946例头癣病因及发病趋势分析

A survey of 946 cases of tinea capitis,with emphasis on possible trends in etiology and reemergence

目的了解我国华东地区近18年头癣趋势及病原菌分布情况。方法采用回顾性分析方法对1993年1月～2010年12月在我院皮肤科门诊诊治的华东地区的头癣患者进行分析。结果 946例头癣患者,男410例,女536例;年龄20d～93岁;784例真菌培养阳性患者中,白癣473例、黑癣216例、脓癣94例、黄癣1例。主要病原菌为羊毛状小孢子菌470株、紫色毛癣菌154株、断发毛癣菌81株。其中,培养出亲人性皮肤癣菌(紫色毛癣菌32例、断发毛癣菌12例、红色毛癣菌8例)的头癣患者与各种动物有密切接触史。本研究显示头癣发病率2001年达高峰之后逐渐下降,但于2010年又出现新的上升趋势。结论我国华东地区头癣患者中白癣发病率占首位,其主要致病菌为羊毛状小孢子菌。培养出亲人性皮肤癣菌的头癣患者与各种动物有密切接触,提示亲人性皮肤癣菌在人与动物之间有互相传染的现象。2010年新的上升趋势值得我们关注。

Objective To investigate the trend and distribution of the pathogens of tinea capitis in eastern China.Methods A total of 946 patients of tinea capitis diagnosed at the Mycology laboratory,Department of Dermatology of our Hospital,from January 1993 to December 2010 were retrospectively analysed.Results During an 18-year period,a total of 946 patients with tinea capitis were diagnosed,including 410 males and 536 female,from 20 days to 93 years old.Of the 784 culture-proven tinea capitis,there were 473 cases of gray patch type tinea capitis（60.3%）,216 cases of black dot type tinea capitis（27.6%）,94 cases of kerion（12.0%） and only one case of tinea favosa（0.1%）.The most common pathogenic fungi was Microsporum canis（470,59.9%）,followed by Trichophyton violaceum（154,19.6%） and Trichophyton tonsurans（81,10.3%）.Many of the patients with culture-proven Anthropophilic dermatophytes（Trichophyton violaceum in 32 cases,Trichophyton tonsurans in 12 cases and Trichophyton rubrum in 8 cases） had history of intimate contact with variable kinds of animals,mostly cats and dogs.The incidence of tinea capitis reached a peak in 2001 and declined thereafter,however,10 years later,another peak occurred in 2010.Conclusions The most common type of tinea capitis in eastern China is tinea blanca and the main pathogenic fungus is Microsporum canis.Many of the tinea capitis patients with culture-proven anthropophilic dermatophytes had history of intimate contact with variable kinds of animals.The latter observation may imply a reverse zoonosis phenomenon.The occurrence of a new peak of incidence suggests reemergence of the tinea capitis.