星形奴卡菌性足菌肿1例

患者女,40岁。左足背被田间竹枝戳伤后出现结节、肿块,部分破溃伴少量溢脓,逐渐加重8年。皮损组织病理示:真皮组织中见散在分布放射状结构的杵状体,周围有大量中性粒细胞、淋巴细胞及组织细胞浸润。深部组织真菌镜检和培养均(-),深部组织脓液培养见菌落生长,菌种鉴定为星形奴卡菌。诊断:星形奴卡菌性足菌肿。予复方磺胺甲恶唑、青霉素G和阿米卡星联合治疗,局部清创处理后好转。     

奴卡菌性足菌肿

报告1例奴卡菌性足菌肿。患者男,56岁。左腹股沟术后出现皮肤红肿、破溃、脓液溢出半年。组织病理检查可见大量肉芽性炎性浸润,并见小脓肿形成,其内可见硫磺颗粒;分泌物涂片+抗酸染色镜检见阳性菌,菌丝内连串阳性颗粒;脓液培养见奴卡菌,诊断为奴卡菌性足菌肿。给予复方磺胺甲恶唑联合头孢曲松治疗,皮损完全消失。     

奴卡氏菌性足菌肿1例

患者男,34岁,左膝外伤后1年局部皮下组织出现红肿,硬化,窦道流脓,肌腱肿块,伴腹股沟淋巴结肿大,组织病理诊断肌腱肿块为足菌肿,窦道内肉芽组织培养有巴西奴卡氏菌生长,以青霉素G和复方甲基异恶唑连续用药2个月结合外科手术治疗,皮损和肿块完全消退,随访8个月未见复发。     

足菌肿5例临床分析

目的 探讨足菌肿的临床特点及诊断与治疗方法,加深疾病认知,减少临床误诊误治。方法 对近6年来本科室收治的5例足菌肿患者的临床特点及治疗进行详细报道,并在中国知网数据库检索2000—2022年发表的“足菌肿”相关中文文献,纳入资料完整的患者13例,分析其临床特点及诊疗方法。结果 共纳入18例足菌肿病例,其中男13例,女5例,年龄27～70岁。外伤致皮肤破损(72.22%)是该病常见诱因,足部(77.78%)最常累及,临床多表现为局部肿胀、结节、皮肤破溃,排出含颗粒的脓性或血性分泌物。细菌及真菌培养、组织病理和影像学检查是辅助诊断手段,抗菌药物和手术清创是常用治疗方案。9例(50.00%)患者存在误诊误治病史,多数病程较长,持续2个月～44年不等。结论 足菌肿的诊断需综合临床表现、细菌及真菌培养、组织病理及影像学检查,抗菌药物联合手术是常规治疗方案。早期明确诊断,合理规范化治疗是提高足菌肿治愈率和降低致残率的关键。     

镰形支顶孢所致的足菌肿一例

患者男,４６岁,安徽人。于１９８９年赤足在田间行走时被一木刺扎入左足内踝侧,当时取出木刺后未作处理。约３个月后该部位出现数个皮色结节,约黄豆大小,活动,不与皮肤粘连。以后结节逐渐增大变红,与皮肤粘连,局部红肿,有时疼痛和微痒。３年前结节破溃,流出脓液。局部肿胀加重且影响行走。曾在当地行外科手术并使用抗结核、抗细菌和中草药熏蒸等方法治疗,未见好转。以后局部肿胀继续缓慢扩大,反复破溃流脓,行走更为不便,遂来本院治疗。体检：患者一般情况好。血尿常规、肝肾功能正常,血磷偏高（１．８mmol／L）。X线检查见…     

马杜拉分支菌引起下颌部真菌性足菌肿一例

目的 探讨1例真菌性足菌肿的临床病理特点、诊断、治疗及预后,并对其致病菌进行鉴定。方法 分析我科收治的1例下颌部真菌性足菌肿的临床及病理特点,进行真菌学及分子生物学鉴定。结果 该患者以下颌部肿胀、多发窦道形成、排大量黑色颗粒为主要症状,病理检查示化脓性肉芽肿性炎症,PAS染色可见大量藕节状真菌菌丝。ITS1、ITS2和D1/D2区测序结果示:病原菌与足菌肿马杜拉分支菌有最大的相似性,但相似性小于97%。结论 本病例为发生在下颌部的由马杜拉分支菌属内一新的菌种引起的真菌性足菌肿。     

