伞状毛霉和近平滑念珠菌致皮肤和皮下组织感染  

Cutaneous and subcutaneous coinfecfion by Lichthelmia corymbifera and Candida parapsilusis： a case report

作　　者：卢伟[1] 卢洁[1] 冉玉平[2] 林昭春[1] 万慧颖[1] 崔凡[1] 曹泸丹[2] 潘宁[1] 宋翔[1] 陈金[1] 王有为[1] 余梅[1] 

机构地区：[1]四川省医学科学院四川省人民医院皮肤病性病研究所,成都610031 [2]四川大学华西医院皮肤性病科

出　　处：《中华皮肤科杂志》2012年第10期727-730,共4页Chinese Journal of Dermatology

摘　　要：报道一例由伞状毛霉和近平滑念珠菌所致皮肤和皮下感染。患者女，67岁，因左手腕“骨折”后外敷中草药夹板固定后形成增生性肉芽肿就诊。皮损分泌物直接涂片见革兰染色阳性出芽酵母细胞，组织病理检查：过碘酸雪夫及六胺银染色显示角质层及真皮内有粗大无分隔菌丝。皮损组织真菌培养在35℃时分别有霉菌和酵母样菌生长。霉菌经小培养形态学鉴定及DNAITS1～4区测序证实为伞状毛霉。温度试验显示伞状毛霉在37℃以上生长迅速，40℃时生长较缓慢。扫描电镜见孢子囊顶生呈洋梨状，孢子囊梗圆锥形，孢囊梗生于匍匐菌丝顶部，在假根之间，不与假根相对着生。酵母样菌经柯玛嘉显色试验和D1／D2片段DNA测序证实为近平滑念珠菌。药敏试验显示伞状毛霉菌对特比萘芬和伊曲康唑最敏感。细胞外酶活性测定结果显示伞状毛霉的蛋白酶活性高于近平滑念珠菌。患者口服抗真菌药物伊曲康唑200mg/次，每日2次，并予肉芽肿切除术联合治疗，治疗6周后患处肉芽组织完全消退，随访4年无复发。To report a ease of cutaneous and subcutaneous coinfeetion caused by Liehtheimia corymbifera and Candida parapsilosis. A 67-year-old female peasant consulted about proliferative granuloma developing on her left forearm after topical application of a Chinese herbal drug and splint fixation for the treatment of suspected fracture of the wrist. Direct microscopic examination showed gram positive budding yeast cells in lesion secretions. Pathological study with periodic acid-Sehiff （PALS） and gormori methenamine silver （GMS） staining revealed broad non-separate hyphae in the corneum and dermis. Fungal culture of lesional tissue at 35~C grew both mould and yeast. The mould was identified as Lichtheimia corymbifera based on morphological findings and sequences of the internal transcribed space （ITS） 1-4 regions. Thermal tolerance study revealed that the isolate grew fast at 37~C but slowly at 40~C. Under a scanning electron microscope, the acrogenous sporangia were pear-shaped with conical sporangiophores originating from the top of stolon, which were among but not opposite to the rhizoids. The yeast was identified as Candida parapsilosis by Chromagar test and D1/D2 region sequencing. As antimicrobial susceptibility test indicated, the Lichtheimia corymbifera isolate was most sensitive to terbinafine and itraconazole. The proteolytic activity of Lichtheimia eorymbifera was higher than that of Candida parapsilosis. The granuloma completely subsided after surgical resection and 6-week treatment with oral itraconazole 200 mg twice a day. No recurrence was observed during a 4-year follow-up.

关 键 词：伞状毛霉 近平滑念珠菌 皮肤皮下感染 

分 类 号：R756[医药卫生—皮肤病学与性病学]