以皮肤受累为首发表现的播散性念珠菌病1例并文献复习

目的：播散性念珠菌病是一种致命性真菌感染性疾病,在免疫缺陷患者中发病率逐年增多,报道1例以双下肢多发皮下结节为首发表现,伴有肺及脑受累的播散性念珠菌病,并文献复习播散性念珠菌病的皮肤受累临床表现。方法患者女,37岁。因双下肢多发皮下结节6个月余就诊。有局灶节段性肾小球硬化病史,口服强的松及他克莫司2a余。取患者皮损组织行病理学检查,皮损组织、脓液、血、痰、尿、粪、脑脊液进行真菌镜检及真菌培养,并文献检索统计播散性念珠菌病皮肤受累患者临床特点。结果皮损组织病理见假菌丝,皮损组织、脓液、痰、尿、粪标本直接涂片均见假菌丝并培养出白念珠菌,CT显示肺受累,诊断为播散性念珠菌病,予抗真菌治疗,患者皮损愈合及肺部病灶部分吸收,但因自行停药,最终出现颅内播散。结论以皮损为首发表现的播散性念珠菌病临床罕见,临床诊疗中应重视应用免疫抑制剂患者皮损的组织病理及微生物检查,及早进行诊断和治疗,防止出现系统性播散,从而降低死亡率。     

抗烯醇化酶抗体与（1-3）-β-D-葡聚糖检测诊断侵袭性念珠菌病的临床比较

目的：比较抗烯醇化酶抗体（抗-Eno）检测与（1-3）-β-D-葡聚糖（BG）检测对侵袭性念珠菌病（invasivecandidia-sis,IC）的诊断价值。方法留取临床为诊断IC而送检BG测定的患者血样,用ELISA法测定抗-Eno抗体,以真菌培养结果为基础,分析比较两种血清学方法诊断IC的效能。结果210例患者为研究对象。15例患者经念珠菌培养确诊IC,确诊感染率71%;BG阳性54例,阳性率为257%;抗-Eno阳性33例,检出阳性率为157%。抗-Eno和G试验诊断IC感染的敏感性、特异性、阳性预测值、阴性预测值分别为467%、867%、212%、955%和333%、749%、93%、936%。两种血清学方法联合检测,敏感性提高至667%。结论抗-Eno对IC的诊断性能优于G试验;联合两种血清学方法,能有效提高敏感性。     

乳杆菌活菌胶囊辅助治疗妊娠期外阴阴道假丝酵母菌病疗效观察

目的探讨乳杆菌活菌胶囊辅助治疗妊娠期外阴阴道假丝酵母菌病疗效观察。方法选取妊娠期外阴阴道假丝酵母菌病患者70例,采用随机数字表将纳入患者分为观察组35例和对照组35例。观察组患者予以乳杆菌活菌胶囊联合制菌素阴道栓治疗,对照组予以单纯的制菌素阴道栓治疗,均连用10d。两组患者停药2周后进行临床疗效观察,并比较治疗后随访3个月的复发率。结果治疗后停药2周,观察组患者的临床总有效率（91．43％）明显优于对照组（71．43％）（χ2=4．63,P〈0．05）;治疗后随访观察3个月,对照组复发11例（44．00％）,观察组复发5例（15．63％）,观察组患者复发率明显低于对照组（χ2=5．60,P〈0．05）。结论乳杆菌活菌胶囊辅助治疗妊娠期外阴阴道假丝酵母菌病疗效好,复发率低,对外阴阴道假丝酵母菌病具有治疗和预防复发的双重功效。     

EPICO 2.0 project. Development of educational therapeutic recommendations using the DELPHI technique on invasive candidiasis in critically ill adult patients in special situations

