特比萘芬联合伊曲康唑治疗孢子丝菌病失败1例

伊曲康唑和特比萘芬治疗孢子丝菌病（sporo-trichosis）有效安全,目前已成为孢子丝菌病治疗指南中的推荐用药[1].但少数患者单用伊曲康唑或特比萘芬不能有效控制病情,研究显示两药分别联合碘化钾溶液或两药联合治疗皮肤型孢子丝菌病显示疗效增强2-6].最近,我们诊治1例由球形孢子丝菌引起的皮肤固定型孢子丝菌病患者,采用特比萘芬联合伊曲康唑治疗失败,之后经特比萘芬联合碘化钾溶液治疗才获得痊愈.鉴于该病例治疗过程的特殊性,我们对其分离菌株进行了一些相关的实验研究,现报道如下.     

伊曲康唑联合特比萘芬治疗孢子丝菌病1例

孢子丝菌病（sporotrichosis）是由申克孢子丝菌引起的一种亚急性或慢性真菌感染,本病易侵犯皮肤、皮下组织及其附近的淋巴管,当存在免疫缺陷时,可能出现播散型感染。最近我们用伊曲康唑联合特比萘芬治疗1例淋巴管型孢子丝菌病患者,报告如下。     

球形孢子丝菌致婴儿固定型孢子丝菌病1例及相关实验研究

报道1例由球形孢子丝菌所致的婴儿固定型孢子丝菌病。患儿女,3个月,因左眼下内侧皮损2个月就诊,皮损脓液标本进行真菌培养,对培养获得菌株进行形态学、生理学和分子生物学鉴定,并进行药物敏感性检测。真菌培养阳性,镜下可见典型的套袖样菌丝。钙调蛋白基因序列分析鉴定为球形孢子丝菌。药敏试验显示特比萘芬和伊曲康唑对该菌株的菌丝相最低抑菌浓度（minimal inhibitorycon centration,MIC）分别为0．5μg／mL和0．5μg／mL;对该菌株的酵母相的MIC值分别为0．25μg／mL和0．5μg／mL。给予患者口服特比萘芬32．5mg／d治疗10周后皮损消退呈瘢痕化修复。依据临床及实验室检查确诊该病例为球形孢子丝菌所致固定型孢子丝菌病,特比萘芬治疗本病例显示较好疗效。     

特比萘芬治愈癣菌疹1例

癣菌疹临床较常见,诊治本病患者1例,取得真菌镜检阴性,未复发（见图2）。了满意疗效,报告如下。     

伊曲康唑联合特比萘芬治疗孢子丝菌病疗效及其对病原真菌体外抗菌活性研究

目的 初步探讨伊曲康唑和特比萘芬联合治疗孢子丝菌病的疗效,评价两药体外联合对申克孢子丝菌菌丝相和酵母相的抗菌活性.方法 口服伊曲康唑200mg/d和特比萘芬250mg/d治疗孢子丝菌病;体外联合药敏试验采用棋盘微量稀释法,计算分数抑菌浓度(FIC)指数判定两药相互作用具有协同、拮抗或无关作用.结果 伊曲康唑和特比萘芬联...     

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.     

系统性红斑狼疮并发孢子丝菌病8例临床分析

随着糖皮质激素及广谱抗生素的应用,系统性红斑狼疮（SLE）患者的生存期延长,但继发真菌感染的概率也在增加。为了解SLE并发孢子丝菌病的临床特点,提高认识和诊治水平,我们回顾性分析了1998年1月～2005年12月间诊治的资料完整的8例SLE并发孢子丝菌病患者的临床资料,现报告如下：     

鼻部固定型孢子丝菌病1例

报道1例猫抓后引起的固定型孢子丝菌病.患者男,16岁,皮损表现为鼻翼部位的增生物,其上覆有脓痂.临床上易与细菌感染混淆,但根据患者的病史、临床表现、病理、真菌镜检及培养诊断为申克孢子丝菌引起的孢子丝菌病.患者在应用7个月的碘化钾结合特比萘芬软膏外用治疗后,皮损完全消失.     

