儿童和老年人真菌感染的现状与对策

通过检索近10 a国内外期刊发表的资料包括以往河北医科大学第四医院皮肤科报道的临床资料,复习、探讨国内外有关儿童和老年人真菌感染的概况和防治对策。结果发现儿童和老年人真菌感染有上升趋势。儿童浅部真菌病主要是皮肤念珠菌病和头癣,老年人浅部真菌病主要是手、足癣和甲癣;深部真菌病主要是念珠菌病,其他依次为隐球菌病、曲霉病、马尔尼菲青霉病、毛霉病等。由于深部真菌病诊断困难,目前主张对高危人群,应及早给予预防治疗和经验治疗,一旦确诊应根据患者具体情况和药敏监测等确立具体治疗方案。     

47766例拟诊皮肤真菌病患者病原菌分离培养结果分析

目的了解本院门诊拟诊皮肤真菌病患者真菌感染状况,掌握近期本地区皮肤真菌感染菌种分布结构。方法采用KOH直接涂片或染色显微镜观察与分离培养相结合的方法,对分离的菌落进行形态学鉴定,对真菌镜检和培养鉴定结果进行统计分析。结果 47 766例拟诊皮肤真菌病患者中,直接镜检和(或)培养阳性25 078例,占52.50%。其中皮肤癣菌病9 310例(48.94%)、马拉色菌感染8 938例(46.99%)、念珠菌及其他酵母菌感染603例(3.17%)。除外马拉色菌镜检和(或)培养阳性,其余38 839例镜检阳性率40.33%、分离培养阳性率25.99%。分离培养与镜检阳性符合率61.41%。皮肤癣菌菌种结构方面,红色毛癣菌为优势菌种占88.19%。结论皮肤癣菌病位居皮肤真菌病之首,以红色毛癣菌为优势菌,念珠菌及其他酵母菌感染亦值得关注。     

林生地霉所致小鼠系统感染的形态学研究

目的用组织病理学和电镜的方法观察林生地霉(Geotrichum Silvicola)所致小鼠各感染脏器的形态学改变。方法将72只健康昆明小鼠随机分为3组,免疫正常 腹腔接种组(A组)、免疫抑制 腹腔接种组(B组)和正常对照组(C组)。分期处死各组小鼠,取出肝、肾、脾、肺、心进行大体观察和组织病理学检查,病理切片分别进行HE和PAS染色,同时送扫描和透射电镜观察。结果A组仅有少数几只小鼠肝脏表面见到针尖至粟粒大小的脓性感染灶,数目较少(1.10±1.63),其余脏器偶见。B组大多数小鼠肝脏表面可见脓灶数目较多(8.18±2.59),约针尖至粟粒大小;其次为肺。C组无变化。B组的病理学改变早期以急性炎症反应为主,后期逐渐形成肉芽肿伴慢性炎细胞浸润,PAS染色可见灶状分布的真菌孢子和菌丝。电镜可见感染组织中的孢子和炎症细胞。结论林生地霉所致的系统性感染,肝脏最为易感。组织病理学改变为真菌感染非特异性炎症。     

犬小孢子菌病67例临床观察

犬小孢子菌病为亲动物真菌,感染人类致头皮、头发、皮肤及甲的传染性疾病,还可致头皮深在性感染引起脓癣等。以往均按其发病部位分别归人其他皮肤癣菌病如头癣、体癣等病种内报告。国内少有人将犬小孢子菌所致的病作为一独立的疾病来全面描述。为进一步认识犬小孢子菌及其所致疾病的特征,提高诊断、治疗、预防水平。作者在上海复旦大学华山医院皮肤科进修期间观察了经真菌培养为犬小孢子菌的67例癣菌病患者的真菌学特点和临床表现,并对其特征进行分析研究,现归纳报道如下。     

