深在型皮肤念珠菌病1例报告

深在型皮肤念珠菌病一般包括念珠菌肉芽肿（Candidal granuloma）和慢性皮肤黏膜念珠菌病两种。前者临床表现为增生、结节、溃疡或肉芽肿形成。国内1964年张永圣[1]等报道1例后,陆续有病例报道。该病有两种类型：Houser-Rothman型和Busse-Buschke型。Houser-Rothman型也被认为属于慢性皮肤黏膜念珠菌病的一种较严重表现[2]。本文报告1例面部的深在型皮肤念珠菌病。     

中国大陆慢性皮肤黏膜念珠菌病回顾性分析(1980-2020年)CSCD

目的总结与探讨中国大陆慢性皮肤黏膜念珠菌病(chronic mucocutaneous candidiasis,CMC)的病因、流行病学、临床特征及诊疗情况。方法检索分析中国知网、万方、维普及PubMed等数据库中1980—2020年中国大陆确诊为慢性皮肤黏膜念珠菌病的相关文献资料。结果共纳入文献24篇,病例61例。患者平均发病年龄为3.38岁,本病以反复发作的皮肤(57.38%)、口腔黏膜(95.08%)、甲(63.93%)念珠菌感染为特点。信号转导和转录活化子1功能获得性突变(STAT1 gain-of-function,STAT1 GOF)为最常见病因,治疗以唑类药物最常用,复发率高。结论慢性皮肤黏膜念珠菌病是一种少见的免疫缺陷病,临床表现多样,可有多器官和系统的异常,早期诊断和治疗非常重要。     

婴幼儿皮肤黏膜念珠菌病临床特点及其病原菌体外药敏分析

目的分析并探讨婴幼儿皮肤黏膜念珠菌病的临床特点,检测其病原菌对常用抗真菌药物的体外敏感性。方法入选105例0～3岁皮肤黏膜念珠菌病的患儿,均经临床表现及真菌学检查确诊,用调查表收集患儿有关资料,统计并分析患儿的临床特点。用科玛嘉显色培养基及API20AU测试卡鉴定菌种。参照CLSI酵母菌检测方案M27-A3测定菌株对咪康唑、益康唑、酮康唑、联苯苄唑及特比萘芬等5种药物的体外敏感性。结果 105例婴幼儿皮肤黏膜念珠菌病年龄分布为0.4～36个月,平均10.67个月,以1岁以内感染最多(75%)。皮损位于尿布区最多,其次为颈部及腋下。共分离念珠菌189株,菌种鉴定显示白念珠菌最多(81.5%),其次为近平滑念珠菌(10.6%)和光滑念珠菌(3.2%)。咪康唑和酮康唑对白念珠菌的MIC_(90)值最小(0.25μg/mL)。酮康唑和益康唑对所有菌株包括非白念珠菌的MIC_(90)值分别为0.25μg/mL和2μg/mL。联苯苄唑和特比萘芬对白念珠菌的MIC_(90)值最大(16μg/mL),对非白念珠菌的MIC_(90)值分别为8μg/mL和16μg/mL。结论婴幼儿皮肤黏膜念珠菌病的年龄分布以1岁内为主,皮损主要位于尿布区、颈部和腋下等温暖潮湿部位。白念珠菌仍是婴幼儿皮肤黏膜念珠菌病中最常见的菌种,非白念珠菌中以近平滑念珠菌为主。咪康唑和酮康唑是治疗婴幼儿皮肤黏膜念珠菌病较好的外用药选择,尤其是酮康唑。     

慢性皮肤黏膜念珠菌病1例

报道l例慢性皮肤黏膜念珠菌病.患者女,16岁.1岁开始发病,持续存在口腔、皮肤、甲板损害,真菌镜检阳性,真菌培养为白念珠菌,皮损组织病理为感染肉芽肿改变,在角质层中可见大量真菌菌丝,内分泌功能和免疫学检查未见明显异常.口服伊曲康唑治疗有效.     

