威尼克何德霉感染14例  

Hortaea werneckii infection:report of 14 cases

作　　者：郑文爱 徐和平[3] 乔凤 吴伟伟 杨先旭 唐小正 林昌炎 ZHENG Wen’ai;XU Heping;QIAO Feng;WU Weiwei;YANG Xianxu;TANG Xiaozheng;LIN Changyan(Department of Laboratory Medicine,The Fifth People’s Hospital of Hainan Province,Haikou 570206,China)

机构地区：[1]海南省第五人民医院检验科,海口570206 [2]海南省第五人民医院皮肤科,海口570206 [3]厦门大学附属第一医院检验科.

出　　处：《中国感染与化疗杂志》2021年第5期552-556,共5页Chinese Journal of Infection and Chemotherapy

基　　金：海南省自然科学基金(819MS132);海南省卫生计生行业科研项目(18A200003);海南省自然科学基金面上项目(817374)。

摘　　要：目的报道14例威尼克何德霉感染的临床特征与体外药敏试验结果,为临床诊疗提供依据。方法取患者皮损(皮/甲屑)镜检和培养,通过测序确定菌种并进行药敏试验,同时分析患者的感染途径、临床特征和抗真菌治疗效果。结果14例患者分离的14株真菌经测序鉴定均为威尼克何德霉,药敏试验结果显示5种抗真菌药物的MIC几何均值为:伊曲康唑0.0657 mg/L,伏立康唑0.0363 mg/L,特比萘芬0.0381 mg/L,酮康唑0.0488 mg/L,氟康唑3.2813 mg/L。患者的感染途径大部分与密切接触含盐的沙土有关,特比萘芬和酮康唑擦拭皮损部位1周内有明显疗效,伊曲康唑对于甲感染的治疗效果欠佳。结论威尼克何德霉是掌黑癣的致病菌外,还可引起甲真菌病。体外药敏试验结果显示伊曲康唑、伏立康唑、特比萘芬、酮康唑、氟康唑对该菌的MIC值均较低,这些药物在临床上治疗威尼克何德霉感染导致的掌黑癣均具有明显疗效。Objective To describe the clinical characteristics of Hortaea werneckii infection and the results of antifungal susceptibility testing for H.werneckii isolates to improve clinical treatment.Methods Samples were taken from skin lesions(nail)of the patients for microscopic examination and fungal culture.The strains were identified by gene sequencing and characterized by in vitro antifungal susceptibility test.The route of infection,clinical characteristics and antifungal therapy were reviewed and analyzed.Results All the 14 strains of bacteria isolated from patients were identified as H.werneckii by gene sequencing.The in vitro antifungal susceptibility testing for the 14 strains of H.werneckii showed that the geometric mean minimum inhibitory concentration(MIC)of itraconazole,voriconazole,terbinafine,ketoconazole,and fluconazole was 0.0657,0.0363,0.0381,0.0488,and 3.2813 mg/L,respectively.The infection was resulted from close contact with salt-containing sand.Terbinafine and ketoconazole had apparent effect on the tinea nigra within 1 week,while the effect of itraconazole on onychomycosis was poor.Conclusions H.werneckii is not only the pathogenic agent of tinea nigra,but also causes onychomycosis.The MIC values of itraconazole,voriconazole,terbinafine,ketoconazole,and fluconazole were lower against H.werneckii isolates.All of these antifungal drugs are effective in treatment of the tinea nigra caused by H.werneckii infection.

关 键 词：威尼克何德霉 掌黑癣 甲真菌病 药敏试验 

分 类 号：R519[医药卫生—内科学]