马拉色菌相关疾病研究现状

马拉色菌感染是皮肤科常见的真菌感染性疾病,其中花斑癖的发病与该菌属存在着直接的相关性,目前研究表明脂溢性皮炎、特应性皮炎、马拉色菌毛囊炎、银屑病等相关疾病的发生与发展与马拉色菌属的感染存在着一定的联系。本研究综述结合相关文献报道,对马拉色菌属在一些常见皮肤疾病中的发病机制和相关致病机制作了一定概述。     

马拉色菌相关疾病的现状与研究进展

马拉色菌是人类及温血动物皮肤上的正常菌群之一,其与花斑癣、马拉色菌毛囊炎、脂溢性皮炎、银屑病等多种疾病的相关性日益受到关注,作者对马拉色菌的分类及其相关疾病的发病机制、病因、临床表现及诊断作一综述。     

马拉色菌在特应性皮炎免疫学发病机制中的研究进展

近年来,对马拉色菌与免疫系统之间关联的研究明显增加,其重要内容是马拉色菌在特应性皮炎发病中的作用。本文主要概述近期一些研究中对马拉色菌与树突状细胞、角质形成细胞间的关联性及其在特应性皮炎发病的免疫学机制中的作用所获得的进展。     

与马拉色菌相关的皮肤垢着病1例

患者男,18岁,以双侧面颊污秽样皮损3个月就诊。患者3个月前因经常不洗脸双侧面颊起较多粟粒至绿豆大黄褐色结痂,皮损发生后患者因害怕,拒绝擦洗面部,痂皮逐渐增厚,融合扩大成不规则斑块。患者自发病以来,除面部有绷紧感外,无其他不适。家庭其他成员未发现类似情况。既往体健,无慢性病史,无药物过敏史。     

江西地区花斑癣患者马拉色菌菌种分析

目的了解江西地区花斑癣患者马拉色菌菌种分布情况。比较传统吐温试验和改良吐温试验。方法对141例临床典型、真菌镜检阳性的花斑癣患者,采用Leeming和Notman培养基培养皮屑。以标准菌株为对照,按形态学和生理生化特点进行分类,分析马拉色菌菌种构成情况。同时比较传统吐温试验和改良吐温试验优缺点。结果培养到95株马拉色菌,分离出5个菌种:合轴马拉色菌62株,糠秕马拉色菌17株,球形马拉色菌9株,钝形马拉色菌6株,限制马拉色菌1株。结论合轴马拉色菌占有明显优势(65.26%)。改良吐温试验易于操作、费时短,尤其适合多标本的流行病学调查研究,值得推广。     

从尼僧头皮皮损中分离和鉴定马拉色菌

我们在2008年4～6月对武汉市区内某尼庵中尼僧头皮屑及头皮毛囊炎中马拉色菌分布情况进行调查,现将结果报道如下。     

伊曲康唑治疗马拉色菌毛囊炎的疗效观察

马拉色菌毛囊炎系由马拉色菌引起的毛囊炎性皮肤真菌病。伊曲康唑治疗本病有效,但有报道停药后复发率较高,可达30％。作者采用伊曲康唑以不同疗程治疗本病67例,取得较好效果,现将其治疗情况报告如下。     

马拉色菌病误诊为痤疮、湿疹2例分析CSCD

报道2例马拉色菌感染引起的毛囊炎和花斑糠疹。患者1,男,19岁,背部红色丘疹2个月,1个月后红色丘疹增多至双颌下、颈前,按痤疮治疗无效。患者2,女,13岁,腹部淡红色斑片1个月,3周后斑片增大,按湿疹治疗1周后无效。真菌镜检病例1可见球形出芽酵母细胞,病例2可见酵母细胞及香蕉样菌丝,含橄榄油SDA培养可见表面呈白色酵母样菌落,生长缓慢。2例分别诊断为马拉色菌属导致的毛囊炎和花斑糠疹。治疗:马拉色菌毛囊炎给予口服伊曲康唑胶囊及外用抗真菌药物综合治疗6周后,复查真菌镜检及培养阴性,外用抗真菌药物6周后花斑糠疹患者红色斑片消退。     

