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Diagnosis and Treatment of Cutaneous Aspergillosis 皮肤曲霉菌病的诊断与治疗
Q4 Medicine Pub Date : 2021-12-31 DOI: 10.17966/jmi.2021.26.4.83
K. Park
Aspergillosis is an opportunistic mycosis caused by fungi in the genus Aspergillus, mostly A. fumigatus and A. flavus.Typical entry portals in primary cutaneous aspergillosis include burns, trauma sites, surgical wounds, intravenouscatheters, and macerated skin in underlying occlusive dressings. In individuals who are immunocompromised, thedissemination risk is significant. Skin findings range from firm papules and necrotic papulonodules to hemorrhagicbullae and ulcers. The prognosis is poor but improves when the patient is no longer neutropenic or whencorticosteroids are discontinued. Localized primary cutaneous aspergillosis can be excised surgically, followed byoral antifungal administration. For the first-line treatment of pulmonary invasive aspergillosis, isavuconazole andvoriconazole are the preferred agents, whereas liposomal amphotericin B is supported moderately.
曲霉病是由曲霉属真菌引起的机会性真菌病,主要是烟曲霉和黄曲霉。原发性皮肤曲霉病的典型入口包括烧伤、创伤部位、外科伤口、静脉导管和浸泡在封闭敷料下的皮肤。在免疫功能低下的个体中,传播风险是显著的。皮肤表现从硬丘疹和坏死丘疹结节到出血性小泡和溃疡。预后差,但当患者不再嗜中性粒细胞减少或停用皮质激素时,预后会改善。局部原发性皮肤曲霉病可手术切除,随后给予抗真菌药物。对于肺侵袭性曲霉病的一线治疗,依唑康唑和伏立康唑是首选药物,而脂质体两性霉素B则是适度支持的。
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引用次数: 0
The Findings of Reflectance Confocal Microscopy in theDiagnosis of Green Nail Syndrome 反射共聚焦显微镜在绿指甲综合征诊断中的应用
Q4 Medicine Pub Date : 2021-12-31 DOI: 10.17966/jmi.2021.26.4.100
S. Oh, Hye-Jin Ahn, Minkyung Shin
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引用次数: 0
Dermoscopic Patterns of Onychomycosis:A Cross-sectional Study in One Institution 甲真菌病的皮肤镜模式:一个机构的横断面研究
Q4 Medicine Pub Date : 2021-12-31 DOI: 10.17966/jmi.2021.26.4.87
Kyung Jae Lee, J. Kim
Background: Several dermoscopic findings that could be helpful in diagnosing onychomycosis have been reportedin many cases, but they have not been sufficiently utilized in clinical practice.Objective: To evaluate and identify the dermoscopic findings that may assist in the accurate diagnose ofonychomycosis.Methods: The study included 42 patients with clinical features suggestive of onychomycosis based on the clinicalhistory, physical examination, dermoscopic findings, and mycological investigation. Clinical photographs and naildermoscopy images were obtained, which were retrospectively reviewed and analyzed according to the onychomycosisclassification.Results: In total, 42 representative nails were reviewed. Common dermoscopic patterns such as yellow/browndiscoloration and subungual hyperkeratosis were found in our onychomycosis patients. Key findings observed inspecific subtypes were distolateral subungual onychomycosis with "jagged edges with spikes", proximal subungualonychomycosis or white superficial onychomycosis with irregularly bordered homogeneous leukonychia withpostinflammatory hyperpigmentation on the proximal nail fold, and fungal melanonychia with nail plate roughnessand nail fold hyperkeratosis.Conclusion: Our study, along with previous studies, demonstrated dermoscopy as a quick and effective tool fordiagnosing onychomycosis. In addition, periungual dermoscopic findings can be an important clue in onychomycosisdiagnosis, especially in cases of fungal melanonychia and leukonychia.