特比萘芬片及特比萘芬乳膏治疗多发性体癣1例

1资料与方法 1．1临床资料 患者男．56岁,因右侧腰、腹部,右上肢,右背部红斑、鳞屑、瘙痒3个月余,于2007年5月来我院就诊。患者于就诊4个月前右侧腰部开始出现红斑,渐向周围扩大,并出现鳞屑,瘙痒明显：自认为患“湿疹”,外用“皮炎平,艾洛松、尤卓尔”等药物治疗每次使用上述药物后红斑消退,停药后皮损再次出现,并向周围扩展。2个月前于右上肢出现红斑、鳞屑、瘙痒,并且扩大,20余d前又于背部出现类似皮损。     

固定型皮肤孢子丝菌病1例

1 资料与方法 1.1 临床资料 患者女,60岁。山东齐河人,在家务农。因右腕背侧斑块、红斑3个月于2003年1月就诊。患者3个月前在家砍树时被树枝刺伤,一周后伤处出现淡红色丘疹,斑丘疹,约绿豆大小,后逐渐增大,融合成斑块。表面有渗液、结痂,之后在斑块右侧出现红斑,偶痒,曾于多家医院就诊。给予抗真菌药、抗生素和皮质类固醇药物外用并抗过敏,抗结核治疗无效。     

Local heat in the treatment of sporotrichosis

Summary After making some considerations concerning the therapeutic methods used in the treatment of sporotrichosis, the case of a 45 years old woman with numerous tumor-like dermoepidermic lesions with lymphangitic dissemination of sporotrichosis of the left leg is presented. Treatment by immersing the affected limb in a waterbath at 45° C for 30 minutes 4 times daily was performed. After the third day of treatment the lesions began to improve, and the number of colonies in the cultures decreased. After the 21th day of treatment cultures from the lesions were consistently negative. After 8 weeks of treatment the patient was discharged and a year later there have been no recurrences. The effect of temperature on this organism and the distribution of lesions in patients in the tropics are discussed.

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Resumen Después de hacer algunas consideraciones sobre los procedimientos terapéuticos utilizados en la esporotricosis, se presenta un caso de esporotricosis, con gran número de lesiones tumorales dermoepidérmicas y diseminación linfática, localizada en la pierna izquierda de una mujer de 45 años de edad.El tratamiento de esta paciente por medio de inmersión del miembro afectado en un baño de agua a 45° C durante 30 minutos 4 veces al día, determinó que desde el tercer día comenzaron a mejorar las lesiones y a disminuir el número de colonias en los cultivos tomados de las mismas. A partir del 21° día de tratamiento los cultivos sembrados con material de las lesiones fueron siempre negativos. Se consideró terminado el tratamiento al cabo de 8 semanas. Un año más tarde no se había presentado recidiva.Se hacen algunas consideraciones sobre los mecanismos de acción de los yoduros y el calor en la esporotricosis y del calor en otras enfermedades cutáneas producidas por protozoarios o por virus. Se señala el hecho de que en zonas tropicales como Centro América no se conocen casos de esporotricosis visceral u ósea.

     

Short term treatment of dermatophyte onychomycosis with terbinafine.

OBJECTIVE--To evaluate the effect of short term treatment with terbinafine on dermatophytosis. DESIGN--Multicentre, randomised, double blind placebo controlled trial of 250 mg/day terbinafine for 12 weeks in dermatophyte onychomycosis. SETTING--Eight dermatology centres in the United Kingdom. PATIENTS--112 patients (mean age 44, range 19-78), 99 with mycologically proved toenail infections and 13 with fingernail infections, of whom eight were subsequently excluded and 19 failed to complete the study. INTERVENTION--Terbinafine 250 mg daily or placebo for 12 weeks. Follow up for 36 weeks after stopping treatment. MAIN OUTCOME MEASURES--Mycological cure (negative results on microscopy and culture) and clinical cure at the end of follow up, adverse events, and biochemical and haematological variables at monthly intervals during treatment. RESULTS--After follow up 82% (37/45) (95% confidence interval 68% to 92%) mycological cure and 69% clinical cure were recorded for evaluable patients treated with terbinafine for toenail infection and 71% (5/7) (30% to 96%) mycological cure and clinical cure for those treated for fingernail infection. The corresponding values for those treated with placebo were 12% (3% to 31%) mycological cure and no clinical cure for toenail infections and 33% (1% to 91%) mycological cure and no clinical cure for fingernail infections. On an intention to treat basis for toenail infections the figures were 73% (38/52) (58% to 85%) mycological cure for terbinafine compared with 6% (0% to 30%) for placebo (p less than 0.007). Two withdrawals were related to adverse events with terbinafine, and there were no significant abnormal laboratory test results. CONCLUSION--12 weeks'' terbinafine is effective and safe treatment for nail dermatophytosis.     

