新生隐球菌致头皮和颅骨损害1例报道

A case of scalp and skull cryptococcosis induce by Cryptococcus neoformans

目的隐球菌病是由新生隐球菌引起的人和动物的播散性感染,最常累及肺及中枢神经系统,文中报道1例新生隐球菌致头皮和颅骨损害。方法全面临床检查排除其他疾病,患者皮损进行组织病理学检查并对皮损处分泌物进行真菌培养和形态学鉴定,分离菌株进行rDNA内转录间隔区(internal transcribed spacer,ITS)测序鉴定,对分离菌株进行抗真菌药物体外药敏试验和致病性检查。结果患者头部CT示颅骨破坏,头皮肿胀。皮损病理示:肉芽肿性炎,并可见球形病原体,特殊染色示PAS(+)、PAM(+)、阿新兰染色阳性。分泌物墨染涂片显微镜下见圆形菌体,沙堡培养基25℃培养出乳白色菌落,表面光滑湿润。科玛嘉平皿划线培养菌落呈淡紫红色。根据真菌形态学特点和基因序列结果鉴定为新生隐球菌。体外药敏试验显示该菌对伏立康唑、伊曲康唑敏感。致病性研究显示对小鼠具有致病性且呈播散性。结论该病例为国内首报的由新生隐球菌所致的头皮和颅骨损害。

Objective Cryptococcosis is a disseminated infection in man and animals caused by Cryptococcus neoformans.The most commonly involved sites are the lungs and the central nervous system.Here we report a case of scalp and skull cryptococcosis caused by Cryptococcus neoformans in China.Methods We conducted a series of clinical examinations to exclude other diseases,isolated the tissue and secretion from the scalp lesion for fungal cultivation and morphological identification,performed rDNA ITS sequence analysis and determined the antifungal drug sensitivity and pathogenicity of the isolates.Results Right skull CT showed osteolytic lesion and swelling scalp.Histopathological examination revealed granulomatous inflammation and some round microorganisms.The presence of fungi was confirmed by special stains PAS（＋）,PAM（＋） and AB（＋）.Round pathogens were observed from ink stained smear of the secretion under the light microscope.All the colonies on the SDA plate were milky white,smooth and moist at 25 ℃,while those on the CHROM agar were light prunosus.The isolates were identified as Cryptococcus neoformans based on their biological characteristics and gene sequences,sensitive to Voriconazole and Itraconazole and virulent to the lung,liver and brain of mice.Conclusion This is the first case of scalp and skull cryptococcosis induced by Cryptococcus neoformans ever reported in China.