) and caspofungin (8 μg/ml) were found.     

A Case of Relapsed Chromoblastomycosis Due to Fonsecaea monophora: Antifungal Susceptibility and Phylogenetic Analysis

Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis. The management of this infection continues to be challenging because there is no consensus on the therapeutic regimen. We report here a case of a 69-year-old male patient with cauliflower-like lesions on his left leg and foot. He had already been treated with itraconazole at a dose of 200 mg/day for 5 months, with mycological cure for all the affected areas. However, the lesions relapsed at both sites, and treatment with itraconazole was resumed at the dose previously used. Initially, direct mycological examination, cultural, and microculture slide observation were performed. Afterward, sequencing of the ITS1-5.8S rDNA-ITS2 region of the fungal DNA and evaluation of its susceptibility to antifungal agents alone and in combination were performed. In direct mycological examination, the presence of sclerotic cells was verified, and the fungus was identified as Fonsecaea based on cultural and microscopic examinations. Identification as Fonsecaea monophora was confirmed after sequencing of the ITS region and phylogenetic analysis. The isolate was susceptible to itraconazole and terbinafine. The combinations of amphotericin B and terbinafine and terbinafine and voriconazole were synergistic. The use of drugs for which the causative agent is susceptible to singly or in combination may be an alternative for the treatment of mycosis. Furthermore, the identification of the agent by molecular techniques is important for epidemiological purposes. To the best of our knowledge, this is the first case of relapsed chromoblastomycosis caused by F. monophora in Brazil.     

Inhibition of Nitric Oxide Production by Macrophages in Chromoblastomycosis: A Role for Fonsecaea pedrosoi Melanin

Chromoblastomycosis is a chronic and progressive deep mycosis that is usually found in tropical and subtropical areas. Fonsecaea pedrosoi is considered its most frequent etiologic agent and causes a typical granulomatous inflammatory response, whose degree reflects the immune status of the host. Since macrophages play a fundamental role in the control of the infection, this study aimed at investigating the production of oxygen reactive specimens, the phagocytic capacity and the production of nitric oxide (NO) by macrophages employing in vitro assays and an in vivo model of chromoblastomycosis. Our results demonstrated that, during the infection, peritoneal macrophages show an increased phagocytic capacity and H₂O₂ production, but also a reduced ability to produce NO. Moreover, F. pedrosoi stimulated H₂O₂ production in vitro but not the synthesis of NO. The incubation of IFNγ and LPS-stimulated macrophages with melanin, obtained from the fungus, inhibited NO production. Examination of the liver and spleen of infected animals, at day 30 or 60 following inoculation, showed a progressive increase in the number and size of granulomas, indicating that macrophages are properly mobilized and activated. Our data suggest that the inability of the host to clear F. pedrosoi, leading to a chronic disease, is due, at least in part, to the inhibition of NO synthesis by macrophages by fungus-produced melanin.     

Chromoblastomycosis Caused by Fonsecaea nubica: First Report in Northern China and Literature Review

Mycopathologia - Chromoblastomycosis is found worldwide with higher incidence in tropical and subtropical regions. Fonsecaea spp. is one of the major causative agents of this disease. First case of...     

我国首见斑替支孢瓶霉引起脑脓肿1例

目的报道1例斑替支孢瓶霉引起脑脓肿。方法抽取脑脓液作直接镜检和真菌培养,分离菌株行DNA序列分析、KOH耐受试验、温度试验和明胶液化试验。结果脑脓液直接镜检发现大量棕色、分隔或不规则膨胀菌丝,SDA培养出灰黑色、绒状、纽扣样菌落,微量培养可见棕色、单支或分支特长的孢子链结构,DNA序列分析属于斑替支孢瓶霉。菌株具有耐碱性,不能液化明胶,可在25-42℃环境下生长。脓肿穿刺术、两性霉素B脂质体静脉滴注和脓腔内注射等治疗无明显疗效,放弃治疗后死亡。结论根据其形态学特点和DNA序列分析,菌株被鉴定为斑替支孢瓶霉。该菌引起的脑脓肿为国内首例报道,脓肿穿刺术和单用两性霉素B治疗无明显疗效。