Expert consensus on the diagnosis and treatment of cryptococcal meningitis / 中华内科杂志

Cryptococcal meningitis is a common and refractory central nervous system infection,with high rates of mortality and disability.The experts of the Society of Infectious Diseases of Chinese Medical Association have reached this consensus after a thorough discussion.Based on the current situation of cryptococcal meningitis in China,the management of cryptococcal meningitis includes 6 aspects:introduction,microorganism identification,clinical manifestations and diagnosis,principles of antifungal therapy,treatment of refractory and recurrent meningitis,treatment of intracranial hypertension.There is not a separate consensus on human immunodeficiency virus (HIV) infection in patients with cryptococcal meningitis.This article focuses on different antifungal regimens and reducing intracranial pressure by reference to Infectious Disease Society of America (IDSA) guidelines.The importance of early diagnosis,combined long-term antifungal therapy,control of intracranial hypertension are emphasized.

Detection of Prototheca zopfii infection in mouse skin tissue sections by using fluorescence in situ hybridization / 中华皮肤科杂志

Objective To evaluate the feasibility to detect Prototheca in a mouse model of Prototheca zopfii cutaneous infection by using fluorescence in situ hybridization (FISH).Methods The model of Prototheca zopfii cutaneous infection was established by abdominal subcutaneous inoculation of Prototheca zopfii suspensions into 20 male BALB/c mice.Seven days after the inoculation,the mice were sacrificed,and tissue specimens were obtained from abdominal skin and subjected to microscopic examination,fungal culture and paraffin embedding.A PZ-probe was artificially synthesized and used to detect Prototheca in paraffin-embedded sections by using FISH.Moreover,both periodic acid-Schiff (PAS) and hematoxylin-eosin (HE) staining were performed to examine the paraffin-embedded sections.Skin specimens obtained from normal mice and Candida albicans-or Cryptococcus neoformans-infected mice served as the negative control.Results Clinical presentations,pathological examination and fungal culture results all confirmed the successful establishment of Prototheca zopfii skin infection model in mice.Prototheca was identified by FISH with the PZ-probe in the paraffin-embedded skin tissue sections from the murine model of Prototheca zopfii cutaneous infection,but not detected in the negative control tissue specimens,which was consistent with the results of PAS and HE staining.Conclusion FISH can be used to detect Prototheca in paraffin-embedded skin sections from the mouse model of Prototheca zopfii cutaneous infection.

Establishment of a mouse model of cutaneous protothecosis / 中华皮肤科杂志

Objective To develop a mouse model of cutaneous protothecosis.Methods Totally,48 BALB/c mice were randomly and equally divided into four groups:high-and low-concentration immunosuppressive groups-immunosuppressed mice inoculated with P.zopfii var.portoricensis suspension of 1 × 109 and 1 × 106 colony forming units (CFU) conidia/ml respectively,high-concentration healthy group-healthy mice inoculated with P.zopfii var.portoricensis suspension of 1 × 109 CFU conidia/ml,and control group-healthy mice inoculatedwith sodium chloride physiological solution.The P.zopfii suspension or sodium chloride physiological solution was subcutaneously inoculated to the abdominal skin of mice,with the inoculation volume being 200 μl.Skin appearance at the inoculation site was observed,and four mice were sacrificed in each group on day 7,14 and 28 after the inoculation.Skin specimens were resected from the inoculation sites of mice and subjected to pathological and mycological examinations.Results Mice in the three experiment groups inoculated with the P.zopfi suspension were all infected,with the appearance of papules and abscess at the inoculation sites of all mice as well as ulcer and crusts in some mice.Meanwhile,no mice were infected in the control group.Significant differences were noted in the diameter of skin lesions between the three time points in these experiment groups (all P ＜ 0.05),and the largest diameter of lesions was observed on day 7,which was (6.75 ± 1.09) mm in the high-concentration immunosuppressive group,(5.88 ± 1.17) mm in the low-concentration immunosuppressive group,and (5.96 ± 0.99) mm in the high-concentration healthy group.Comparisons of lesion diameter between the three experiment groups revealed a statistical difference on day 28 (F =8.91,P ＜ 0.05),with the largest lesion diameter observed in the high-concentration immunosuppressive group (4.38 ± 0.86 mm),but no statistical difference was found on day 7 or 14 (both P ＞ 0.05).Pathology of skin specimens consistently revealed necrosis,abscess and granuloma formation in the three experiment groups.Spores were found in the lesions of infected mice by haematoxylin-eosin staining,periodic acid-Schiff staining,and direct microscopy.Culture of tissue samples from the experiment groups grew Prototheca.Conclusion The mouse model of protothecosis can be established by subcutaneous inoculation of Prototheca suspension in the abdominal skin of healthy or immunosuppressed mice.

