中华皮肤科杂志 ›› 1998, Vol. 31 ›› Issue (5): 276-279.

• 论著 • 上一篇    下一篇

从一例甲真菌病患者病甲中分离出糠秕孢子菌临床和实验研究

冉玉平1, 周光平1, 李薇1, 彭雪梅2, 杜晓平1, 刘德操1   

  1. 1. 华西医科大学附属第一医院皮肤性病科, 成都610041;
    2. 华西医科大学附属第一医院法医系电镜室, 成都610041
  • 收稿日期:1997-08-25 修回日期:1997-12-02 出版日期:1998-10-15 发布日期:1998-10-15
  • 基金资助:
    中华医学会皮肤科学会科研基金

Isolation of Pityrosporum ovale from a Patient with Onychomycosis: Clinical and Laboratory Investigation

Ran Yuping1, Zhou Guangping1, Li Wei1   

  1. Department of Dermatovenereology, First University Hospital, West China University of Medical Sciences, Chengdu 610041
  • Received:1997-08-25 Revised:1997-12-02 Online:1998-10-15 Published:1998-10-15

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摘要： 从一例甲真菌病患者的病甲标本中分离出糠秕孢子菌,并进行了培养、组织病理、扫描电镜、溶甲等研究。患者为64岁女性,因指趾甲变色、增厚、粗糙20余年就诊。体检见各指、趾甲增厚变色,表面粗糙不平,指甲前端甲板与甲床分离。指甲培养结果发现在沙堡培养基有红色毛癣菌生长,在含菜子油培养基有卵形糠秕孢子菌生长。病理检查发现甲组织裂隙中有卵形出芽孢子,扫描电镜观察见大量有颈圈样结构的卵形出芽孢子镶嵌于甲组织中。20%KOH、56℃处理1小时的甲沉淀物涂片经Parker墨水染色后镜下可见与卵形糠秕孢子菌和红色毛癣菌形态一致的孢子和菌丝。患者接受伊曲康唑间歇冲击治疗,第四疗程结束后1～2月时甲颜色明显光亮,以后未见进一步好转。治疗结束后6个月时再剪病甲培养又有红色毛癣菌和卵形糠秕孢子菌生长。结论此为国内首次报道卵形糠秕孢子菌与甲真菌病有关。复习文献,对红色毛癣菌和卵形糠秕孢子菌在发病中的地位进行了讨论。

关键词: 甲真菌病, 卵形糠秕孢子菌, 红色毛癣菌, 显微镜,电子

Abstract: Objective To isolate and observe Pityrosporum yeasts from a patient with onychomycosis. Methods The involved nail specimens were investigated by means of culture, pathological and scanning electron microscopic examination and 20% KOH preparation. Results Physical examination showed that each finger and toe nail appeared brownish black, rough and thick, some of the fore part of the nail plate detached from the nail bed. Fingernail specimen's culture results showed that Trichophyton rubrum grew on Sabouraud's dextrose agar and Pityrosporum ovale grew on the medium containing rapeseed oil. The pathological examination revealed P.ovale yeast involvement in the fissure of the nail plate. Under the scanning electron microscopy, a lot of P.ovale yeasts with characteristic collarette structure inserted in the nail tissue was noticed. In the 20% KOH preparations of nail incubated at 56℃ for 1h and stained with Quink Parker ink, spores and hyphae were identified morphologically with P.ovale and T.rubrum respectively. The patient received intermittent pulse therapy with itraconazole, the color of the nails became much brighter 1 to 2 months after the fourth cycle of therapy, but no further improvement was observed afterwards. P.ovale and T.rubrum grew again 6 months after treatment when the clippings of the fingernail were cultured. Conclusion This is the first document of onychomycosis related with P.ovale in China.

Key words: Onychomycosis, Pityrosporum ovale, Trichophyton rubrum, Microscope, electron