浅部真菌感染和变态反应性皮肤病相关性研究

目的 通过比较合并与未合并浅部真菌感染的变态反应性皮肤病对常用变应原的敏感性,综合从皮肤或指(趾)甲中分离出的菌种情况,评估浅部真菌感染在变态反应性皮肤病的病因学中的作用.方法 受试者包括353例慢性荨麻疹、湿疹及特应性皮炎患者.通过真菌直接镜检法将受试者分为两组.实验组:变态反应性皮肤病合并浅部真菌感染组(n =173);对照组:变态反应性皮肤病无浅部真菌感染组(n=180).对所有实验组及对照组受试者进行9种真菌变应原和9种非真菌变应原皮内试验.实验组患者进一步进行真菌培养以鉴定菌种.结果 慢性荨麻疹患者实验组须发癣菌、新月弯孢霉,特异青霉、烟曲霉变应原阳性率显著高于对照组(P＜0.05),慢性湿疹患者实验组须发癣菌变应原阳性率显著高于对照组(P ＜0.001).慢性湿疹、荨麻疹患者其他真菌变应原及粉尘螨、屋尘螨等非真菌变应原阳性率比较差异均无统计学意义(P＞0.05).134例患者皮肤或指(趾)甲分离鉴定主要为红色毛癣菌(52.86％)、须癣毛癣菌(14.18％)、絮状表皮癣菌(5.22％)、白念珠菌(6.72％),实验组须发癣菌变应原阳性率及皮肤分离皮肤癣菌阳性率比较差异无统计学意义(P＞0.05).结论 实验结果表明,须发癣菌变应原阳性的慢性荨麻疹、湿疹患者往往合并皮肤癣菌感染,皮肤癣菌感染可能在部分慢性荨麻疹、湿疹的病因学中起重要作用.     

林生地霉培养基形态学观察及生理学实验

目的观察林生地霉在5种不同培养基中的形态;通过一些常规的生理学实验,初步了解林生地霉的生理学特征。方法将林生地霉分别接种在沙堡培养基(SDA)、马铃薯葡萄糖琼脂(PDA)、麦芽汁琼脂(MEA)、玉米粉琼脂(CMA)和察氏琼脂(CZA)平皿培养基上,置37℃和27℃温箱培养2周,每天观察菌落生长情况。通过芽管试验、厚壁孢子试验、硝酸盐同化试验、放线菌酮耐受试验、尿素酶试验、糖发酵试验及API20C酵母系统等初步了解林生地霉的生理学特性。结果菌落在PDA、SDA和MEA培养基上生长较快、较好,在其他培养基上生长较差。芽管试验、硝酸盐同化试验、糖发酵试验均阴性;厚壁孢子试验、放线菌酮耐受试验阳性;尿素酶试验弱阳性;API20C酵母系统鉴定中葡萄糖、甘油、木糖、山梨醇为阳性,余为阴性。结论PDA、SDA和MEA较适合林生地霉生长;尿素酶试验可作为地霉属属内鉴定的参考依据。API20C鉴定结果及厚壁孢子试验可为其与毛孢子菌属的属间鉴别提供依据。     

念珠菌应激传导通路研究进展

念珠菌的无性阶段是属于隐球菌酵母目,隐球酵母科的一种临床上重要的致病真菌,其有性阶段属于子囊菌亚门。在临床上,念珠菌致病病谱广,它可引起皮肤、黏膜及内脏系统的感染。近年来,由于肿瘤、AIDS患者的增多,念珠菌感染的发病率均呈上升趋势。在美国的一项调查中,发现念珠菌引起的院内感染居第四位,其引起的死亡率高。由于上述特点,所以念珠菌越来越引起人们的重视。     

