季也蒙念珠菌性皮肤肉芽肿  

Cutaneous granuloma caused by Candida guilliermo ndii： a case report

作　　者：向耘[1] 冉玉平[1] 代亚玲[2] 张浩[1] 何晓丹[1] 万慧颖[1] 王琳[1] 

机构地区：[1]四川大学华西医院皮肤性病科,成都610041 [2]四川大学华西医院医学检验科,成都610041

出　　处：《中华皮肤科杂志》2008年第2期76-79,共4页Chinese Journal of Dermatology

基　　金：高等学校博士学科点专项科研基金（20050610058） 志谢 中山大学附属二院皮肤科医学真菌研究中心席丽艳教授和鲁长明老师

摘　　要：患者女，44岁，因左手背外伤后出现结节14个月就诊。取病变组织做直接镜检和真菌培养，根据培养菌落形态、镜下特征、API-20C AUX鉴定系统、显色培养基和核糖体DNA测序确定致病菌种，RAPD分析基因型。病理切片经HE染色，氯胺银和过碘酸雪夫染色观察真菌在组织中的形态。对致病菌进行体外药敏和胞外酶活性分析。病变组织直接镜检可见菌丝和孢子，4次真菌培养均有奶油样菌落生长，镜下见成簇卵圆形孢子和假菌丝。根据形态学、生理实验、ITS及D1／D2区DNA测序等鉴定为季也蒙念珠菌，且4株菌基因型一致。组织病理见角质层内有孢子，真皮内见大量炎性细胞浸润和上皮肉芽肿。该菌株对伊曲康唑的MIC值为1．5μg／mL。通过APIZYM系统测定出9种胞外酶活性。患者经内服酮康唑（0．2g／d）和外用萘替芬酮康唑乳膏6个月后痊愈。A 44-year-old woman was admitted to the hospital with a 14-month history of nodules on the dorsum of her left hand that occurred after injury. The following examiniations were performed on the lesional skin： direct microscopic examination, KOH staining and fungal culture. API-20C AUX system was used to identify the carbohydrate assimilation profile. The gene of ribosome DNA was sequenced for the isolates. Random amplification of polymorphic DNA was used to analyse the genotype of the isolates. Histologic sections were subjected to hematoxylin and eosin stain, chloramines silver stain and periodic acid Schiff stain. Antifungal susceptibility of the isolates was analyzed by E-test. The extracellular enzymatic activities were detected by API ZYM system. Hyphae and spores were observed by direct microscopic examination of the lesional tissues. Four times of fungal culture all yielded flat, smooth, cream-colored colonies characteristic of yeast; microscopic examination of the isolates showed clusters of oval spores and short pseudohyphae. The four isolates were consistently identified as Candida guilliermondii according to their morphological characteristics, biochemical test results, and gene sequence of internal transcribed spacer （ITS） and D1/D2 regions of rDNA. All the isolates possessed the same genotype. Histopathological examination showed spores in the stratum corneum as well as a massive infiltration of inflammatory cells and epithelioid granuloma in the dermis. The isolates were resistant to itraconazole with an minimal inhibitory concentration of 1.5 μg/mL. A total of 9 exocellular enzyme activities were detected by API ZYM system. The patient completely recovered after 6 months of oral ketoconazole （0.2 g/d） and topical application of naftifine hydrochloride and ketoconazole cream.

关 键 词：念珠菌病 念珠菌属 肉芽肿 

分 类 号：R756[医药卫生—皮肤病学与性病学]