淡紫拟青霉所致皮肤及皮下感染:临床和实验研究

目的 报道国内首见淡紫拟青霉所致皮肤及皮下感染患者1例。方法 取患者皮损标本多次直接镜检，真菌培养，根据真菌培养的菌落特点和镜下形态、扫描电镜及DNA序列测定鉴定致病菌种，并对分离的致病菌进行体外药敏试验。结果 患者为6个月患儿，出生12d时面部出现粟粒大暗红丘疹，脓疱，并缓慢扩大。刮取脓疱直接镜检见无色细长分支菌丝。多次培养见灰紫色羊毛状菌落生长，光镜及电镜下可见无色细长分支、分隔菌丝、直立的分生孢子梗、顶端单轮生帚状支及大量柱状或分散柱状排列椭圆形、近球形小分生孢子。根据其菌落颜色及瓶梗形态等形态学特征鉴定为淡紫拟青霉，其rRNA基因DNA测序分析证实其表型分类。动物实验证实该菌的致病性，组织相中胶质性损害为其主要病理特征。体外药敏试验提示其对特比萘芬、酮康唑较敏感，对伊曲康唑、氟康唑敏感陛较差。结论 该病例被确定为淡紫拟青霉所致的皮肤及皮下感染，为国内首例。

Cutaneous and subcutaneous infection caused by Paecilomyces lilacinus:clinical and experimental study

Objective To report the first case of cutaneous and subcutaneous infection caused by Paecilomyces lilacinns in China. Methods Skin specimens were collected and examined by 10% KOH preparation and fungus culture repeatedly. The pathogenic strain was identified by fungus culture, scanning electron microscopy and DNA sequencing. Antimicrobial susceptibility test was held too. Results A 6-month-old infant presented with a 22-week history of a slowly enlarging erythematous and crusted lesion on her left cheek. Repeated examination of pus from the lesion revealed hyaline slender hyphae on microscopy. Growth of the isolate on Sabouraud dextrose agar produced a slightly grayish-lavender wooly colony. Microscopy and scanning electron microscopy test displayed a typical microscopic structure ofP. lilacinns. Identification of the strain was confirmed by DNA sequencing of rRNA gene. Animal experiment confirmed pathogenecity of the strain. Colloidal alteration was the major pathologic feature in the tissue phase. The clinical isolate appeared sensitive to terbinafine and ketoconazole in vitro , while resistant to itraconazole and fluconazole. Conclusions This is the first case report of cutaneous and subcutaneous infection caused by P. lilacinns in China.