摘要
患者女,54岁,农民。左上肢近手腕部外伤后出现豌豆大小的单一红色结节15d,后肿大、破溃,并在30d内发展为多个成串状分布的结节。皮肤科检查:患者左上肢可见多个呈线性排列的紫红色结节,质硬;部分结节破溃,伴少许脓性分泌物。组织病理提示,感染灶呈混合炎性细胞浸润为主的化脓性肉芽肿炎症;过碘酸雪夫染色阴性,未见真菌孢子、菌丝及星状体。活检组织真菌培养阳性。根据培养物形态学分析和内部转录间隔区(ITS)及钙调蛋白(CAL)编码区靶位的分子生物学鉴定结果,确诊该病例为狭义申克孢子丝菌致淋巴管型孢子丝菌病。给予患者10%碘化钾溶液10ml/次每日3次口服;治疗2个月后,患者自觉症状明显改善,后失访。本例报道提示联合应用表型鉴定和“ITS/CAL”靶位的基因分析能够准确将孢子丝菌复合体鉴定到种水平。
A 54-year-old female farmer presented with a pea-sized red nodule on the left upper limb near the wrist for 15 days, which occurred after trauma, gradually became swollen and ruptured, and developed into multiple nodules arranged in a chain in 30 days. Skin examination revealed multiple hard purple-red nodules arranged in a line on her left upper limb, some of which were ruptured with a small amount of purulent exudate. Histopathological examination further revealed that the focus of infection manifested as pyogenic granuloma- like inflammation mainly infiltrated with mixed inflammatory ceils. Periodic acid Schiff (PAS) staining showed no fungal structures, including fungal spores, hyphae and asteroid body. The biopsy tissue culture yielded the fungus. According to the morphological analysis of the cultures and results of molecular identification based on internal transcribed spacer (ITS) and calmodulin (CAL) coding regions, this case was finally diagnosed as lymphocutaneous sporotrichosis caused by Sporothrix schenckii sensu stricto. The patient was treated with oral potassium iodide 10% solution in a dose of 10 ml thrice a day. After 2-month treatment, the patient felt that the lesions were obviously improved, but afterwards she was lost to follow-up. This research report suggests that phenotypic analysis combined with ITS/ CAL-based molecular identification can accurately identify Sporothrix schenckii complex at the species level.
作者
董碧麟
陈瑶
刘钟
张惠芳
童中胜
陈柳青
李东升
Dong Bilin Chen Yao Liu Zhong Zhang Huifang Tong Zhongsheng Chen Liuqing Li Dongsheng(Department of Dermatology, Wuhan No. 1 Hospital, Wuhan 430022, China)
出处
《中华皮肤科杂志》
CAS
CSCD
北大核心
2017年第3期204-207,共4页
Chinese Journal of Dermatology
基金
国家自然科学基金(81301376)
湖北省自然科学基金(2014CFB308)
关键词
孢子丝菌病
孢子丝菌属
表型
序列比对
狭义申克孢子丝菌
Sporotrichosis
Sporothrix
Phenotype
Sequence alignment
Sporothrix schenckii sensu stricto