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目的报道1例暗孢节菱孢引起的皮肤真菌病。方法患者男,25岁,左臀部一片慢性肉芽肿样损害,呈疣状增生。表面多片溃疡、糜烂,轻压有脓性分泌物溢出,有腐臭味,触之略硬,且有轻度触痛。中心部位有明显淡灰褐色萎缩斑,边缘明显隆起,表面附有黑色痂皮。从患者皮损取材,进行涂片、培养及组织病理学检查,并经家兔致病性研究重现组织病理特征,同时作体外药敏试验。结果直接镜检、组织病理切片均未见真菌菌丝,但5次培养均为同一种菌生长,镜下见透明、线样的分生孢子梗从葫芦形的母细胞长出并产生侧生分生孢子,分生孢子呈眼晶体状,黑棕色,具有一中纬部的线状芽裂,为此菌的主要特征。在实验家兔的皮损刮屑中可见菌丝及类似厚壁孢子的肿胀细胞。体外药敏试验显示5种抗真菌药物的MIC值分别为:氟康唑>64μg/mL;伊曲康唑>64μg/mL;特比萘芬0.125μg/mL;酮康唑4.0μg/mL;咪康唑8.0μg/mL。结论根据在SDA培养基上的菌落形态和显微镜下特征性结构,该病例为暗孢节菱孢引起的皮下真菌感染。
Objective To report the skin fungal disease caused by a conidia spore conidia. Methods Male, 25 years old, with a chronic granulomatous lesion on the left hip, showed verrucous hyperplasia. Multi-surface ulcers, erosion, mild pressure purulent discharge overflow, rancid odor, slightly touches the touch, and mild tenderness. The central part of the obvious grayish brown shrinking spots, the edge was obviously uplift, the surface with a black crust. Derived from the patient’s skin lesions, smear, culture and histopathological examination, and histopathological features of reproductive pathology in rabbits to reproduce, and in vitro susceptibility testing. Results Direct microscopic examination and histopathological examination showed no mycelial growth. However, all the five cultures showed the same kind of bacteria growth. Microscopically, the mycoplasma was transparent, and the line-like conidiophores grew from the gourd-shaped mother cells and produced lateral growth Conidia, conidia ocular crystals, dark brown, with a mid-line of linear bud burst, the main characteristics of this bacteria. In the experiment rabbit skin scraping debris can be seen in mycelium and similar thick-walled spore swollen cells. In vitro susceptibility testing showed MIC values of the five antifungal agents were: fluconazole> 64 μg / mL; itraconazole> 64 μg / mL; terbinafine 0.125 μg / mL; ketoconazole 4.0 μg / mL; Miconazole 8.0 μg / mL. Conclusion Based on the colony morphology and microscopic structural features on SDA medium, this case is a subcutaneous fungal infection caused by Arthrobacter sp.