伏立康唑联合手术治愈小腿镰刀菌感染1例

目的探讨串珠镰刀菌致小腿溃疡患者临床及实验室特征。方法多次取患者溃疡分泌物作直接镜检和真菌培养,观察真菌形态学特征。取皮损组织病理活检。结果在马铃薯培养基中25℃培养均长出白色棉絮状菌落,显微镜及扫描电镜下见大分生孢子呈镰刀状,小分生孢子链生和假头状着生并存,在沙堡琼脂25℃和37℃均生长良好,经鉴定为串珠镰刀菌。组织病理学显示为慢性炎性肉芽肿改变,PAS及六胺银染色均未见真菌成分。伏立康唑联合特比萘芬治疗有效,整形外科清创植皮后治愈。结论确诊1例串珠镰刀菌引起的小腿溃疡,伏立康唑联合手术治疗皮肤镰刀菌感染疗效好。

Leg Fusarium infection cured by voriconazole combined with surgery:one case report

Objective To explore the clinical and laboratory features of leg ulcer caused by Fusarium moniliforme.Methods Characteristics of Fusarium moniliforme was observed by microscopy and fungal culture.Pathological examination was performed for diagnosis.Results White and cottony mould colony grew on PDA agar at 25℃ with sickle-like macroconidia,concatenate and capitulum-like microconidium under microscope and scanning electron microscope.The fungi was identified as F.moniliforme with the ability growing at 25℃ and 37℃ on Sabrous agar.Chroic granuloma was found,but no fungal components were observed by PAS or silver staining.The lesions were cured after voriconazole and terbinafine treatment combined with debridement and skingrafting.Conclusions A case of leg ulcer caused by Fusarium moniliforme was diagnosed and cured by combination therapy of voriconazole with surgery.