背景:在许多病例中,已经报道了几种有助于诊断甲真菌病的皮肤镜检查结果,但它们在临床实践中没有得到充分利用。目的:评价和鉴定皮肤镜检查结果,以帮助准确诊断真菌病。方法:根据临床病史、体格检查、皮肤镜检查和真菌学调查,纳入42例临床特征提示甲真菌病的患者。根据甲真菌病的分类,对临床照片和指甲镜图像进行回顾性分析。结果:共对42颗具有代表性的指甲进行了回顾性分析。在我们的甲真菌病患者中发现了常见的皮肤镜模式,如黄色/棕色变色和甲下角化过度。在特定亚型中观察到的主要发现是“锯齿状边缘带尖刺”的远端甲下甲真菌病、近端甲下甲癣或白色浅表甲真菌病,伴有不规则边界的均质白质甲真菌病和近端甲襞炎症后色素沉着过多,以及甲板粗糙和甲襞角化过度的真菌性黑色素甲真菌病。结论:我们的研究和以前的研究表明,皮肤镜检查是诊断甲真菌病的一种快速有效的工具。此外,蹄周皮肤镜检查结果可能是甲真菌病诊断的重要线索,尤其是在真菌性黑甲和白甲病例中。
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引用次数: 0
Balanoposthitis with Fungal and Bacterial Coinfection balanposthitis合并真菌和细菌感染
Q4 Medicine Pub Date : 2021-12-31 DOI: 10.17966/jmi.2021.26.4.95
Joon-ho Son, Y. Kim, Ji Hyun Lee
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引用次数: 0
Tinea Manus and Tinea unguium After Plaster Casting 石膏浇铸后的马癣和蹄癣
Q4 Medicine Pub Date : 2021-12-31 DOI: 10.17966/jmi.2021.26.4.98
Won Ji Song, J. Mun
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引用次数: 0
Cutaneous Manifestation of Disseminated CryptococcosisMimicking Herpes Zoster 播散性隐球菌性带状疱疹的皮肤表现
Q4 Medicine Pub Date : 2021-09-30 DOI: 10.17966/jmi.2021.26.3.77
Hoon Choi, Dong Hyun Shim, Min Sung Kim, B. Shin, C. Na
Cutaneous cryptococcosis is classified either as localized cutaneous cryptococcosis, in which the lesions are confined to one area of the skin, or as disseminated cryptococcosis, in which cutaneous manifestations are more widespread. We report a case of fatal disseminated cryptococcosis with characteristic cutaneous manifestations. An 84-year-old woman with diabetes presented with crusted plaques and ulcers that were painful, diffuse, and erythematous to crusted and on only the left side of her face, neck, and upper chest. She was referred to our hospital from a local clinic, where herpes zoster had been suspected. She had no specific systemic symptoms. Histological examination of the skin lesion revealed granulomatous reactions and purple to reddish encapsulated spores. Cryptococcus neoformans was identified in fungal culture, and hospitalization was recommended. Oral fluconazole was prescribed, and she was admitted to another hospital. After 2 weeks, the patient's condition deteriorated, and she was transferred to our hospital. C. neoformans antigen was detected in the blood and urine during the evaluation for systemic involvement. The patient was treated with intravenous amphotericin B and fluconazole; however, she died 10 days after admission. Cutaneous manifestations of disseminated cryptococcosis can appear in various forms and mimic molluscum contagiosum, Kaposi's sarcoma, and cellulitis. In this case, the skin lesions occurred on only the left side of the face, neck, and chest, as in herpes zoster. Cutaneous cryptococcosis can occur before the onset of symptoms of systemic involvement; therefore, diagnosis is important. Systemic evaluation may reveal early markers of disseminated cryptococcosis.