Extracutaneous sporotrichosis in a patient with liver cirrhosis

We report an unusual case of disseminated cutaneous sporotrichosis with oral mucous and tracheal involvement in a forty-year-old male with a history of heavy drinking and liver cirrhosis. We also review the literature and other similar published cases.     

Oral potassium iodide for the treatment of sporotrichosis

Potassium Iodide is the antimycotic of choice for the treatment of cutaneous sporotrichosis, because of its efficacy, safety and low cost. We carried out a review of published studies on the benefits and adverse reactions of using SSKI (Saturated Solution Potassium Iodide) as treatment for sporotrichosis, but could not identify any well-designed clinical trails. There is an urgent need to conduct randomized double-blind placebo-controlled trials and critically assess usefulness of SSKI by using a standardize monitoring or an effective self-report system.     

Treatment of postreconstructive collapsed nasal ala with a costal cartilage graft

A technique to restore the skeletal support of the postreconstruction collapsed ala is proposed. This makes use of the elastic characteristic of costal cartilage to provide a natural spring to elevate the ala and thereby enlarge the nostril. Three illustrative cases are described.     

Recurrence of sporotrichosis in cats with zoonotic involvement

The aim of this work is to describe the prevalence of the disease in the same cattery after three years, and to report a case of human sporotrichosis following a cat scratch. In May 1997, four felines presenting a cachexy state and ulcerous lesions on the head, nose and limbs were examined in a veterinary clinic in the town of Rio Grande (RS-Brazil). Exudate and crusts were collected for microbiological diagnosis. The cat's owner returned to the clinic reporting that another eleven felines presented similar lesions. She had ulcerous lesions on her hand and ascending lymphangitis. She was conducted to medical examination where exudate and crusts from the lesions were collected and after the culture Sporothrix schenckii was isolated. After three years the same person sought veterinary assistance for seven more cats with similar lesions to the five previously described. Microbiological tests resulted again in isolation of S. schenckii. Treatment with potassium iodine was effective for the cure of human sporotrichosis, whereas for the felines it showed toxic effect. Only one showed regression of the disease while all the others presented progression of the lesions or even death. The authors call attention to the possible persistence of S. schenckii in cat populations.     

Biofeedback for the treatment of anal incontinence in a child with ureterosigmoidostomy

The case of a 7-year-old boy born with exstrophy of the bladder is presented. Biofeedback and behavioral therapy were employed in the treatment of anal incontinence, which occurred following ureterosigmoidostomy diversion. After 19 treatment and follow-up sessions over a period of 12 months, there was significant decrease in fecal/urinary incontinence. The patient was soiled 29% of waking hours over the first 4 weeks of treatment. This figure dropped to 9.7% over the last three sessions. Subjective satisfaction of parent, child, and teachers was high. These gains were maintained over a 12-month follow-up period. Given the design of the present study, it is not possible to determine whether the biofeedback per se had a specific treatment effect. The case demonstrates the usefulness of a broad-based behavior therapy in the management of fecal/urine soiling, which is a frequent, refractory complication of ureterosigmoidostomy.     

Biofeedback for the treatment of anal incontinence in a child with ureterosigmoidostomy

The case of a 7-year-old boy born with exstrophy of the bladder is presented. Biofeedback and behavioral therapy were employed in the treatment of anal incontinence, which occurred following ureterosigmoidostomy diversion. After 19 treatment and follow-up sessions over a period of 12 months, there was significant decrease in fecal/urinary incontinence. The patient was soiled 29% of waking hours over the first 4 weeks of treatment. This figure dropped to 9.7% over the last three sessions. Subjective satisfaction of parent, child, and teachers was high. These gains were maintained over a 12-month follow-up period. Given the design of the present study, it is not possible to determine whether the biofeedback per se had a specific treatment effect. The case demonstrates the usefulness of a broad-based behavior therapy in the management of fecal/urine soiling, which is a frequent, refractory complication of ureterosigmoidostomy.