慢性皮肤黏膜念珠菌病1例

报道慢性皮肤黏膜念珠菌病1例。表现为口腔和皮肤损害,真菌镜检可见大量假菌丝,真菌培养为白念珠菌;皮损组织病理显示为感染肉芽肿改变,在角质层中可见大量真菌菌丝;实验室检查未见明显免疫缺陷和内分泌异常。口服氟康唑治疗痊愈。     

白念珠菌生物被膜的研究进展

白念珠菌是一种机会性致病真菌,也是引起真菌血症和播散性念珠菌病的主要病原体[1]。白念珠菌定植于人体的皮肤和黏膜等部位,当机体的正常防御功能受损时,如创伤、营养失调、免疫功能缺陷、激素和抗生素的应用导致菌群失调等[2],白念珠菌会过度生长,从口腔、咽喉和生殖道等浅表黏膜感染转变为循环系统、骨骼和大脑的全身性侵袭性念珠菌病[3]。白念珠菌常以生物被膜的形式生长在植入体内的生物材料上,比如中心静脉导管、导尿管、心脏起搏器和其他与器官直接接触的材料。     

侵袭性念珠菌病的抗原抗体检测进展

念珠菌是常见的一种条件致病菌,可在皮肤、黏膜等部位与宿主共存.当正常寄居部位的微生态环境失调或机体免疫机能低下时,易侵入体液及器官,引起念珠菌病.近年来,侵袭性真菌感染的发病率及死亡率呈明显上升的趋势,最新的流行病学调查结果[1]显示,美国念珠菌病医院感染率为0.28‰ ～0.96‰,欧洲为0.2‰ ～0.38‰.拉丁美洲念珠菌院感率为1.2‰ ～ 5.5‰,若伴长期的中性粒细胞缺乏或发热,医院感染率可升至7％[1].     

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。     

白色念珠菌胞外囊泡的组成及其功能研究进展

念珠菌病指念珠菌属引起的急性、亚急性或慢性感染,通常累及皮肤、黏膜,也可累及内脏和各个系统器官,可造成严重后果,是目前发病率最高的深部真菌病.白色念珠菌是念珠菌种中最为常见的一种机会致病性真菌,近来,越来越多的研究证实了白色念珠菌的细胞外囊泡对其致病性具有重要的作用,它参与重要蛋白、遗传物质的转运,影响白色念珠菌的耐药...     

黏膜念珠菌病治疗指南

黏膜念珠菌病主要包括口咽念珠菌病、外阴阴道念珠菌病和念珠菌性包皮龟头炎。上述3种病症各自有不同的易感因素、临床表现及治疗预防特点。1口咽念珠菌病1.1易感因素与临床表现口咽念珠菌病是主要由白念珠菌感染引起的     

The C-terminal antibody binding domain of Candida albicans mp58 represents a protective epitope during candidiasis

The 58-kDa surface mannoprotein of Candida albicans (mp58) elicits strong antibody responses during infection. Epitope mapping with sera from patients with candidiasis and control individuals indicated the presence of multiple IgG-reactive continuous epitopes on the protein, expanding both the amino- and carboxy-terminal domains and several internal regions. These immunoreactive regions were similar to the ones previously identified using sera from immunized animals. Two of the epitopic regions (including the C-terminal domain) showed increased reactivity with antibodies present in sera from patients with candidiasis as compared to control individuals. Patients who survived the infection displayed increased antibody reactivity towards the C-terminal epitope as compared to those succumbing to candidiasis. A monoclonal antibody directed towards this epitopic region conferred protection in serum therapy experiments in a murine model of hematogenously disseminated candidiasis. Together, these observations indicate the carboxy-terminal antibody binding domain of C. albicans mp58 represents a protective epitope during candidiasis.     

A single injection of polyethylene-glycol granulocyte colony-stimulating factor strongly prolongs survival of mice with systemic candidiasis

Systemic candidiasis is a life-threatening disease occurring in immunocompromized patients. Granulocyte colony-stimulating factor (G-CSF) reduces mortality in experimental invasive candidiasis. Covalent conjugation of polyethylene-glycol (peg) to proteins increases their stability and in vivo bioactivity. In this study, the effect of a single subcutaneous injection of peg-G-CSF on lethal candidiasis was assessed. This was performed in acute and chronic candidiasis models in non-neutropenic FVB/N mice. Peg-G-CSF rapidly increased circulating polymorphonuclear leukocyte (PMNL) numbers in mice, sustaining high for >4 days. Candida albicans outgrowth from kidneys of infected mice was strongly reduced after peg-G-CSF treatment (5.76 log cfu/g kidney vs 7.66 control), with absence of hyphal outgrowth and enhanced PMNL influx. Moreover, peg-G-CSF increased survival of C. albicans -infected mice, whereas efficacy of uncoupled G-CSF was obtained only after repeated treatment. These data document a potent in vivo biological effect of peg-G-CSF, resulting in strongly enhanced resistance against systemic candidiasis.     

