[A case of onychomycosis caused by Aspergillus sydowii].
[A case of onychomycosis caused by Aspergillus sydowii].
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sydowii曲霉引起的甲真菌病1例[J].
DOI：
10.3314/mmj.53.205
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发表时间：
2012
影响因子：
1
通讯作者：
M. Hiruma
中科院分区：
文献类型：
--
作者：
Ayako Yamada;H. Noguchi;H. Sakae;T. Sugita;Midori Hiruma;M. Hiruma
由西多曲霉引起的甲肌病是一种罕见且难以诊断的疾病。我们报告一个用分子生物学方法诊断这种疾病的病例。患者为53岁女性，既往无明显病史。她于2010年6月到我们医院就诊，抱怨右第一脚趾甲周围瘙痒，尽管她已经注意到指甲浑浊4年了。指甲不透明增厚，占正常指甲面积的57.3%。直接镜检显示菌丝厚，有隔和黑色孢子。25℃时，在Sabouraud葡萄糖琼脂培养基上培养的菌落中心为红棕色，边缘为灰蓝绿色；在玻片培养中，分生孢子在分生孢子头部呈径向排列。因此，怀疑是由曲霉引起的甲真菌病。血液及生化检查均无异常。我们直接从指甲中提取脱氧核糖核酸，分析核糖体核糖核酸基因内部转录间隔区1和2区的碱基序列，鉴定出西多曲霉。由于伊曲康唑（ITCZ）的最低抑制浓度为0.25 μg/ml，我们采用脉冲治疗，每月1周周期口服ITCZ 400mg /天，连续3个月。不透明区域下降至17。治疗完成后6个月，指甲恢复正常的9%。但3个月后，不透明面积再次增加到22。3%，分离鉴定出相同的真菌。反复进行3个月的ITCZ脉冲治疗，症状消失，第二次治疗3个月完全治愈。
Onychomyosis caused by Aspergillus sydowii is rare and difficult to diagnose. We report a case in which this disease was diagnosed by molecular-biological methods. The patient was a 53-year-old woman without any notable past history. She visited our hospital complaining of itching around the right first toenail in June 2010, although she had noticed nail opacification for 4 years. Opaque thickening of the nail, covering 57.3% of the normal nail area, was observed. Direct microscopic examination revealed thick mycelia with septa and black spores. While colonies with a red brown center and a grayish blue-green margin were observed in culture on Sabouraud ' s glucose agar at 25℃, radially arranged conidia in the conidial head were observed in slide culture. Thus, onychomycosis caused by Aspergillus was suspected. There were no blood or biochemical test abnormalities. We directly extracted deoxyribonucleic acid from the nail and analyzed the base sequences of the internal transcribed spacer 1 and 2 regions of the ribosomal ribonucleic acid gene, and identified Aspergillus sydowii. Because the minimal inhibitory concentration of itraconazole (ITCZ) is 0.25 μg/ml, we administered pulse therapy with monthly 1-week cycles of oral ITCZ 400 mg / day for 3 consecutive months. The opaque area subsided to 17. 9% of the normal nail by 6 months after treatment completion. However, 3 months later, the opaque area increased again to 22. 3%, and the same fungus was isolated and identified. The 3-month ITCZ pulse therapy was repeated and the symptoms disappeared, with complete cure achieved by 3 months after the second therapy.