红色毛癣菌raubitschekii变种致Majocchi肉芽肿一例  

A case of Majocchi＇s granuloma induced by vat. raubitseheldi of Trichophyton rubrum

作　　者：马蕾[1] 李若瑜[1] 余进[1] 万喆[1] 王晓红[1] 

机构地区：[1]北京大学第一医院皮肤科,真菌和真菌病研究中心,100034

出　　处：《中华皮肤科杂志》2008年第6期364-366,共3页Chinese Journal of Dermatology

摘　　要：目的报道1例Majocchi肉芽肿，对其病原菌红色毛癣菌变种raubitschekii的形态学、生理学及分子学特征进行研究，并通过基因分型的方法分析其深在感染与浅表皮肤感染的关系。方法进行临床和病理检查，真菌镜检和培养，尿素酶试验，内转录间隔区（ITS区）序列分析。对来源于该患者病变趾甲及组织的菌株及7株红色毛癣菌的rDNA非转录间隔区（NTS）串联重复亚单位1（TRS—1区）进行PCR。结果48岁女性患者，背部、臀部、大腿出现红色丘疹、结节2个月。9个月前曾行肝移植术，甲癣病史3年，术后加重。经病理和真菌学检查，确诊为Majocchi肉芽肿。足趾甲和组织真菌培养菌落和显微镜下形态、尿素酶试验阳性，结合ITS区序列分析结果，证实致病菌为红色毛癣菌变种raubitschekii。TRS—1区扩增后显示，病变趾甲和组织来源的菌株基因型完全一致，与其余临床分离株有差异。结论NTS区的TRS—1区显示基因多态性，病变趾甲和组织基因型完全一致，提示两者来源相同。Objective To report a case of Majocchi＇s granuloma induced by var. raubitschekii of Trichophyton rubrum, and to evaluate the relationship between deep and superficial fungal infection with genotyping technique. Methods The patient underwent physical, pathological and mycologic examination, which included microscopic observation, fungal culture, and urease reaction. The sequence of intertranscribed spacer （ITS） of rDNA was analysed by PCR and sequencing. Isolates from affected toes and tissue as well as one reference strain and six clinical strains of T. rubrum, were subjected to analysis of the tandem repeat subelement（TRS-1 ） in nontranscribed spacer（NTS ）of rDNA by PCR. Results A 48-year-old female patient presented with a 2-month history of red papules and nodular lesions on the back, buttock and thigh, as well as a 3-year history of onychomycosis which had become more severe after a liver transplantation 9 months before. Pathological and mycologic examinations confirmed the diagnosis ofMajocchi＇s granuloma. The pathogen was identified as var. raubitschekii of T. rubrum by microscopic examination, fungal culture, positive urease reaction and the sequence of ITS. As shown by the amplications of TRS-1 of NTS, the genotypes of strains fi＇om affected nails and tissue were identical, but differed from those of other clinical strains of T. rubrum. Conclusions There is a polymorphism in TRS-1 of rDNA NTS of T. rubrum, with the genotypes of isolates from affected nails and tissue being identical, which suggests they are of the same origin.

关 键 词：发癣菌属 Majocchi肉芽肿 真菌学 

分 类 号：R756[医药卫生—皮肤病学与性病学]