首次报道中国北方Fonsecaea monophora所致着色芽生菌病1例及其相关实验研究  

Chromoblastomycosis caused by Fonsecaea monophora in North China:first case report and laboratory study

作　　者：赵作涛[1] 鲁巧云[1] 高那[1] 陈伟[1] 万喆[1] 王晓红[1] 武玲慎[1] 王爱平[1] 李若瑜[1] 

机构地区：[1]北京大学第一医院皮肤性病科北京大学真菌和真菌病研究中心,北京100034

出　　处：《中国真菌学杂志》2010年第4期193-195,共3页Chinese Journal of Mycology

基　　金：北京大学第一医院院内青年基金

摘　　要：目的首次报道中国北方1例由Fonsecaea monophora所致着色芽生菌病。方法患者男性,58岁,主因＂右腕部皮损伴瘙痒8-9a＂就诊。对皮损脓液直接镜检,皮损组织病理检查,真菌培养,并对培养获得菌株进行形态学,分子生物学鉴定等实验室研究。结果脓液直接镜检可见多个圆形、厚壁、棕色硬壳细胞,皮损组织病理表现为慢性肉芽肿样改变,并可见硬壳小体。真菌培养可见暗棕色,橄榄色至黑色菌落生长,生长速度较慢,镜下可见枝孢型和喙枝孢型产孢。ITS区序列分析鉴定为Fonsecaea monophora。依据临床及实验室检查确诊该例为Fonsecaea monophora所致的着色芽生菌病。口服伊曲康唑200mg,1次/d;特比萘芬250mg,1次/d。治疗3个月后,皮损消退痊愈。结论 Fonsecaea monophora感染也可见于我国北方地区的着色芽生菌病患者,而ITS区序列分析是该菌种鉴定的重要手段,伊曲康唑联合特比萘芬治疗本例患者显示较好疗效。Objective To report a case of chromoblastomycosis caused by Fonsecaea monophora in North China and related laboratory investigation.Methods A 58-year-old man was admitted with skin granulomatous lesions on the right wrist for 8 to 9 years.Histopathologic examination,direct smear examination and fungal culture,PCR and ribosomal internal transcribed spacer（ITS）sequence analysis were performed for diagnosis.Results Sclerotic bodies were observed by direct smear examination.Histopathologic examination showed chronic granuloma and round,thick-walled sclerotic bodies.Fungal culture produced olivaceous to black colonies.Rhinocladiella type and cladosporium type conidia were observed in the slide culture identified as Fonsecaea monophora by sequence analysis of ITS region.After treatment with itraconazole（200 mg,QD）combined with terbinafine（250 mg,QD）for 3 months,the patient diagnosed as chromoblastomycosis caused by Fonsecaea monophora was cured.Conclusions Chromoblastomycosis caused by Fonsecaea monophora exists in North China,which can be identified by ITS analysis.Itraconazole with terbinafine has good effect.

关 键 词：Fonsecaea monophora 着色芽生菌病 伊曲康唑 特比萘芬 

分 类 号：R379.9[医药卫生—病原生物学]