Value of serum arabinitol for the management of Candida infections in clinical practice

To determine the value of serum arabinitol concentrations in clinical practice, we identified all patients at the University of Utah Medical Center for whom a serum arabinitol determination had been requested by the attending physician or housestaff to assist in the management of candidiasis. The patient populaton was divided into three categories on the basis of clinical and pathological findings: (1) superficial candidiasis, (2) possible deep, invasive candidiasis, and (3) definite, deep invasive candidiasis. Abnormal renal function was associated with elevated concentrations of serum arabinitol in proportion to the degree of renal dysfunction. Both the serum arabinitol concentration and the arabinitol/creatinine ratio were increased in the combined patient population with candidiasis relative to normal uninfected controls (p=0.06 and 0.001, respectively). However, neither of these tests reliably distinguished patients with invasive candidiasis from those with only superficial candidal disease.     

The continuous changes in the aetiology and epidemiology of invasive candidiasis: from familiar <Emphasis Type="Italic">Candida albicans</Emphasis> to multiresistant <Emphasis Type="Italic">Candida auris</Emphasis>

Recent changes in the aetiology and epidemiology of invasive candidiasis have serious implications for current and future diagnosis, treatment and prognosis. The aim of the current review was to discuss the epidemiology of invasive candidiasis, the distribution of Candida species in different regions of the world, the medical concerns of the changing aetiology and the emergence of antifungal resistance. Overall burden of invasive candidiasis remains high, especially in vulnerable persons, such as the elderly, immunosuppressed or debilitated patients. Moreover, there is a progressive shift in the aetiology of invasive candidiasis from Candida albicans to other species of Candida, probably related to the increased use of azole drugs with a clear trend towards increased antifungal resistance. Finally, the emergence and rise of multiresistant species, such as Candida auris or Candida glabrata, is a major threat making necessary invasive candidiasis worldwide surveillances. These changes have serious implications for the diagnosis, treatment and prognosis of invasive candidiasis. Updated knowledge of the current local epidemiology of invasive candidiasis is critical for the clinical management.     

Insights from human studies into the host defense against candidiasis

Candida spp. are the most common cause of mucosal and disseminated fungal infections in humans. Studies using mutant strains of mice have provided initial information about the roles of dectin-1, CARD9, and Th17 cytokines in the host defense against candidiasis. Recent technological advances have resulted in the identification of mutations in specific genes that predispose humans to develop candidal infection. The analysis of individuals with these mutations demonstrates that dectin-1 is critical for the host defense against vulvovaginal candidiasis and candidal colonization of the gastrointestinal tract. They also indicate that CARD9 is important for preventing both mucosal and disseminated candidiasis, whereas the Th17 response is necessary for the defense against mucocutaneous candidiasis. This article reviews the recent studies of genetic defects in humans that result in an increased susceptibility to candidiasis and discusses how these studies provide new insight into the host defense against different types of candidal infections.     

Kinetics of Anti-Mannan Antibodies Useful in Confirming Invasive Candidiasis in Immunocompromised Patients

In studying the anti-mannan antibodies longitudinally in serial serum samples of three immunocompromised patients, it was observed that anti-mannan antibodies started to increase shortly after the moment that cultures of deep-tissue sites became positive with Candida albicans. The mean anti-mannan antibody titers determined in a group of 36 immunocompromised patients with invasive candidiasis increased within two weeks after the probable onset of invasive candidiasis. In contrast, anti-mannan antibody levels in serial serum samples of 14 immunocompromised patients who were only colonized with C. albicans remained stable or decreased over time. The HA test measuring the anti-mannan antibodies was 64% sensitive and 89% specific in determining invasive candidiasis. In contrast, antibodies specific for candidal cytoplasmic antigens or enolase alone were of little value in confirming invasive candidiasis in these immunocompromised patients.     

