石膏样小孢子菌致儿童脓癣20例鉴定与临床分析

Clinical analysis of 20 cases of child kerion caused by Microsporum gypseum

目的报道九江地区20例由石膏样小孢子菌所致的儿童脓癣病例,分析石膏样小孢子菌的鉴定要点以及其所致儿童脓癣的感染途径、临床表现和治疗方法。方法详细记录患儿临床资料,留取患儿病发、皮损行真菌直接镜检和真菌培养及鉴定。结果 20例儿童患者结合临床表现和真菌病原学检查确诊为脓癣,18例真菌直接镜检阳性,20例真菌培养阳性,菌种鉴定为石膏样小孢子菌;其中18例有宠物接触史而接触兔者达15例;口服伊曲康唑或特比萘芬同时合用小剂量糖皮质激素类药再铺以外用抗真菌剂治疗后20例患儿均痊愈,其中5例遗留永久性萎缩瘢痕。结论石膏样小孢子菌易引发儿童脓癣,儿童脓癣的主要感染途径为接触宠物,九江地区尤以接触家兔为主;石膏样小孢子菌的鉴定要点为其菌落特征和大分生孢子的形态特征;给脓癣患儿口服伊曲康唑或特比萘芬同时合用糖皮质激素类药再铺以外用抗真菌剂治疗后能达到痊愈。

Objective To study the main identification points of Microsporum gypseum and analyze its infective pathway,clinical manifestations and therapies of child kerion through analyzing of 20 kerion children caused by Microsporum gypseum.Methods The clinical data of children with kerion were noted meticulously,damaged hair and skin were collected for fungal microscopy examination,culture and identification.Results Twenty cases were definitely diagnosed by clinical manifestations and pathogenic examination.Among them,18 cases had positive direct microscopy results,20 cases had positive fungal culture results of Microsporum gypseumm.Further analysis showed that 18 cases had contacted with pets,15 cases had contacted with rabbits.All of them were cured by low-dose glucocorticosteroid,antimycotic drugs and oral itraconazole or terbinafine.All patients were recovery,but five of them remained permanent atrophic scar.Conclusions Microsporum gypseum is apt to cause child kerion.Contacting with pets is considered as the major infection route of child kerion,especially rabbits in Jiujiang.Colony characteristics and macroconidia morphology are the key points of Microsporum gypseum identification.Using these drugs mentioned above can cure the disease.