中华皮肤科杂志 ›› 2001, Vol. 34 ›› Issue (5): 329-332.

• 论著 •    下一篇

阿萨希丝孢酵母引起播散性毛孢子菌病国内首例报告

杨蓉娅1, 敖俊红1, 王文岭1, 李大伟1, 李若瑜2, 王端礼2   

  1. 1. 北京军区总医院皮肤科, 北京 100700;
    2. 北京大学第一医院皮肤科
  • 收稿日期:2001-01-18 出版日期:2001-10-15 发布日期:2001-10-15

Disseminated Trichosporonosis:The First Case Report in China

YANG Rongya1, AO Junhong1, WANG Wenling1   

  1. Department of Dermatology, General Hospital of Beijing Military Command of PLA, Beijing 100700, China
  • Received:2001-01-18 Online:2001-10-15 Published:2001-10-15

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摘要： 目的 报道国内首见阿萨希丝孢酵母(T. Asahii)所致播散性毛孢子菌病1例.方法 全面临床检查排除其他疾病;多部位皮损组织及肝穿组织活检,组织病理检查;皮损组织、口腔假膜、阴道及鼻腔分泌物、尿、粪、肝穿组织及皮损表面痂皮多次真菌培养、直接镜检证实为系统性真菌病;菌种与标准菌株对照进行培养、生化试验、菌种鉴定及DNA序列分析;临床系统抗真菌治疗观察.结果 发现皮肤、肝、肾、肠道、口腔、阴道粘膜等广泛受累,组织病理发现在感染性肉芽肿损害中有大量真菌孢子.真菌学培养均为同一菌落生长.菌落呈乳白色至淡黄色,表面褶皱,暗淡,边缘有菌丝长出.镜下见大小不一的矩形关节孢子及大量圆形或卵圆形孢子,出芽或不出芽,并见分支分隔菌丝.菌种经生化试验、糖发酵试验、同化硝酸盐试验、温度试验及碳源同化试验等最终鉴定为阿萨希丝孢酵母(No. AS2. 2174),DNA序列分析证实该菌与阿萨希丝孢酵母的模式菌株在核糖体D1/D2区域碱基序列完全相同.经脂质体两性霉素B联合氟康唑治疗5个月后病情显著好转,各种真菌学检查阴性.结论 阿萨希丝孢酵母所致播散性毛孢子菌病为国内首见;阿萨希丝孢酵母所致皮肤、粘膜、肝、脾、肾、肠道等系统损害,范围广、病程长,且基础病变不明,实为罕见.

关键词: 毛孢子菌属, 毛孢子菌病

Abstract: Objective To report the first case of disseminated trichosporonosis in China.Methods A series of clinical,histopathologic,and mycologic studies were carried out in a 20 year-old-female patient,who had no definite underlying disease.The causative fungus was identified according to culture,biochemical test and DNA sequencing.Results Abundant fungal spores,yeasts and hyphae were shown in the specimens taken from infectious granulomas.The fungal colonies in the culture of skin lesions or crusts,liver, oral psedomembrane,vagina,nasal cavity,urine,and stool were the same.The colonies exhibited creamy white to yellowish in color,rugose on the surface,and hyphae at the periphery.Under microscopy,there were a lot of rectangular arthrospores,round or oval spores with or without buddings,as well as branched and septate filaments.The isolated fungus was unanimously identified as Trichosporon asahii(No. AS 2.2174) through culture,biochemistry and molecular biology tests.The patient's condition was improved obviously after the combination treatment of amphotericin B liposome(Amphotec) and fluconazole.Conclusion The extensive and lasting systemic impairments caused by T. asahii have scarcely been reported at home and abroad.Combination therapy with amphotericin B and fluconazole is effective.

Key words: Trichosporon, Trichosporonosis