马拉色菌相关病例的探讨

目的探讨马拉色菌与相关皮肤病的特殊临床症状,提高对其的认识及疗效。方法回顾性分析相关病例的特殊临床表现、真菌学检查及治疗。结果3例临床表现为鳞屑性红斑患者的皮损中发现大量马拉色菌菌丝,经在含脂质的培养基上生长出球形马拉色菌,抗真菌治疗有效。1例表现为甲营养不良的患者甲屑中发现有大量马拉色菌菌丝。结论在非花斑癣患者的皮损中发现大量马拉色菌,可能与其外用皮质类固醇激素制剂有关。     

实验准备工作对马拉色菌直接镜检的影响

目的探讨实验准备工作对马拉色菌直接镜检的影响,旨为提高直接镜检的检出率,为花斑癣诊断和鉴别诊断提供病原学证据。方法对217例花斑癣患者皮损处的皮屑进行直接镜检。结果取材方法、标本处理方式等实验准备工作,大大影响直接镜检的效果。用透明胶布粘贴法取材,制成的湿片外观能看到患者皮损的原始形状,镜下马拉色菌分布按体表状态自然分布,无明显角化皮损镜检的阳性率高达94．5％～100．0％,有明显角化皮损镜检的阳性率仅为45．8％。用锉刀刮取法取材,无明显角化皮损镜检的阳性率〈90．0％,有明显角化皮损镜检的阳性率达87．5％。不同的载液处理标本以及载液作用标本的时间长短都影响皮屑直接镜检的阳性率。结论不同的皮损采用不同的取材方法及标本处理方式,将大大提高直接镜检的阳性率和准确率。     

Humoral immune response to Malassezia furfur in patients with pityriasis versicolor and seborrheic dermatitis

Humoral immune responses against exoantigen components of oval, elliptic and round yeast forms of Malassezia furfur were analysed by ELISA and Western blotting assays, using sera from patients with pityriasis versicolor (PV), seborrheic dermatitis (SD) and healthy adults (HA), as control. Sera from patients with SD showed IgG anti-oval M. furfur titers ranging from 1/400 to 1/6400 showing geometric mean (GM) of 1/1472, higher than those obtained with sera from patients with PV (1/200 to 1/6400, GM = 1/1239). Both patient groups showed mean titres statistically superior (p < 0.05) than those obtained from HA (GM = 1/229). Similar data were also obtained with the elliptic and round antigens. However, the anti-oval IgG mean titers from patients' sera were much higher than those obtained with elliptic or round antigenic components (p < 0.05). Anti-M. furfur IgM titers obtained from patient's sera with PV against all three exoantigens were statistically superior (p < 0.05) than HA group. Patients with SD showed IgM titers statistically superior (p < 0.05) only to oval yeasts of M. furfur. The IgA mean titers from patients' groups against the different morphological antigens were shown be slightly higher than those HA group. By Western blot, using rabbit anti-sera, the different antigenic components of M. furfur showed a close relationship mainly between oval and elliptic yeast cells antigens. The 70 kDa component of the M. furfur exoantigen of oval morphology was recognized by 84% of the PV patients' sera. On the other hand, SD patients' sera recognized 3 principal components of 70 kDa (100%), 65 kDa (67%) and 84 kDa (53%). These components may be considered immunological markers for PV and SD. Twenty-five percent of HA sera recognized the components of 65, 70 and 94 kDa. This investigation shows that M. furfur antigens can sensitize the host, mainly the oval yeast form of M. furfur with a very important specific IgG response in patients with SD and PV. This revised version was published online in June 2006 with corrections to the Cover Date.     

