在日本工作的越南工人对特比萘芬敏感的吲哚癣菌株引起的体癣病例

Takashi Mochizuki, Kazushi Anzawa, Andrea Marie Bernales‐Mendoza, Akira Shimizu
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引用次数: 0

摘要

日本石川县一名 42 岁的越南蛋厂工人因躯干和左小腿出现同心圆红斑而感到瘙痒。经氢氧化钾直接检测,病变呈阳性,并分离出两种真菌菌株。分离出的菌株产生大量分生孢子,从形态上看与门冬癣菌(Trichophyton mentagrophytes/interdigitale)没有区别,但通过核糖体 DNA 内部转录间隔序列被鉴定为 indotineae 毛癣菌。外用卢立康唑(LLCZ)乳膏治疗 4 周后,皮损仍难治,但口服伊曲康唑(ITCZ)100 毫克/天,联合外用兰诺康唑(LCZ)乳膏治疗 4 周后,皮损有所缓解。停用口服伊曲康唑 6 周后,皮损复发,又培养出了一个分离株。首次就诊时培养出的分离株的抗霉菌药物最低抑菌浓度为:特比萘芬(TBF)0.03 μg/mL,ITCZ 0.015 μg/mL,LLCZ 0.0005 μg/mL,LCZ 0.002 μg/mL。在该分离株中,角鲨烯环氧化物酶的氨基酸序列(即 Leu 393 Ser/Phe 或 Phe 397 Leu)中没有检测到抗 TBF 的突变。尽管该分离物对抗霉剂很敏感,但其抗药性的原因尚不清楚。可能的因素包括抗霉菌药物使用不足、未完全清除病灶中大量产生的分生孢子、患者所处的环境以及患者与医生之间的语言障碍阻碍了沟通。
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Case of tinea corporis caused by a terbinafine‐sensitive Trichophyton indotineae strain in a Vietnamese worker in Japan
A 42‐year‐old Vietnamese egg factory worker in Ishikawa prefecture, Japan, presented with itchy concentric erythema on the trunk and left calf. The lesions tested positive by direct potassium hydroxide examination, and two fungal strains were isolated. The isolates produced conidia abundantly and were morphologically indistinguishable from Trichophyton mentagrophytes/interdigitale, but were identified as Trichophyton indotineae by internal transcribed spacer sequence of ribosomal DNA. The lesions were refractory to treatment with topical luliconazole (LLCZ) cream for 4 weeks but subsided with oral itraconazole (ITCZ) 100 mg/day for 4 weeks in combination with topical lanoconazole (LCZ) cream. The lesions recurred 6 weeks after discontinuation of oral ITCZ, and an additional isolate was cultured. The minimum inhibitory concentrations of antimycotics for the isolate cultured at the first visit were: terbinafine (TBF) 0.03 μg/mL, ITCZ 0.015 μg/mL, LLCZ 0.0005 μg/mL, and LCZ 0.002 μg/mL. No TBF‐resistant mutation in the amino acid sequence of squalene epoxidase, i.e., Leu 393 Ser/Phe or Phe 397 Leu, was detected in the isolate. The reason for recalcitrance in this case, despite the isolate's sensitivity to antimycotics, was unclear. Possible factors include insufficient use of the antimycotics, incomplete removal of abundantly produced conidia from the lesions, the patient's environment, and a language gap between the patient and physician hindering communication.
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