可直接克隆PCR产物的毕赤酵母分泌型表达载体

从毕赤酵母表达载体pPICZαA出发,构建了可直接克隆PCR产物的毕赤酵母分泌型表达载体（毕赤酵母表达型T载体）。设计合适的引物扩增一DNA片段,使该片断的上游含XhoⅠ和Eam1105Ⅰ酶切位点,下游含Eam1105Ⅰ和XbaⅠ酶切位点。通过XhoⅠ和XbaⅠ位点将扩增产物与质粒pPICZαA连接形成重组质粒。用Eam1105Ⅰ酶切重组质粒,回收大片段即得到毕赤酵母表达型T载体pPICZαT。使用该表达型T载体进行了里氏木霉纤维二糖水解酶Ⅱ基因（cbh2）的克隆和在巴氏毕赤酵母中的表达。结果表明,使用表达型T载体可以直接克隆PCR产物,而且可以使外源基因在毕赤酵母中成功表达。另一方面,使用该载体时不需要使用限制性内切酶,从而可以避免在所表达蛋白的N-末端引入多余的氨基酸。     

暗色丝孢霉病的临床及研究现况

暗色真菌（dematiaceous fungi）是指菌丝和（或）孢子的细胞壁具有黑色素样颜色的一组真菌,可引起人类皮肤甚至多种组织的感染。迄今尽管有的学者仍在使用“着色霉菌病（chromomycosis）”来命名所有的暗色真菌感染,然而自20世纪90年代已形成的共识是将暗色真菌感染主要分为着色芽生菌病（chromoblastomycosis）和暗色丝孢霉病（phaeohyphomycosis）两类独立的疾病。本文主要就暗色丝孢霉病的命名、病原学、流行病学、临床类型及分子生物学研究现况进行综述。     

浅部真菌感染中的抗真菌药物治疗进展CSCD

浅部真菌感染是致病真菌侵犯皮肤的角质层、毛发和甲板所导致的感染,困扰着世界约25%的人口,导致患者生活质量下降[1-3]。浅部真菌感染可由皮肤癣菌、念珠菌属、马拉色菌属等引起,而尤以皮肤癣菌最为常见。临床上以足癣最为常见,其次为体癣、股癣以及甲真菌病[4]。除此之外,外阴阴道念珠菌病(vulvovaginal candidiasis,VVC)也是常见的由念珠菌属引起的真菌感染,约75%的女性在其育龄期至少经历过一次VVC[5]。     

念珠菌病的临床研究进展

念珠菌病是由念珠菌属的某些种群引起的条件致病真菌感染,是人类真菌感染性疾病中最多见的疾病。临床上分为浅部皮肤黏膜念珠菌病和深部念珠菌病（亦称系统性念珠菌病）。近年来深部念珠菌病的发病率有上升趋势,该病涉及临床各科室,危害性大,病死率高,是临床研究的热点。现复习近年国内外文献,就其致病念珠菌的动态流行病学、分子流行病学以及该病的实验室诊断进展及防治现状加以简要的介绍。     

Zygomycosis Caused by Rhizopus microsporus and Rhizopus oryzae in Madhya Pradesh (M.P.) Central India: A Report of Two Cases

Zygomycosis encompasses infections due to two distinct orders of fungi, Mucorales and Entomophthorales. With rare exception, Entomophthorales are restricted to tropical areas. By contrast, mucorales are ubiquitous opportunistic fungi, which play a crucial part in the natural decay process. In human pathology, they may be opportunistic agents and be responsible for rare infection called (Mucormycosis) zygomycosis. We report two cases of zygomycosis from Madhya Pradesh, Central India, one caused by Rhizopus oryzae in a diabetic patient and another caused by Rhizopus microsporus in an apparently healthy patient. The cases were diagnosed by direct microscopy, histopathological examination and culture. Both the patients were successfully treated with liposomal amphotericin B. Rhizopus microsporus is, for the first time reported from Madhya Pradesh, India, causing rhino-maxillary orbital zygomycosis.     