巴西诺卡菌感染所致的原发性皮肤诺卡菌病一例

原发性皮肤诺卡菌病是一种由诺卡菌属直接感染皮肤及皮下组织引起的少见感染性疾病,临床表现多样,极易被误诊。本例患者左前臂红斑、结节、脓肿及溃疡,表面大量脓性分泌物2周。活检组织培养长出黄白色菌落,鉴定为巴西诺卡菌。患者口服复方磺胺甲噁唑治疗50天后痊愈。     

小范围发生皮肤诺卡菌病23例

目的 报道国内首见群体发生的皮肤诺卡菌病23例。方法 详细检查了23例患者的皮疹表现，对6例患者的标本进行了病原学鉴定，同时对可能的发病原因进行了调查。结果 发现全部患者同住一个自然村，发病均与臀部肌内注射有关，每例患者均于肌内注射治疗后2-10个月内出现臀部（肌肉注射部位）结节，脓肿，部分皮损破溃成溃疡及窦道，病原学检查证实为星形奴卡菌。结论 23例皮肤奴卡菌病的发生均与肌内注射有关。     

念珠菌与细菌混合感染引起足菌肿1例

报告1例由热带念珠菌、娄德罗念珠菌和金黄色葡萄球菌所致足菌肿。患者男,45岁。左足及左小腿红肿,足底破溃形成窦道伴溢液2个月。真菌直接镜检阴性。皮损组织病示:表皮下组织可见菌丝、孢子及颗粒物质。真菌培养有酵母样菌落生长,DNA测序鉴定为热带念珠菌和娄德罗念珠菌;细菌培养为金黄色葡萄球菌。诊断为足菌肿,给予伊曲康唑、阿奇霉素及局部外洗治疗后痊愈。     

皮肤巴西诺卡菌感染1例及文献复习

患者男,55岁,左前臂、背部红肿热痛4 d.皮肤科情况:左前臂、背部分别可见一大小约3 cm x3 cm皮肤红肿,局部皮温增高,皮色暗红,局部皮肤破溃,有渗液,触痛明显.脓液细菌培养及鉴定为巴西诺卡菌.诊断:原发性皮肤巴西诺卡菌感染.经脓肿切开引流术及阿米卡星抗感染治疗后好转,出院1个月后随访伤口恢复良好.     

Isolation of both Sporothrix schenckii and Nocardia asteroides from a mycetoma of the forefoot

Mycetoma is a localized primary subcutaneous infection due to fungi (eumycetoma) or aerobic actinomycetes (actinomycetoma). We report a patient who acquired an implantation infection on the forefoot following a motorcycle accident in Crete. Both Sporothrix schenckii and Nocardia asteroides were isolated simultaneously from the lesion. Under combined therapy with itraconazole and trimethoprim-sulphamethoxazole for 7 months the lesion healed completely. A combination of causative organisms in mycetomas is rare, and the combination of S. schenckii and N. asteroides together has not been reported from one lesion.     

Head actinomycetoma with a double aetiology, caused by Nocardia brasiliensis and N. asteroides

We describe a 64-year-old man with an actinomycetoma of the frontal region of the head caused simultaneously by two aetiological agents, Nocardia brasiliensis and N. asteroides. This case is presented due to the unusual body site affected and, above all, because two aetiological agents were isolated.     

A successfully treated case of mycetoma due to Nocardia veterana

We report a successfully treated case of mycetoma from which an unusual Nocardia species was isolated. The isolate was identified as N. veterana by biochemical characterization and 16S ribosomal RNA gene sequencing, and it has not been previously reported as a causative agent of human mycetomas. Treatment with various antibiotics over 6 years and surgical resection failed to cure the disease. However, the combination of intravenous imipenem/cilastatin and amikacin along with oral clarithromycin and minocycline proved very effective in this case. This is the first case report of mycetoma due to N. veterana in a clinical setting.     

