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。     

皮肤诺卡菌病诊断与治疗进展

皮肤诺卡菌病是诺卡菌属经皮肤伤口引起的感染,多种诺卡菌均可引起,包括巴西诺卡菌、星形诺卡菌等.皮肤诺卡菌病临床表现无特异性,但以皮下结节伴有瘘管形成最常见.及时、准确的诊断对皮肤诺卡菌病的治疗有重要意义.磺胺类药物仍是治疗皮肤诺卡菌病的一线药物,但耐药株和多重耐药株的发现为临床治疗带来了新的挑战.建立准确的体外药敏谱和选择敏感抗生素对临床用药有指导意义.     

一株巴西诺卡菌的分离鉴定

诺卡菌是一类需氧的放线菌,它广泛存在于自然界的土壤和淡水中,可分布于世界各地,无地域差别[1].迄今为止可引起人类致病的菌种有星形诺卡菌、巴西诺卡菌、豚鼠诺卡菌和鼻疽诺卡菌,近年来国内陆续有病例报道[2,3].诺卡菌引起人类致病的临床特点主要为皮肤、皮下组织和肺、脑的急慢性化脓性感染,多为局灶性,少为系统性,系统性感染常见于免疫功能低下和慢性消耗性疾病,如白血病、肿瘤等.     

皮疽诺卡菌引起的皮肤坏疽一例

<正>诺卡菌属是革兰阳性丝状杆菌,感染常见于免疫力低下人群,主要经呼吸道或破损皮肤、黏膜形成局部的感染,亦可播散至脑、肝、肾等部位[1]。而由皮疽诺卡菌感染引起皮肤诺卡菌病通常发生在有免疫力的宿主[2],本案例的特点如下。临床资料患者,男,23岁。患处红肿疼痛25天,破溃、流脓5天,于2018年9月30日入院。患者自述25天前无明显诱因左踝红肿疼痛,呈持续性胀痛,无放射痛、畏寒、发热、潮热、咳嗽、咳痰、盗汗等,5天前红肿疼痛加重,并伴破     

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4d。皮肤科情况:左前臂、背部分别可见一大小约3cm×3cm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。     

鼻疽诺卡菌基因组DNA及细胞脂肪酸组成分析

目的：比较鼻疽诺卡菌与其它三种常见诺卡菌随机扩增DNA片段及脂肪酸组成的异同，并初步探讨其分类学意义。方法：(1)采用随机扩增DNA多态性(RAPD)方法，分析鼻疽诺卡菌、星形诺卡菌、巴西诺卡菌、豚鼠诺卡菌基因组DNA片段、(2)采用盐酸甲醇法提取上述菌株脂肪酸，以气相色谱法检测，并以计算机分析其组成。结果：四种诺卡菌DNA片段图谱各异，虽然可见少数一致性片段，但总体差异明显；脂肪酸组成成份有一定相似性，但在饱和／不饱和脂肪酸比值、饱和脂肪酸棕榈酸(C16:0)／油酸(C18:1)比值、不饱和脂肪酸棕榈酸(C16:1)／硬脂酸(C18:0)比值及是否含有C15:0和C17:0脂肪酸方面存在较大差异。结论:采用RAPD分析及气相色谱法脂肪酸组成分析，发现四种诺卡菌间既有遗传共性又存在种间差异。     

IgA肾病合并原发性皮肤诺卡菌病1例

患者男,30岁,左下肢多发红色结节伴疼痛10 d。体检:左小腿可见3个呈链状排列的结节,钱币至核桃大小,其上可见数个"脓头",部分有脓性分泌物,周围红斑浸润明显,并可见一沿淋巴管走形的线状红斑,触痛明显。局部分泌物细菌培养+鉴定为诺卡菌属(巴西诺卡菌),经复方磺胺甲恶唑口服治疗后皮疹愈合,目前无复发。     

万博节皮菌感染引起的头皮脓癣1例

正脓癣是相对少见的儿童皮肤癣菌感染,主要由亲动物性或亲人性的小孢子菌属和毛癣菌属感染,如犬小孢子菌、石膏样小孢子菌、须癣毛癣菌、断发毛癣菌等[1-3],此类皮肤癣菌感染可引起宿主强烈变态反应,主要表现为头皮脱发和毛囊性脓疱,可融合成痈状脓肿,愈合后可形成瘢痕及永久性脱发,严重影响患儿的身心健康。我们报告1例由患体癣的宠物兔引起的儿童脓癣,并进行菌种分型鉴定及临床诊治,随访。     

星形诺卡菌性足菌肿

报告1例星形诺卡菌性足菌肿。患者男,29岁。左踝部外伤后出现肿块、结节,并形成窦道,有脓液溢出,逐渐加重9年。皮损组织病理检查示脓肿中央液化坏死,可见颗粒,颗粒周围有菌鞘。深部组织脓液培养见放线菌生长,但菌种鉴定为星形诺卡菌,诊断为足菌肿。给予青霉素G联合复方磺胺甲口恶唑治疗,病情好转。     

SLE并发鼻疽诺卡菌感染引起皮下及脑脓肿一例

目的 探讨一例ＳＬＥ患者脑脓肿及皮下脓肿的病原菌。方法 从患者脑脊液和皮下脓肿取材,涂片Ｇｒａｍ染色并培养。结果 涂片Ｇｒａｍ染色阳性,培养菌落类似星形诺卡菌,但在生化特性方面略有不同;抗酸性为阳性,不分解酪氨酸,黄嘌呤,能发酵葡萄糖,鼠李糖,赤藓糖。可在４５℃生长,确证为鼻疽诺卡菌并证实此分离菌株对多种药物耐药。小鼠动物实验证明它可引起多发性脑脓肿。结论 鼻疽诺卡菌有致病性,多重耐药性,毒力强。     

SMALL GRAIN MYCETOMAS IN THE TROPICS

Biopsy specimens from 159 patients with mycetoma filed in the departments of pathology of four medical colleges in Tamil Nadu, India, were examined histologically; small grain mycetoma due to Nocardia species was found in 27 cases. In addition, 17 clinically diagnosed cases of mycetoma without the characteristic discharging “granules” were investigated for the presence of Nocardia spp. by paraffin baiting and Nocardia spp. were isolated from nine of them. Of these, five were Nocardia asteroides, one was N. brasiliensis and three were identified as Nocardia spp. The classification and geographic distribution of Nocardia spp. are discussed.     