BackgroundAlthough there has been an improved management of invasive candidiasis in the last decade, still controversial issues remain, especially in different therapeutic critical care scenarios.AimsWe sought to identify the core clinical knowledge and to achieve high agreement recommendations required to care for critically ill adult patients with invasive candidiasis for antifungal treatment in special situations and different scenarios.MethodsSecond prospective Spanish survey reaching consensus by the DELPHI technique, conducted anonymously by electronic e-mail in the first phase to 23 national multidisciplinary experts in invasive fungal infections from five national scientific societies including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious disease specialists, answering 30 questions prepared by a coordination group after a strict review of literature in the last five years. The educational objectives spanned four categories, including peritoneal candidiasis, immunocompromised patients, special situations, and organ failures. The agreement among panelists in each item should be higher than 75% to be selected. In a second phase, after extracting recommendations from the selected items, a meeting was held with more than 60 specialists in a second round invited to validate the preselected recommendations.Measurements and main resultsIn the first phase, 15 recommendations were preselected (peritoneal candidiasis (3), immunocompromised patients (6), special situations (3), and organ failures (3)). After the second round the following 13 were validated: Peritoneal candidiasis (3): Source control and early adequate antifungal treatment is mandatory; empirical antifungal treatment is recommended in secondary nosocomial peritonitis with Candida spp. colonization risk factors and in tertiary peritonitis. Immunocompromised patients (5): consider hepatotoxicity and interactions before starting antifungal treatment with azoles in transplanted patients; treat candidemia in neutropenic adult patients with antifungal drugs at least 14 days after the first blood culture negative and until normalization of neutrophils is achieved. Caspofungin, if needed, is the echinocandin with most scientific evidence to treat candidemia in neutropenic adult patients; caspofungin is also the first choice drug to treat febrile candidemia; in neutropenic patients with candidemia remove catheter. Special situations (2): in moderate hepatocellular failure, patients with invasive candidiasis use echinocandins (preferably low doses of anidulafungin and caspofungin) and try to avoid azoles; in case of possible interactions review all the drugs involved and preferably use anidulafungin. Organ failures (3): echinocandins are the safest antifungal drugs; reconsider the use of azoles in patients under renal replacement therapy; all of the echinocandins to treat patients under continuous renal replacement therapy are accepted and do not require dosage adjustment.ConclusionsTreatment of invasive candidiasis in ICU patients requires a broad range of knowledge and skills as summarized in our recommendations. These recommendations may help to optimize the therapeutic management of these patients in special situations and different scenarios and improve their outcome based on the DELPHI methodology.     

Synthetic antimicrobial β‐peptide in dual‐treatment with fluconazole or ketoconazole enhances the in vitro inhibition of planktonic and biofilm Candida albicans

Fungal infections are a pressing concern for human health worldwide, particularly for immunocompromised individuals. Current challenges such as the elevated toxicity of common antifungal drugs and the emerging resistance towards these could be overcome by multidrug therapy. Natural antimicrobial peptides, AMPs, in combination with other antifungal agents are a promising avenue to address the prevailing challenges. However, they possess limited biostability and susceptibility to proteases, which has significantly hampered their development as antifungal therapies. β‐peptides are synthetic materials designed to mimic AMPs while allowing high tunability and increased biostability. In this work, we report for the first time the inhibition achieved in Candida albicans when treated with a mixture of a β‐peptide model and fluconazole or ketoconazole. This combination treatment enhanced the biological activity of these azoles in planktonic and biofilm Candida, and also in a fluconazole‐resistant strain. Furthermore, the in vitro cytotoxicity of the dual treatment was evaluated towards the human hepatoma cell line, HepG2, a widely used model derived from liver tissue, which is primarily affected by azoles. Analyses based on the LA‐based method and the mass‐action law principle, using a microtiter checkerboard approach, revealed synergism of the combination treatment in the inhibition of planktonic C. albicans. The dual treatment proved to be fungicidal at 48 and 72 h. Interestingly, it was also found that the viability of HepG2 was not significantly affected by the dual treatments. Finally, a remarkable enhancement in the inhibition of the highly azole‐resistant biofilms and fluconazole resistant C. albicans strain was obtained. Copyright © 2015 European Peptide Society and John Wiley & Sons, Ltd.     

The role of cutaneous feedback for anticipatory grip force adjustments during object movements and externally imposed variation of the direction of gravity

