武汉市某三甲医院542例儿童头癣临床类型及病原菌分析

Clinical types and fungal pathogens of children′s tinea capitis:analysis of 542 cases in a tertiary first-class hospital of Wuhan

目的了解武汉地区2011—2020年儿童头癣临床类型及病原菌分布情况,对该病的预防和诊断治疗提供科学依据。方法收集2011—2020年武汉市第一医院皮肤科门诊及住院儿童头癣患者的实验室资料,共收集儿童头癣患者542例,其中男性239例,女性303例。对患儿患处皮损进行真菌镜检和培养鉴定,使用χ^(2)检验分析不同年龄段和临床类型儿童头癣致病菌谱的差异。结果儿童头癣患者以学龄前儿童(3~<7岁)为主,占总人数的48.52%(263/542)。构成比前3位的致病菌分别为紫色毛癣菌(49.26%,267/542)、犬小孢子菌(31.55%,171/542)及须癣毛癣菌(9.96%,54/542)。不同年龄段头癣患儿致病菌种不同,紫色毛癣菌在各年龄段均为主要致病菌,其次为犬小孢子菌,7岁以上患儿犬小孢子菌感染率较7岁以下患儿降低,婴幼儿红色毛癣菌感染率较其他年龄段高。不同临床类型致病菌比较分析中,黑点癣致病菌主要为紫色毛癣菌和断发毛癣菌,白癣致病菌主要为犬小孢子菌,脓癣致病菌主要为须癣毛癣菌、石膏样奈尼兹菌和红色毛癣菌,除铁锈色小孢子菌,其他菌种构成比在头癣临床类型间差异有统计学意义(P<0.05)。结论儿童头癣以学龄前儿童最为常见,黑点癣是主要临床类型,分析儿童头癣的高发年龄、致病菌和临床类型可增加对其流行病学特征的了解,有助于儿童头癣患者的早期诊断和针对性的规范化治疗。

Objective To investigate the clinical types of children's tinea capitis and the distribution of fungal pathogens in Wuhan from 2011 to 2020,and to provide scientific basis for the prevention,diagnosis and treatment of children's tinea capitis.Methods Laboratory data of children with tinea capitis in outpatient and inpatient department of dermatology in Wuhan No.1 Hospital from January 2011 to December 2020 were collected.A total of 542 cases of pediatric tinea capitis were included,with 239 male cases and 303 female cases.Microscopic examination of fungi and culture identification were performed on the affected skin lesions of the children.Chi-square test was used to analyze the differences in pathogen spectrum of children with different age groups and clinical type.Results Among the pediatric tinea capitis patients,the age group with the highest prevalence was preschool children(3 to<7 years old),accounting for 48.52%(263/542).The top three pathogenic fungi were Trichophytes violaceum(49.26%,267/542),Microsporum canis(31.55%,171/542)and Trichophyton mentagrophytes(9.96%,54/542).Trichophyton violaceum was the main pathogen in all ages,followed by Microsporum canis.The infection rate of Microsporum canis in children over 7 years old was lower than that in children under 7 years old,and the infection rate of Trichophyton rubrum in infants was higher than that in other ages.The distribution of Trichophytes violaceum,Trichophyton mentagrophytes,Nannizzia gypseum and Microsporum ferrugineum was uniform in all age groups.Trichophytes violaceum and Trichophyton tousurans mainly caused black-dot ringworm,Microsporum canis mainly caused tinea alba,Trichophyton mentagrophytes,Nannizzia gypseum and Trichophytonrubrum mainly caused kerion.Except for Microsporum ferrugineum,the composition ratios of other fungi species showed statistically significant differences among different clinical types of tinea capitis(P<0.05).Conclusions Preschool children are the most commonly affected age group by pediatric tinea capitis,and black-dot ringworm caused by Trichophytes violaceum is the main clinical type.Analysis of the high-riskage group,pathogenic fungi and clinical types of tinea capitis in children can enhance the understanding of its epidemiological characteristics,which is helpful for early diagnosis and targeted standardized treatment of pediatric tinea capitis.