Cutaneous nocardiosis developing around gravel inserted during a traffic injury

A 65-year-old Japanese woman with nocardial mycetoma which developed five years after a compound bone fracture of the left foot due to a traffic accident was reported. During this accident, two small pieces of gravel had entered her foot. Nocardia asteroides, which had been attached to the gravel, was probably inserted 5 years previously during the trauma. The lesion did not respond to oral minocycline and trimethoprim-sulfamethoxazole and was finally removed surgically; she has been free from recurrences for one year, of follow-up.     

Treatment of actinomycetoma due to Nocardia spp. with amoxicillin-clavulanate

BACKGROUND: Actinomycetoma is a chronic occupational condition that occurs frequently in tropical regions. In Mexico 85% of cases are caused by Nocardia brasiliensis. There are two treatments of choice for these cases: a regimen of dapsone plus trimethoprim-sulfamethoxazole (co-trimoxazole) and, recently, amikacin, either alone or combined. However, not all cases respond properly to these therapies. OBJECTIVES: To report a retrospective, 11-year study of cases of actinomycetomas caused by Nocardia spp., treated with amoxicillin-clavulanate (co-amoxiclav). METHODS: All cases were identified clinically and microbiologically and had previously failed standard therapies. Oral co-amoxiclav 875/125 mg was administered every 12 h. Clinical, microbiological and laboratory follow up was performed every 2 months during the treatment period. RESULTS: Twenty-one cases of actinomycetoma were included, 19 caused by N. brasiliensis and one each by N. asteroides and N. otitidiscaviarum. Clinical and microbiological cure occurred in 15 of 21 cases (71%); two cases improved (10%) and four failed (19%). Mean treatment period was 9.6 months, during which neither side-effects nor laboratory test alterations were reported. CONCLUSIONS: Treatment with co-amoxiclav represents an alternative or rescue treatment for cases that have previously failed standard therapies.     

Primary cutaneous nocardiosis due to Nocardia nova in a healthy woman

We describe a 68-year-old healthy woman with an unusual skin manifestation of mycetoma. A dark reddish erythematous plaque was present on the dorsum of the left hand for over 10 years. A skin biopsy revealed sulphur granules in the abscess, and Nocardia nova was identified from the specimen. Treatment with dapsone resulted in significant improvement. We review the clinical features of cutaneous N. nova infections.     

Mycetoma caused by Nocardia caviae in the first Brazilian patient

Background  Mycetoma is a chronic subcutaneous mycosis caused by exogenous fungi or actinomycetes. This infection has a progressive course and shows a typical clinical characteristic of tumefaction, draining sinuses, and grains. Infection initiation is related to local trauma and can spread to muscle, underlying bone, and adjacent organs. Nocardia brasiliensis is the most frequent actinomycete isolated, while N. caviae is a rare agent. Methods  We present a case of mycetoma in a 37‐year‐old African‐American man on the right hand. The infection had been apparent for four years prior to the consultation. When the infection did not respond to antibiotic therapy, the patient was referred to the Dermatology department. Routine laboratory studies were normal. X‐ray examination of the hand showed an osteolytic lesion on the hand bones. On skin biopsy culture, on Sabouraud Dextrose Agar at 28 °C, a colony was isolated which was further identified as N. caviae by biochemical and hydrolysis testing. Results The patient was treated with oral trimethoprim/sulfamethoxazole (TMP/SMZ) 160/800 mg twice a day for 10 months. Four months after the beginning of the therapy, the subject exhibited clinical improvement and functional recovery of the hand. Five‐year follow‐up X‐ray examination of the hand showed no osteolytic lesion on the hand bones. Conclusion We report the first mycetoma case caused by N. caviae in our country with an unusual location on the hand. The patient showed clinical improvement with oral TMP/SMZ.