Grip force adjustments to changes of object loading induced by external changes of the direction of gravity during discrete arm movements with a grasped object were analyzed during normal and anesthetized finger sensibility. Two subjects were seated upright in a rotatable chair and rotated backwards into a horizontal position during discrete movements with a hand-held instrumented object. The movement direction varied from vertical to horizontal inducing corresponding changes in the direction of gravity, but the orientation of the movement in relation to the body remained unaffected. During discrete vertical movements a maximum of load force occurs early in upward and late in downward movements; during horizontal movements two load force peaks result from both acceleratory and deceleratory phases of the movement. During performance with normal finger sensibility grip force was modulated in parallel with fluctuations of load force during vertical and horizontal movements. The grip force profile adopted to the varying load force profile during the transition from the vertical to the horizontal position. The maximum grip force occurred at the same time of maximum load force irrespective of the movement plane. During both subjects' first experience of digital anesthesia the object slipped from the grasp during rotation to the horizontal plane. During the following trials with anesthetized fingers subjects substantially increased their grip forces, resulting in elevated force ratios between maximum grip and load force. However, grip force was still modulated with the movement-induced load fluctuations and maximum grip force coincided with maximum load force during vertical and horizontal movements. This implies that the elevated force ratio between maximum grip and load force does not alter the feedforward system of grip force control. Cutaneous afferent information from the grasping digits seems to be important for the economic scaling of the grip force magnitude according to the actual loading conditions and for reactive grip force adjustments in response to load perturbations. However, it plays a subordinate role for the precise anticipatory temporal coupling between grip and load forces during voluntary object manipulation.     

靛玉红、蛇床子素抗外阴阴道念珠菌病混合菌生物膜作用的研究

目的研究中药有效成分靛玉红、蛇床子素抗外阴阴道念珠菌病混合菌生物膜的作用。方法体外建立白念珠菌（Candidaalbicans）铜绿假单胞菌（Pseudomonasaeruginosa,P．a）混合菌生物膜（Biofilm,BF）,XTT减低法及形态学观察白念珠菌混合茵生物膜的形成过程;形态学观察、活菌计数法评价中药有效成分靛玉红（indirubin）、蛇床子素（Ostho）对白念珠菌混合菌生物膜的最小抑膜浓度（SMIC）,并经扫描电镜确认。结果白念珠菌混合菌48h能形成成熟的生物膜;62．5mg／L浓度的靛玉红能抑制白念珠菌混合菌生物膜的形成。500mg／L浓度的蛇床子素未见有抑制白念珠菌混合菌生物膜的作用。结论靛玉红由于具有抗生物膜的作用,可用于预防外阴阴道念珠菌病的复发。     

都柏林念珠菌的PCR-RFLP鉴定

目的建立一种准确、可靠的鉴定都柏林念珠菌基因型的方法。方法临床念珠菌分离自临床生殖器念珠菌病患者,45℃温度试验时几乎不生长,且其他表型实验结果也符合都柏林念珠菌特征。对41例临床念珠菌和1例白念珠菌标准株、1例都柏林念珠菌标准株rDNA内部转录间隔区的基因进行聚合酶链反应（PCR）扩增,HpyF10Ⅵ酶切后观察PAGE图谱。结果聚合酶链反应-限制性片段长度多态性（PCR-RFLP）后,39例临床株鉴定为白念珠菌。2例临床菌株带型特殊,测序后行BLAST比对分析,1例鉴定为白念珠菌,另1例尚不能肯定为都柏林念珠菌,还需要进一步以其他分子生物学方法鉴定。结论PCR-RFLP方法酶切后两种念珠菌带型区分明显,可以鉴别大部分临床菌株。基因测序是该方法有意义的补充。     

Non-invasive diagnosis of cutaneous leishmaniasis by the direct boil loop-mediated isothermal amplification method and MinION™ nanopore sequencing

Cutaneous leishmaniasis (CL) is gaining attention as a public health problem. We present two cases of CL imported from Syria and Venezuela in Japan. We diagnosed them as CL non-invasively by the direct boil loop-mediated isothermal amplification method and an innovative sequencing method using the MinION? sequencer. This report demonstrates that our procedure could be useful for the diagnosis of CL in both clinical and epidemiological settings.     

The effects of oxygen on cutaneous propionibacteria grown in continuous culture

Propionibacterium acnes, Propionibacterium avidum and Propionibacterium granulosum were grown in continuous culture at 0–100% air saturation using a semi-synthetic medium. All 3 species utilised oxygen and showed increased growth at 10% air saturation. Oxygen depressed the levels of the fermentation end products propionic and acetic acids. The 3 species differed in the production of ‘oxygen-detoxifying’ enzymes. P. acnes produced catalase, P. avidum produced superoxide dismutase and P. granulosum produced catalase anaerobically and cytochrome c reductase aerobically. The results suggest that under aerobic conditions these bacteria may obtain energy without increased substrate-level phosphorylation and that they may employ different strategies to overcome the toxic effects of oxygen.