Primary cutaneous nocardiosis in an immune-competent patient.

We present a patient who was hospitalized due to a purulent skin lesion with a surrounding erythematous area in the region of the right paranasal crease accompanied by a swelling of the right eyelid. Initially the diagnosis of a carbuncle caused by an infection with Staphylococcus aureus was supposed. A surgical debridement was performed and an antibiotic therapy was started. Only special microbial investigations requested by the clinician led to the diagnosis of a cutaneous infection with Nocardia brasiliensis. The presented case is remarkable because the nocardia infection was in an immune-competent patient and the patient showed a primary cutaneous nocardiosis without dissemination.     

Primary cutaneous nocardiosis

A case of primary cutaneous nocardiosis due to Nocardia asteroides occurring in a steroid-dependent asthmatic with no history of trauma is presented. He had a 5 month history of painful nodules on his right shin and calf. He was initially treated with a 6 week course of oral cephalexin 500 mg four times daily, followed by a 2 week course of minocycline 100 mg twice daily with worsening of the infection. A 12 week course of oral clarithromycin 500 mg twice daily led to complete resolution. A discussion of the problems associated with antimicrobial susceptibility testing and nocardia resistance is presented.     

Pityriasis versicolor

Pityriasis versicolor is a common superficial fungal infection of the skin. It is caused by Malassezia spp., which are normal human saprophytes. Under certain conditions, both exogenous and endogenous, the fungus can convert from a yeast to a pathogenic mycelial form. This alteration results in mild inflammation of the skin, and in characteristic clinical and histological changes. The taxonomy of Malassezia spp. has recently been modified to include six obligatorily lipophilic species, all of which can be found on human skin, plus one non-obligatorily lipophilic species, which only rarely colonizes human hosts. LEARNING OBJECTIVES: At the conclusion of this learning activity, participants should be aware of the role of Malassezia in the development of pityriasis versicolor, the clinical and histological changes arising from this dermatosis, and the diagnosis and treatment of this disorder.     

Humoral response in a patient with cutaneous nocardiosis

The clinical appearance of infection due to Nocardia spp. varies widely. The low sensitivity of direct microscopy and the slow growth of the organism challenge the laboratory diagnosis. We present the case of a skin abscess in an immunocompetent man caused by Nocardia brasiliensis. Diagnosis was made by cultivation and 16S rRNA sequencing. Using indirect immunofluorescence and Western blot, a strong antibody response to the N. brasiliensis isolate could be demonstrated. Serological tests might therefore be useful for the diagnosis and management of nocardial infections. Copyright (R) 2000 S.Karger AG, Basel     

Cutaneous nocardiosis. Case reports and review

Two cases of cutaneous nocardial infection are reported. The Nocardia species are gram-positive, partially acid-fast bacteria. Cutaneous involvement may develop as one of four types: (1) mycetoma, (2) lymphocutaneous (sporotrichoid) infection, (3) superficial skin infection, or (4) systemic disease with cutaneous involvement. A review of each of these types of infection is included, as well as potential clues that may suggest the diagnosis of nocardiosis.     

Disseminated Nocardia brasiliensis infection following cryptococcal disease

Nocardiosis is an increasing clinical problem, especially in immunocompromised patients. The offending species is almost always Nocardia asteroides. Cryptococcosis is also an increasing problem in the immunosuppressed. We describe a patient with probable disseminated cryptococcosis followed by disseminated Nocardia brasiliensis infection. Only eight patients with disseminated N brasiliensis infection have been described, to our knowledge, in the United States.     

Isolation of both Pseudozyma aphidis and Nocardia otitidiscaviarum from a mycetoma on the leg

We describe a case of mycetoma which typified the classic presentation of the disease: a male farmer with affection of the lower limbs and a history of trauma. The patient presented with a swollen right lower limb showing multiple discharging sinuses for 25 years. Histopathologically, grains were found by HE stain, and clustered yeast-like cells were observed by PAS stain. The distinctive 'dot-in-circle' sign was found through MRI. Besides Nocardia otitidiscaviarum, Pseudozyma aphidis was isolated from deep tissue culture, and the identification of the etiologic species was ascertained by DNA sequencing. Generally speaking, Nocardia otitidiscaviarum is an infrequent cause of mycetoma, and Pseudozyma species are usually isolated from plant material rather than clinical specimens. This is the first case of mycetoma from which both Nocardia otitidiscaviarum and Pseudozyma aphidis were isolated.     

少见致病性暗色真菌的相关研究

暗色真菌可以引起人类少见的真菌感染,包括着色芽生菌病、真菌性足菌肿和暗色丝孢霉病,逐渐受到人们的重视。随着分子鉴定技术的广泛应用,越来越多的少见暗色真菌引起感染的报告日渐增多。为更好地了解这些少见致病性暗色真菌,该文将从生态学、分类学、发病机制、诊断以及治疗等方面做一简要综述。     

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。