Mold-inhibitory activity of different yeast species during airtight storage of wheat grain

The yeast Pichia anomala J121 inhibits spoilage by Penicillium roqueforti in laboratory and pilot studies with high-moisture wheat in malfunctioning airtight storage. We tested the biocontrol ability of an additional 57 yeast species in a grain mini silo system. Most yeast species grew to CFU levels comparable to that of P. anomala J121 after 14 days of incubation (>10(6) CFU g(-1)). Of the 58 species, 38 (63 strains) had no mold-inhibitory effects (Pen. roqueforti levels >10(5) CFU g(-1)). Among these were 11 species (18 strains) that did not grow on the wheat grain. Several of the non-inhibiting yeast species have previously been reported as biocontrol agents in other postharvest environments. Weak inhibitory activity, reducing Pen. roqueforti levels to between 10(4) and 10(5) CFU g(-1), was observed with 11 species (12 strains). Candida silvicola and Pichia guillermondii reduced Pen. roqueforti to <10(4) CFU g(-1). Candida fennica, Candida pelliculosa, Candida silvicultrix, P. anomala (29 strains), Pichia burtonii, Pichia farinosa and Pichia membranifaciens strongly inhibited Pen. roqueforti (<10(3) CFU g(-1)) in the mini silos, but none had higher biocontrol activity than P. anomala strain J121. This report is the first of biocontrol activity of C. fennica and C. silvicultrix. The ability of 27 yeast species to grow to high CFU values without inhibiting mold growth suggests that nutrient competition may not be the main mode of action of P. anomala J121.     

Primary Cutaneous Mucormycosis Presenting as a Giant Plaque: Uncommon Presentation of a Rare Mycosis

Mucormycosis is an uncommon opportunistic fungal infection caused by Zygomycetes. It usually affects immunocompromised, diabetic and trauma patients with infected wounds. We report a case of disseminated infection secondary to facial cutaneous mucormycosis caused by Saksenaea vasiformis in a diabetic patient who had a farming accident causing him severe head injury. The patient was treated with a combination of surgical debridement and antifungal therapy with liposomal amphotericin B, but he had a slow and fatal outcome. In cases of tissue necrosis following trauma involving wound contact with soil (i.e., potential fungal contamination), testing for the presence of Zygomycetes fungi such as S. vasiformis in both immunocompetent and immunocompromised patients is crucial. The reason is that this infection usually has a rapid progression and may be fatal if appropriate treatment is not administered.     

鲁氏酵母3-磷酸甘油脱氢酶基因（ZrGPD1）在粉状毕赤酵母中的表达

为探索在野生型粉状毕赤酵母（Pichia farinosa）中整合表达来源于耐高渗鲁氏酵母（Zygosacharomyces rouxii）的3-磷酸甘油脱氢酶基因（ZrGPD1）以提高产甘油能力的可行性,应用PCR方法从P. farinosa的染色体中扩增出乳清苷酸脱羧酶基因（URA3）片段,以此作为同源整合的靶序列,构建了整合型表达载体pUR-ZG。电击转化粉状毕赤酵母,以抗生素Zeocin为筛选标记,获得转化子pfa-gu,摇瓶发酵结果表明：以P. farinosa作为对照菌株,发酵72h后,转化子pfa-gu的生物量和甘油含量均高于对照菌株,其中甘油含量达到37g/L,比对照提高了30%。结论：在P. farinosa中异源表达ZrGPD1能够提高细胞的产甘油能力和对渗透压的调节能力。     

Fungi isolated in onychomycoses

Conclusion Nail-infections caused by dermatophytes are not rare in areas where tinea capitis is endemic. The infection is most prevalent in the age group between 11–20 years predominantly in females in whom infections may last up to the age of 60 years. Candida nail-infections are becoming an important clinical problem increasing in frequency especially among women. It seems that Candida nail-infections are an urban disease. The significance of opportunistic fungi has to be elucidated, especially in cases where no other known pathogenic fungi or microorganisms could be proved.Read in the meeting of the First Congress of the International Society for Tropical Dermatology, Naples, June 8–13, 1964.     

