暗孢节菱孢菌引起面部感染1例及相关研究

A case of cutaneous mycosis caused by Arthrinium phaeospermum

目的报道暗孢节菱孢菌(Arthrinium phaeospermum)引起的面部皮肤感染1例并进行相关真菌学研究。方法患者女,29岁,两颊对称性浸润性红斑数年。皮损直接镜检、真菌培养,经形态观察、分生鉴定菌种、并进行体外药敏试验及利用豚鼠致病性实验重现组织病理特征。结果直接镜检未见明显菌丝,体外培养后为单一菌落,经棉兰染色、小培养、扫描电镜、分子生物学均鉴定为暗孢节菱孢菌(Arthrinium phaeospermum),均可见典型特征。体外药敏试验提示,该菌对卡泊芬净、米卡芬净、泊沙康唑、雷夫康唑、伏立康唑、特比萘芬敏感,对伊曲康唑、氟康唑耐药。豚鼠致病性实验中,对照组和免疫抑制组豚鼠皮下注射处大体可见脓肿,体表涂抹处大体表现红斑、丘疹、脱屑,免疫抑制组症状持续较久。皮下注射处较体表涂抹处有明显的组织病理学改变,可见多核巨细胞包裹菌丝或孢子,伴组织细胞、中性粒细胞、淋巴细胞浸润。结论该患者为罕见的暗孢节菱孢菌(Arthrinium phaeospermum)引起的皮肤真菌感染。免疫功能对该菌感染所致疾病的临床过程可能有影响。

Objective Report of a case of fungal infection caused by Arthriniurn phaeospermurn and the relevant mycologi- cal study.Methods A-29-woman had suffered symmertrical infiltrative erythema for several years. Direct microscopy, cul- ture,microculture,strain identification, drug susceptibility test in vitro, animal experiment were performed. Results While direct microscopy was negative, culture was positive and Arthrinium phaeosperrnum was identified.The typical characteristics of this isolate were observed with Medan staining, microculture and scanning electron microscopy.This isolate was resistant to itraconazole and fluconazole, but was susceptible to caspofungin, micafungin, posaconazole, ravuconazole, voriconazole and ter- binafine.Animal experiment shows the very Arthrinium phaeosperrnum was able to cause disease.Conclusion This was a rare dermatomycosis caused by Arthrinium phaeosperrnurn. Mycological examinations, drug susceptibility test in vitro, and animal experiment would have active guidance meaning and applied value for further cases.Abnormal immune status might be a risk factor for such cases.