Probiotic bacteria for prophylaxis and therapy of candidiasis

A good deal of data support a role for probiotic intestinal bacteria in the prophylaxis and therapy of candidiasis. Candida spp. are highly infectious eukaryotes that can colonize and infect humans and other warm-blooded mammals, worldwide. Although most humans manifest antibody- and cell-mediated immune responses to Candida antigens a large percentage of the human population is colonized with Candida spp. in their alimentary and vaginal tracts. The bacterial flora plays a very important probiotic role in the prophylaxis of candidiasis by suppressing the growth of Candida spp. on mucosal and cutaneous surfaces; however, the specific bacteria and the mechanisms they use to inhibit Candida spp. and candidiasis are still poorly understood. The increased incidence of Candida infections, their increasing resistance to antifungal antibiotics and the fact that vaccines to protect against candidiasis are not yet available (and may not work in immunodeficient, Candida-susceptible, patients) provides a strong impetus for new research efforts to explore the use of probiotic, anti- Candida intestinal bacteria for the prophylaxis and therapy of candidiasis.     

Farmacoeconomía del tratamiento de las candidiasis invasoras

BackgroundInvasive candidiasis episodes have increased during last years and they have been related with high rates of crude mortality. Invasive candidiasis-related deaths have not diminished significantly with the introduction of antifungals in the past decade. Finantial managers are worried about extra costs from acquisition of new antifungal agents.AimThis review includes the main studies age-stratified to assess different variables related to the economic burden of invasive candidiasis.MethodsSystematic review of biomedic databases including Medline, PubMed and EMBASE.ResultsThe studies show hospital stay as the main variable related with higher impact in the increase of invasive candidiasis costs. Acquisition costs of antifungals have a very low impact in the invasive candidiasis costs.ConclusionsPharmacoeconomics applied in candidiasis invasive therapy must avoid assessing acquisition costs of antifungals exclusively, needing to include both direct and indirect costs associated with this fungal infection. The cost of antifungal acquisition represents a low impact in the overall economic burden of this fungal infection. Further pharmacoeconomics evaluations should be performed including similar definitions to decrease the possible bias in results interpretation.     

Use of 65-kDa mannoprotein gene primers for real-time identification of Candida albicans

Invasive candidiasis is associated with high morbidity and mortality, especially in immunocompromised patients. Early diagnosis is often difficult because most clinical signs and symptoms are nonspecific and blood cultures are often negative or become positive too late. Consequently, effective treatment is often delayed. Therefore, there has been an increased interest in the development of molecular-based technology in the diagnosis of invasive candidiasis. In this review, we compare molecular diagnostic tests currently adopted and those under evaluation. We highlight the advantages and the limitations of these methods for the diagnosis of invasive candidiasis. We also describe recent methods based on real time with primers of a gene coding for a 65-kDa mannoprotein of Candida albicans.     

The effect of vaginal candidiasis on the levels of the oxidative biomarkers in plasma and tissue samples of diabetic rats

The aim of this study is to determine the relation between diabetes and vaginal candidiasis in terms of oxidative biomarker levels in a vaginal candidiasis model of the diabetic rats by evaluating malondialdehyde (MDA), sulphydrile groups or glutathione (RSH), and ascorbic acid (C vit) levels. All rats were randomly divided into five groups. All of the groups were observed for 21 days. In the treated diabetes groups, MDA (0.90, 0.68 nmol/ml and 3.78, 3.79 nmol/g tissue, plasma and vaginal tissue, respectively) and RSH (227, 171 nmol/100 ml 0.38, 0.37 μmol/g tissue, plasma and vaginal tissue, respectively) levels were found to be decreased while the levels of C vit were found to be increased (0.49, 0.37 μmol/l 2.39, 2.01 nmol/g tissue plasma, and vaginal tissue, respectively) (P < 0.05). In the groups of untreated diabetes, vaginal candidiasis were found to be more serious and oxidative biomarkers were found to be increased (MDA 1.30, 1.26 nmol/ml and 7.82, 2.37 nmol/g tissue and RSH 258, 145 nmol/100 ml and 0.31, 0.46 μmol/g tissue) while the antioxidant C vit levels were found to be decreased (0.24, 0.17 μmol/l 1.33, 2.66 nmol/g tissue) (P < 0.05). RSH, plasma MDA, blood glucose, and tissue MDA levels of vaginal candidiasis embedeled diabetic rats, were found to be higher than those in untreated diabetic and untreated vaginitis enbedeled rats ‹P < 0.05’. Vaginal candidiasis caused oxidative stress in diabetic rats working together. Systemic oxidative stress biomarkers were found to be affected from vaginal candidiasis although it was a local mucosal infection. This study was presented as a poster in the conference of ‹2nd Trends in Medical Mycology, 23–26 October 2005, Berlin, Germany’.