3例着色芽生菌病的临床分析及病原菌鉴定

目的对着色芽生菌病进行临床分析及病原菌鉴定。方法分析3例患者的临床特点。取患者皮损及分泌物行组织病理及真菌学检查。提取病原菌DNA,利用引物ITS4和ITS5进行rDNA ITS区序列的PCR扩增,扩增产物测序后在Genbank核酸数据库中进行同源性比对。按照CLSI制定的M38-A方案对菌株进行体外药敏实验。结果结合3例患者组织病理、真菌学特征及rDNA ITS区序列分析将病原菌鉴定为Fonsecaea monophora,其引起的着色芽生菌病病程迁延。体外药敏试验显示该菌对伊曲康唑、特比萘芬、伏立康唑、硝酸异康唑均敏感。临床上伊曲康唑和（或）特比萘芬治疗有效。结论 Fonsecaea monophora与裴氏着色霉相似,可通过分子生物学方法鉴别,其引起的着色芽生菌病需长期治疗。     

Activation of the human complement system by pigmented and hypopigmented mycelia of the fungus Fonsecaea pedrosoi

The action of the complement system on pigmented and hypopigmented mycelia of the fungus Fonsecaea pedrosoi, the major aetiological pathogen of the chromoblastomycosis is herein discussed. Fungi were grown in medium Czapeck-Dox at 37°C, for 14 days, without shaking to obtain pigmented mycelium. To obtain hypopigmented mycelium, the fungus was grown at the same conditions, but in the dark and with low oxygenation. Activation was measured by complement consumption and enzyme-linked immunosorbent assay. We also observed by immunofluorescence the deposition of C3, C4 fragments and C9 on the surface of the different forms studied. The results indicate that both forms were able to activate the complement system mainly by the alternative pathway. Pigmented mycelia had the highest consumption results, indicating that the pigment, melanin, may have influence in activation.     

裴氏着色真菌基因组DNA文库的构建

为了进一步研究裴氏着色真菌基因组ＤＮＡ组成，以便为快速、准确地鉴定和诊断该菌的感染提供依据，采用Ｓａｕ３ＡＩ部分酶切基因组ＤＮＡ，以ｐＵＣ１８为载体，首次成功地构建了裴氏着色真菌基因组ＤＮＡ文库。插入片段的长度在２．５～６．０ｋｂ，ＤＮＡ文库的完整性在８４％以上。结果提示本文库大小适度、完整性较高，在实验诊断、菌种鉴定和探针筛选等方面有应用潜力     

Retinoid combined with photodynamic therapy against hyperkeratotic chromoblastomycosis: A case report and literature review

Chromoblastomycosis (CBM) is a chronic granulomatous fungal infection caused by melanised or brown‐pigmented fungi. It can lead to chronic persistent infections and may cause incapacity for labour in some severe clinical forms. The optimal therapy for CBM is still uncertain. Here, we reported the case of a 66‐year‐old male who has had red plaque and recurrent keratinised protrusions on his right forearm for 20 years. He was treated orally with terbinafine, itraconazole and isotretinoin. He also received carbon dioxide(CO₂) laser to eradicate the keratinised protrusions and promote the penetration of photosensitiser. After the CO₂ laser, 5‐aminolevulinic acid‐based photodynamic therapy (ALA‐PDT) was adopted immediately to inhibiting the growth of fungi in subcutaneous tissue. The patient received an important improvement with a plaque and crust reduction after 4 months. For such recalcitrant case of chromoblastomycosis, the use of retinoid, CO₂ laser combined with ALA‐PDT may be a new adjuvant therapy. We further reviewed the cases of chromoblastomycosis treated with laser, photodynamic therapy or retinoic acid.     

A case of cerebral phaeohyphomycosis caused by Fonsecaea monophora,a neurotropic dematiaceous fungus,and a review of the literature

The Fonsecaea species, which are the leading causes of chromoblastomycosis, are not considered neurotropic fungal agents. Fonsecaea pedrosoi is the primary species in the genus and is usually isolated from chromoblastomycosis cases. However, the recently distinguished species F. monophora has been reported in a few cerebral phaeohyphomycosis cases. Here, a case of cerebral phaeohyphomycosis caused by Fonsecaea monophora is presented in a 71‐year‐old female subject with chronic diabetes mellitus and hypertension. The identification of F. monophora was made through mycological and molecular analysis, and an isolate was differentiated from the closely related F. pedrosoi by sequence data on key bases on the ribosomal internal transcribed spacer region. The case was successfully treated with surgical and medical approaches, and the patient has remained healthy and stable after a ten‐month follow up. Given the increasing incidence of this type of infection of the central nervous system (CNS), this case provides further support for the consideration that F. monophora might represent a neurotropic agent.     