皮肤隐球菌病可分为局限性皮肤隐球菌症,病变局限于皮肤的一个区域,也可分为播散性隐球菌病,皮肤表现更为广泛。我们报告了一例具有特征性皮肤表现的致命播散性隐球菌病。一位患有糖尿病的84岁女性出现硬皮斑块和溃疡,疼痛、弥漫、红斑到硬皮,仅出现在面部、颈部和上胸部的左侧。她从当地一家诊所被转诊到我们医院,那里曾被怀疑患有带状疱疹。她没有特定的全身症状。皮肤损伤的组织学检查显示有肉芽肿反应和紫色至红色的孢子囊。在真菌培养中发现了新型隐球菌,建议住院治疗。医生给她开了口服氟康唑的处方,她住进了另一家医院。两周后,患者的病情恶化,她被转移到我们医院。C.在评估全身受累的过程中,在血液和尿液中检测到新生代抗原。患者接受静脉注射两性霉素B和氟康唑治疗;然而,她在入院10天后就去世了。播散性隐球菌病的皮肤表现可以以各种形式出现,类似于传染性软体动物、卡波西肉瘤和蜂窝组织炎。在这种情况下,皮肤病变仅发生在面部、颈部和胸部的左侧,如带状疱疹。皮肤隐球菌病可发生在全身受累症状出现之前;因此,诊断很重要。系统评估可能揭示播散性隐球菌病的早期标志物。
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引用次数: 0
Absence of Reported cases of Microsporum ferrugineum,Trichophyton violaceum, and Trichophyton schoenleiniiin South Korea 韩国未见铁小孢子虫、紫毛孢子虫和雪氏毛孢子虫的报告
Q4 Medicine Pub Date : 2021-09-30 DOI: 10.17966/jmi.2021.26.3.51
K. Park, W. Lee
Dermatophytosis is a skin disorder caused by dermatophytes. Dermatophytes isolated in South Korea include Trichophyton (T.) rubrum, T. mentagrophytes, T. verrucosum, T. tonsurans, T. violaceum, T. schoenleinii, Microsporum (M.) canis, M. ferrugineum, M. gypseum, and Epidermophyton floccosum. T. tonsurans was first found in South Korea in 1992. In contrast, there have been no recent reported cases of T. violaceum, T. schoenleinii, and M. ferrugineum in South Korea. Population mobility, changes in human lifestyles, development of the healthcare system, and the introduction of antifungals have brought about dermatophyte evolution in the skin microenvironment. We have reviewed the cases of dermatophytosis caused by M. ferrugineum, T. violaceum, and T. schoenleinii reported both in South Korea and globally.
皮肤癣是由皮肤癣菌引起的一种皮肤病。在韩国分离到的皮肤真菌包括:rubrum毛癣菌、mentagrophytes毛癣菌、疣状毛癣菌、tonsurans毛癣菌、violaceum毛癣菌、schoenleinii毛癣菌、canis小孢子菌、ferrugineum毛癣菌、gypseum毛癣菌和絮状表皮菌。T. tonsurans于1992年首次在韩国被发现。相比之下,韩国最近没有报告紫罗兰分枝杆菌、schoenleinii和ferrugineum分枝杆菌的病例。人口流动、人类生活方式的改变、卫生保健系统的发展以及抗真菌药物的引入都导致了皮肤微环境中皮肤真菌的进化。我们回顾了在韩国和全球报告的由ferrugineum, T. violaceum和T. schoenleinii引起的皮肤真菌病的病例。
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引用次数: 0
Increased Fungal Infections while using EmergingTherapies (Biologics and Small-molecule Inhibitors)for Treating Skin Diseases: A Review 使用紧急疗法(生物制品和小分子抑制剂)治疗皮肤病时真菌感染增加:综述
Q4 Medicine Pub Date : 2021-09-30 DOI: 10.17966/jmi.2021.26.3.57
J. Kim, Kyung Jae Lee
Biologics, such as tumor necrosis factor-α and interleukin inhibitors, are commonly used for treating immunological skin diseases, including psoriasis, psoriatic arthritis, and atopic dermatitis. The cluster of differentiation inhibitors and immune checkpoint inhibitors has also been used for treating bullous disorders and melanoma, respectively. Other small-molecule inhibitors, such as JAK inhibitors, have been introduced for treating atopic dermatitis and alopecia areata. Hence, given the importance of cytokines and small molecules in antifungal immunity, using these new treatments are proposed to increase the risk of fungal infections. Thus, this review presents an overview of the reported incidences and possible mechanisms of fungal infections related to the use of biologics, including small-molecule inhibitors used for dermatological treatments.
