交织帚枝孢霉致透明丝孢霉病国内首例

Hyalohyphomycosis caused by Sarocladium implicatum:first case report in China

目的 报道国内首例交织帚枝孢霉致透明丝孢霉病。方法 患者女,69岁,主因“左前臂结节9个月”就诊。取结节边缘组织进行病理学和真菌学检查。将组织接种于沙氏培养基、脑心培养基,并对培养物进行形态学及rDNA序列测定。结果 组织病理下可见组织细胞肉芽肿及透明真菌孢子和菌丝。组织真菌培养阳性,菌落生长中等速度,为浅灰色绒毛状菌落。镜下见无色分枝分隔菌丝,分生孢子梗侧生,分生孢子长圆形,薄壁,1~2个隔。经DNA序列分析,与Sarocladium implicatum相似性100%。诊断为透明丝孢霉病,予硝酸舍他康唑乳膏外用及10%碘化钾溶液口服治疗,3个月后患者治愈。结论 根据其形态学特点和DNA序列分析,菌株被鉴定为Sarocladium implicatum。该菌引起的透明丝孢霉病为国内首例报道,舍他康唑及碘化钾联合治疗本病效果显著。

Objective To report the first case of hyalohyphomycosis caused by Sarocladium implicatum （Acremonium implicatum） in China.Methyls A 69-year-old female patient came to us with an nodule on the left forearm for 9 months. Tissue was biopsied {or microbiological and histopathological studies.Pathology showed inflammation,necrosis and granula- tion with fungal element in tissue.A positive fungus was recovered that was later identified as Sarocladium implican （Acre- monium implicatum） according to morphology and DNA sequencing identification.Results This case was diagnosed as hya- lohyphomycosis according to the finding of uncolored fungal elements in histopathological examination,with the positive fun- gal culture of the tissue.The isolate grown on culture was demonstrated belong to S.implicatum by DNA sequence analysis. She was cured after 8 months treatment with oral kalium iodidum solution and topical sertaconazole nitrate cream.Conclusion This is the first case of hyalohyphomycosis caused by S.implicatum in China confirmed both by culture and by pathological methods.Morphological characteristics and sequence of the ITS region of ribosomal DNA confirmed the identification of the isolate.Combination of kalium iodidum and sertaconazole is effective.