正常人耵聍中马拉色菌菌种构成研究

目的研究正常人耵聍中马拉色菌菌种构成及同一宿主耵聍中菌种是否一致。方法采集45名健康志愿者双侧耵聍,0.1%曲拉通X-100溶解稀释后接种于含菜籽油培养基,生化及形态学方法鉴定到种,同时提取菌种DNA,用真菌通用引物ITS1/ITS4做PCR扩增并测序鉴定。结果有44例(97.78%)双侧耵聍中均培养出马拉色菌(共分离出88株菌),菌种构成:糠粃马拉色菌29株(32.95%)、斯洛菲马拉色菌23株(26.14%)、合轴马拉色菌18株(20.45%)、球形马拉色菌11株(12.50%)、限制性马拉色菌7株(7.95%)。44例(88株菌)中双侧耵聍菌种相同者有38例(76株菌)(一致率86.36%)。结论正常人耵聍中马拉色菌菌种分布较广,主要菌种为糠秕马拉色菌。同一宿主双侧耵聍中马拉色菌菌种具有一定的一致性。     

Potential role of chemerin in recruitment of plasmacytoid dendritic cells to diseased skin

Interferon α-producing plasmacytoid dendritic cells (pDC) are crucial contributors to pro-inflammatory or tolerogenic immune responses and are important in autoimmune diseases such as psoriasis. pDC accumulate in the lesional skin of psoriasis patients, but are rarely found in the affected skin of patients with atopic dermatitis (AD). While homeostatic chemokine CXCL12 and inducible pro-inflammatory CXCR3 chemokine ligands may regulate pDC influx to psoriatic skin, the mechanism responsible for selective pDC recruitment in psoriasis vs. AD remains unknown. Circulating pDC from normal donors express a limited number of chemoattractant receptors, including CXCR3 and CMKLR1 (chemokine-like receptor 1). In this work, we demonstrate that circulating pDC from normal donors as well as psoriasis and AD patients express similar levels of CXCR3 and responded similarly in functional migration assays to CXCL10. We next found that blood pDC from normal, AD, and psoriasis patients express functional CMKLR1. In contrast to normal skin, however, lesional skin from psoriasis patients contains the active form of the CMKLR1 ligand chemerin. Furthermore, in affected skin from psoriatic patients the level of active chemerin was generally higher than in AD skin. Taken together, these results indicate that local generation of active chemerin may contribute to pDC recruitment to psoriatic skin.     

Unusual Observations in the Histology of Pityriasis Versicolor

Histological studies were carried out on 25 patients with various morphological types of pityriasis vesicolor. In addition to the usual features, acanthosis nigricans-like picture in papular lesions, dilated blood vessels in erythematous lesions were observed. In sections stained with Periodic acid Schiff's stain (PAS) absence of granular layer in areas of close approximation of filaments to the stratum malpighii and presence of only mycelia in the vicinity of acrosyringium were found unusual, interesting and are new findings to our knowledge. This revised version was published online in June 2006 with corrections to the Cover Date.     

复方苦参洗剂联合伊曲康唑治疗马拉色菌毛囊炎临床观察

目的 了解复方苦参洗剂联合伊曲康唑治疗马拉色菌毛囊炎的疗效.方法 将马拉色菌毛囊炎患者48例随机分为治疗组和对照组,各24例.两组均口服伊曲康唑胶囊200 mg,1次/d,疗程为2周,治疗组同时加用复方苦参洗剂外洗4周为1个疗程,2次/d.分别于开始治疗2周后及8周后观察皮疹消退情况和马拉色菌镜检结果,评价其疗效.结果 治疗2周时,治疗组总有效率75.0％,对照组总有效率41.7％,两组总有效率比较差异有统计学意义（x2=5.49,P＜0.05）,8周时,治疗组总有效率91.7％,对照组总有效率62.5％,两组有效率比较差异有统计学意义（x2=5.78,P＜0.05）.结论 复方苦参洗剂联合伊曲康唑治疗马拉色菌毛囊炎疗效显著,值得临床推广.     