不同pH值对几种常见暗色致病真菌生长的影响

目的观察不同pH值对几种暗色致病真菌生长的影响。方法将裴氏着色真菌、紧密着色真菌、疣状瓶霉、卡氏支孢霉、皮炎外瓶霉、甄氏外瓶霉、假阿利什菌、链格孢和申克氏孢子丝菌接种在pH值为1～14的沙氏培养基上,观察其生长情况。结果几种着色真菌在pH值为5、6、7的沙氏培养基上均生长良好;疣状瓶霉、皮炎外瓶霉适宜生长的pH值范围较广,在pH值为4～12的培养基上均生长良好;在pH值为1、2、14的培养基上以上6种真菌均不生长。假阿利什菌在pH4～14的培养基上可生长,链格孢、申克氏孢子丝菌在pH3～14的培养基上可生长。结论 pH值对几种着色真菌、外瓶霉、假阿利什菌、链格孢和申克氏孢子丝菌的生长均有不同程度的影响。皮炎外瓶霉、疣状瓶霉较裴氏着色真菌、卡氏支孢霉适宜生长的pH值范围广。     

Human leukocyte antigen class I and MICA haplotypes in a multicase family with Cladophialophora carrionii chromoblastomycosis

Previous studies carried out in an endemic semiarid region northwest of Venezuela at Falcon State have shown a prevalence of 15.4/1000 of chromoblastomycosis following traumatisms with xenophile vegetation infected with Cladophialophora carrionii. We performed high-resolution DNA typing of human leukocyte antigen (HLA)-A, -B and -C and major histocompatibility complex class I chain related gene A (MICA) alleles and segregation analysis in 49 members of one extended family with 12 affected individuals, who have lived for approximately 70 years in this endemic zone. None of the alleles, haplotypes or genotypes is shared by all the patients. No deviation from the expected HLA haplotype distribution or association of chromoblastomycosis with HLA-A, -B and -C haplotypes was observed. Further, a haplotype-sharing transmission/disequilibria testing of 11 nuclear families did not give enough evidence to claim linkage (P = 0.398), suggesting that genes located in the short arm of chromosome 6 may not be relevant in the immune response toward infection with C. carrionii in this Venezuelan endemic zone. Deleted MICA alleles on HLA-B*4802 haplotypes were present among several members of the extended family, but only two of them were affected.     

Chromoblastomycosis Caused by Fonsecaea pedrosoi

We report herein a case of chromoblastomycosis caused by Fonsecaea (F.) pedrosoi in a 39-year-old male, who showed multiple, asymptomatic, scaly erythematous plaques on the left shin for 12 months. Histopathologically, chronic granulomatous inflammation and either sclerotic or muriform cells were observed. The fungal culture produced typical black colonies of F. pedrosoi. The DNA sequence of the internal transcribed spacer (ITS) region of the clinical sample was 100% match to that of F. pedrosoi IFM 47061 (GenBank accession number {"type":"entrez-nucleotide","attrs":{"text":"AB240943","term_id":"81295273","term_text":"AB240943"}}AB240943). The patient was treated with 200 mg of itraconazole daily, for 3 months. Skin lesions were improved. In Korea, only 9 cases of chromoblastomycosis, including this case, have been reported until now. The etiologic agent was F. pedrosoi in the majority of cases (6/9;67%). The incidence of chromoblastomycosis was slightly higher in female, and the upper limbs were more affected than the lower limbs in patients.     

Successful treatment for chromoblastomycosis caused by Fonsecaea monophora: a report of three cases in Guangdong, China

Fonsecaea pedrosoi is the most prevalent aetiological agent of chromoblastomycosis. Fonsecaea monophora is a new species segregated from Fonsecaea pedrosoi . Herein, we report on three cases of chromoblastomycosis caused by F. monophora that were successfully treated with terbinafine and/or itraconazole. Clinical characteristics and mycological parameters are described. Two of the three patients underwent combination therapy with itraconazole and terbinafine during early stages of treatment and were completely healed in a relatively short course of treatment.