生物制品,如肿瘤坏死因子-α和白细胞介素抑制剂,通常用于治疗免疫性皮肤病,包括银屑病、银屑病关节炎和特应性皮炎。分化抑制剂和免疫检查点抑制剂的集群也已分别用于治疗大疱性疾病和黑色素瘤。其他小分子抑制剂,如JAK抑制剂,已被引入治疗特应性皮炎和斑秃。因此,鉴于细胞因子和小分子在抗真菌免疫中的重要性,建议使用这些新的治疗方法来增加真菌感染的风险。因此,这篇综述概述了与使用生物制剂(包括用于皮肤病治疗的小分子抑制剂)相关的真菌感染的发病率和可能机制。
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引用次数: 0
A Case of Cutaneous Purpureocillium lilacinumInfection Looking like Psoriasis 皮肤淡紫色紫毛菌感染1例,表现为银屑病
Q4 Medicine Pub Date : 2021-09-29 DOI: 10.17966/jmi.2021.26.3.72
N. Ha, K. Park, Y. Bang, J. Jun, J. Choi, W. Lee
Purpureocillium lilacinum is a saprophytic fungus with a ubiquitous environmental distribution, and it can be detected in soil samples and decaying materials worldwide. It has been reported as an emerging pathogen in both immunocompromised and immunocompetent patients, showing various cutaneous presentations. Herein, we report a case of a patient with a localized cutaneous P. lilacinum infection, which resembles the skin lesions of psoriasis. A 72-year-old female was presented with a peripherally spreading, well-demarcated, asymptomatic, scaly, erythematous patch on her forehead for several months. Histopathological examination showed pinkish septated fungal elements and mixed inflammatory and granulomatous infiltrates in the dermis. Furthermore, a fungal culture on potato dextrose agar showed gray, velvety colonies with light yellow background after being subcultured. Phialides with chains of oval conidia were observed on lactophenol cotton blue staining. The ITS region of rRNA gene sequence obtained from the colony was identical to that of Purpureocillium lilacinum. The lesion was resolved with oral itraconazole (200 mg/day) after four months of treatment.
紫丁香是一种环境分布普遍的腐生真菌,在世界各地的土壤样本和腐烂物质中都能检测到。据报道,它是免疫功能低下和免疫功能低下患者的一种新病原体,表现出各种皮肤表现。在此,我们报告了一例局部皮肤紫丁香感染的患者,其类似于银屑病的皮肤病变。一名72岁女性的前额出现了一个外周扩散、界限清晰、无症状、鳞状红斑斑块,持续了几个月。组织病理学检查显示真皮中有粉红色分隔的真菌成分和混合性炎症和肉芽肿浸润。此外,在马铃薯葡萄糖琼脂上的真菌培养物在传代培养后显示出浅黄色背景的灰色、天鹅绒般的菌落。乳酚棉蓝染色观察到具有椭圆形分生孢子链的假丝酵母。从菌落中获得的rRNA基因序列的ITS区与紫丁香的ITS区相同。治疗四个月后,口服伊曲康唑(200mg/天)使病变消退。
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引用次数: 1
Dermatomycosis from the Perspective of Dermatopathology(Version 1.1) 从皮肤病理学角度看皮肤霉菌病(1.1版)
Q4 Medicine Pub Date : 2021-09-01 DOI: 10.17966/jmi.2021.26.3.65
Taekwoon Kim Kim, Jeongsoo Lee, J. Park
Dermatomycosis is a skin disease caused by fungi, including dermatophytes and yeasts. Its diagnostic methods include KOH smear, fungal culture test, Wood's lamp test, biopsy, and molecular biology test. Superficial dermatomycosis can already be diagnosed using only KOH smear and culture test, so biopsy has not yet received attention from many clinicians. Nonetheless, biopsy is one of the most basic tests in the field of dermatology, with high diagnostic value for deep and superficial dermatomycoses, which often shows negative findings on KOH smear or fungal culture test. In this study, the histopathologic findings and special chemical staining methods in dermatomycosis are described. This review article is an upgraded English version of the review paper "Dermatomycosis from the perspective of dermatopathology (Korean Version 1.0)" published in 2016.
皮肤真菌病是一种由真菌引起的皮肤病,包括皮肤癣菌和酵母。其诊断方法包括KOH涂片、真菌培养试验、Wood's灯试验、活检和分子生物学试验。浅表性皮肤真菌病只需KOH涂片和培养试验就可以诊断出来,因此活检尚未得到许多临床医生的重视。尽管如此,活组织检查是皮肤科领域最基本的检查之一,对深部和浅部皮肤真菌病具有很高的诊断价值,这些疾病通常在KOH涂片或真菌培养测试中显示阴性结果。本文介绍了皮肤真菌病的组织病理学表现和特殊的化学染色方法。这篇综述文章是2016年发表的综述论文“从皮肤病理学的角度看皮肤真菌病(韩语1.0版)”的英文升级版。
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引用次数: 0
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Journal of Mycology and Infection
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