Genotyping by RAPD-PCR analyses of Malassezia furfur strains from pityriasis versicolor and seborrhoeic dermatitis patients

Malassezia furfur is lypophilic yeast commonly associate with dermatological disorders. In the present work, we described the isolation of 47 M. furfur strains from three groups of patients: pityriasis versicolor (21 isolates), seborrhoeic dermatitis (15 isolates) and seborrhoeic dermatitis of the HIV positive patients (11 isolates). To investigate the identity of the strains at molecular level, DNA genomic of M. furfur strains were prepared and used to RAPD-PCR analyses. RAPD assay were carried out using two decamer primers and bands pattern generated were analyzed by an Unweighted Pair-Group Method (UPGMA). Dendrogram established a distinct differentiation between M. furfur isolates from pityriasis versicolor and seborrhoeic dermatitis patients with or without AIDS. We concluded that RAPD typing presented a high discriminatory power between strains studied in this work and can be applied in epidemiological investigation of skin disease causing by M. furfur.     

Quantitative analysis of cutaneous malassezia in atopic dermatitis patients using real-time PCR

We quantified the cutaneous Malassezia in patients with atopic dermatitis using a real-time PCR assay. Seven to 12 times more Malassezia colonized the head and neck compared to the trunk or limbs, and the species M. globosa and M. restricta accounted for approximately 80% of all Malassezia colonization at any body site.     

Isolation of Malassezia globosa and M. sympodialis from patients with pityriasis versicolor in Spain

Pityriasis versicolor is a superficial infection of the stratum corneum by several yeast species formerly collectively named Malassezia furfur. The genus Malassezia has been recently enlarged with new species. With the exception of M. pachydermatis, the remaining six species have an absolute requirement in vitro for supplementation of long-chain fatty acids in media. These lipophilic yeasts comprise six species: M. furfur, M. globosa, M. obtusa, M. restricta, M. slooffiae and M. sympodialis. The aim of this study was to establish whether there was any association between the various species of Malassezia and pityriasis versicolor lesions. Thus, we studied the isolates from 79 patients with pityriasis versicolor, both from lesions and from apparently healthy skin close to the visible lesions. In pityriasis versicolor lesions, the species most frequently isolated was M. globosa (90%), followed by M. sympodialis (41%). Almost all isolates (99%) belonged to one of these two species. The most frequent pattern was M. globosa as the sole species (58% of cases), although the association with M. sympodialis was also frequent (30%). These results confirmed M. globosa as the main agent of pityriasis versicolor and M. sympodialis as the second agent in importance. Malassezia globosa was found to be a species with high levels of esterase and lipase enzymes of probable importance in their pathogenicity. This revised version was published online in June 2006 with corrections to the Cover Date.     

糠秕马拉色菌酵母态和菌丝态蛋白差异表达的研究

目的通过双向电泳及串联质谱技术鉴定糠秕马拉色菌酵母态及菌丝态差异蛋白,在蛋白水平探讨两态转化机制及致病机理。方法分别诱导糠秕马拉色菌标准株酵母态和菌丝态菌体,利用玻璃珠研磨和超声波破碎细胞壁,三氯乙酸/丙酮沉淀获取总蛋白。双向电泳分离蛋白,PDQuest软件比对找出差异蛋白点。电喷雾串联质谱对差异点进行肽段测序,用Mascot和NCBI的Blast软件经蛋白质数据库鉴定蛋白质。结果经双向电泳分离的糠秕马拉色菌酵母态、菌丝态蛋白各有800多个蛋白点、64个蛋白点表达量有3倍以上差异,其中11个为酵母态特有,9个菌丝态特有。在选取的40个差异点中,成功鉴定出22个点,共16个蛋白。经Mascot和Blast软件检索,有明确功能的蛋白中,肌动蛋白、丝切蛋白等9个蛋白在菌丝态上调,谷胱甘肽转移酶、细胞支架信号蛋白等5个蛋白下调。结论鉴定出16个蛋白分别与细胞代谢、运动、氧化应激等功能相关,为了解糠秕马拉色菌表型转换机制和致病机理提供重要信息。