Isolated Cutaneous Granuloma Caused by <Emphasis Type="Italic">Candida glabrata</Emphasis>: A Rare Case Report and Literature Review

The incidence of candidiasis due to non-albicans Candida species (especially Candida glabrata) has significantly increased in recent decades. Candida glabrata often invades immunocompromised hosts and causes systemic or mucosal infections, whereas cutaneous infections are rarely reported. We present a rare case of cutaneous infection caused by C. glabrata and review all similar cases available in the PubMed database. A patient was admitted to the hospital with a 2-month history of a plaque on the face. Histopathological examination displayed typical infectious granulomas in the deep dermis, and the pathogen was finally confirmed as C. glabrata using a series of microbial examinations (fungal culture, biochemical test, and PCR-directed sequencing). The patient was completely cured after 4 months of treatment with oral itraconazole combined with topical terbinafine. We reviewed similar reports of cutaneous infection caused by C. glabrata. All the data suggested that an accurate diagnosis of cutaneous candidiasis depends mainly on histological and fungal examinations, especially molecular biological assays. Antifungal agents based on microbial susceptibility tests are the first-line treatment choice for C. glabrata infection, but the prognosis might be more dependent on the basic condition of the host.     

Opportunistic zygomycotic infections

This is a literature review of 361 opportunistic fungal infections caused by the Zygomycetes. The clinical and laboratory diagnosis, pathogenesis, management, treatment, and outcome of infection are discussed. The Zygomycetes are a group of opportunistic fungi (orders Mucorales and Entomophthorales) which cause severe infections which may be fatal. Early clinical recognition, prompt diagnostic procedures, control of underlying disease and treatment with high doses of amphotericin B and aggressive surgery increases survival in an otherwise lethal infection.     

IL-23 and IL-17A, but not IL-12 and IL-22, are required for optimal skin host defense against Candida albicans

IL-23 and Th17 cells play important roles in host defense against systemic infections with extracellular bacteria and fungi, although their roles in immunity against localized skin infections are less well defined. Here, the contributions of IL-23 and Th17 cytokines in host defense against cutaneous Candida albicans infection were evaluated. Mice deficient in IL-23 or IL-17A demonstrated delayed healing and decreased IL-17A production after skin infection with C. albicans compared with wild-type mice or mice deficient in IL-12 or IL-22. Histologic examination revealed epidermal hyperplasia overlying infected dermis four days postinoculation in wild-type mice. In IL-23-deficient mice, fungal burden was greater in skin, neither IL-17A nor IL-22 mRNAs were expressed postinfection, and these mice demonstrated only minimal epidermal hyperplasia. Exogenous recombinant IL-17A injected at the site of skin infection promoted more rapid healing of candidiasis in both wild-type mice and mice deficient in IL-23 and IL-12. Taken together, these results demonstrate that IL-23 and IL-17A, but not IL-12 and IL-22, are required for optimal host defense against cutaneous candidiasis. In addition, recombinant IL-17A may serve as a potential therapy to enhance healing in individuals with chronic cutaneous candidiasis.     

The opportunistic yeast pathogen Trichosporon asahii colonizes the skin of healthy individuals: analysis of 380 healthy individuals by age and gender using a nested polymerase chain reaction assay

Deep-seated trichosporonosis is an opportunistic fungal infection with a poor prognosis and high mortality rate. The major causative agent is Trichosporon asahii; its route of infection is not clear. To elucidate whether this microorganism is part of the cutaneous microbiota, we examined skin samples from 380 healthy Japanese ranging in age from 0 to 82 years using a nested PCR assay. The colonization frequency of T. asahii increased with age up to 13-15 years in male and 30-39 years in female subjects, subsequently decreasing gradually in both sexes until senescence. Of the nine genotypes of the intergenic spacer region of the T. asahii rRNA gene, type 1 predominated (81.7%), followed by types 4 (6.7%) and 6 (5.5%). The distribution of identified genotypes was similar to that for T. asahii isolated from clinical specimens (blood and urine) of patients with deep-seated trichosporonosis and quite different from that of environmental isolates. Additionally, T. asahii DNA was detected stably from skin samples over 1 year. The opportunistic yeast pathogen T. asahii is part of the cutaneous fungal microbiota in humans. Cutaneous T. asahii may be one of the routes through which deep-seated trichosporonosis is acquired, whereas environmental T. asahii is not associated with this infection.