Clinical feature and antifungal susceptibility analysis of 111 cases of invasive fungal disease / 中国感染与化疗杂志

Objective To describe the clinical features of invasive fungal disease in Huashan Hospital,Fudan University from January 2004 to December 2006.Methods The medical data were reviewed retrospectively for the patients with fungal infection, which was confirmed by positive fungal culture or microscopic examination with blood,sterile body fluid,deep tissue,sputum specimen or isolation of Aspergillus spp.and Cryptococcus spp.from bronchoalveolar lavage.The proven and probable cases of invasive fungal disease were included in this analysis.Results A total of 111 patients were diagnosed as invasive fungal dis-ease,including 104 proven cases and 7 probable cases.Sixty-one cases were community-acquired and the other 50 were nosoco-mial.The most common site of infection was bloodstream (51,45.9%),followed by central nervous system (44,39.6%)and respiratory system (14,12.6%).The most common pathogens were Candida spp.(50,45%),Cryptococcus (47,42.3%) and Aspergillus spp. (12, 10.8%). The community-acquired fungal infections were mostly found in central nervous system (44,72.1%),and respiratory system (12, 19.7%),mainly caused by Cryptococcus and Aspergillus. The nosocomial fungal infections occurred primarily in blood-stream (96.0%),mainly due to Candida spp.No underlying disease or risk factor was identified in more than half of the pa-tients with community-acquired infection,while almost all the patients with nosocomial fungal infection had underlying disease and predisposing factors.Indwelling venous catheter was closely associated with nosocomial bloodstream infection.Indwelling venous catheter lasted for more than 1 week in 64.7% of the patients with Candida bloodstream infection.The same fungal strain was isolated from both the cather and blood of the same patient in 11 cases.The overall mortality of these invasive fungal diseases was 14.4% (16/111).The mortality rate was 18.0% (9/50)in the patients with nosocomial invasive fungal infection, and 11.5% (7/61)in the patients with community-acquired invasive fungal infection.Conclusions The most common site of in-vasive fungal infection is bloodstream,followed by central nervous system,and respiratory system.Majority of the fungal patho-gens are Candida spp.,Cryptococcus and Aspergillus spp.The community-acquired invasive fungal disease is primarily meningitis caused by Cryptococcus.The nosocomial invasive fungal disease is mainly bloodstream infection caused by Candida spp.

Random amplified polymorphic DNA combined with microfluidic chips in the identification of Malassezia species / 中华皮肤科杂志

Objective To evaluate the performance of microfluidic chips in the identification and genotyping of Malassezia species.Methods This study included 6 reference Malassezia strains and clinical Malassezia isolates from the scrapings of patients with pityriasis versicolor and follicular contents of patients with Malassezia folliculitis.These isolates were identified by DNA sequencing,random amplified polymorphic DNA (RAPD)-PCR and microfluidic chips.Cluster analysis was carried out and tree diagrams were generated.Results A total of 83 Malassezia isolates were obtained from 72 patients with pityriasis versicolor and 11 patients with Malassezia folliculitis.Genomic DNA of most strains was successfully amplified by PCR with two primers S22 and S24,and PCR with S22 primer produced more stable and clear amplification bands than that with S24.Positive bands of different sizes were repetitively obtained by using microfluidic chips,with interspecies and intraspecies polymorphisms observed in all the strains.On the basis of DNA sequencing,microfluidic chips and RAPD-PCR could be used to successfully distinguish the following eight species,i.e.,M.furfur,M.sympodialis,M.globosa,M.pacbydermatis,M.slooffiae,M.Japonica,M.yamatoensis and M.dermatis.Conclusions As a rapid,high-throughput and high-sensitivity method,microfluidic chips combined with RAPD-PCR shows an advantage for analyzing interspecies genetic diversity,genetic relationship of Malassezia species,as well as for identifying new Malassezia species.

Comparison of 1-week terbinafime hydrochloride cream, 1- and 4-week miconazole nitrate cream in the treatment of interdigital tinea pedis: a multi-center, randomized and double-blind study / 中华皮肤科杂志

ObjectiveTo compare the efficacy and tolerability of 1-week 1％ terbinafine hydrochloride cream, 1- and 4-week 2％ miconazole nitrate cream in the treatment of interdigital tinea pedis, and to observe the relapse in patients treated with these regimens. MethodsA multi-center, randomized, double-blind and parallel group study was conducted. By using a stratified randomization protocol, patients were divided into 3 groups to apply terbinafine cream twice daily for 1 week and inert cream(placebo) for the next 3 weeks (1week terbinafine group), miconazole cream twice daily for 1 week and inert cream(placebo) for the next 3 weeks (1-week miconazole group), and miconazole cream twice daily for 4 weeks (4-week miconazole group),respectively. Clinical and mycological assessment was made on week 1, 3, 4, 6, 9 and 12 after the initiation of treatment. ResultsA total of 152 patients with positive baseline mycological culture were eligible for the efficacy analysis. After 4-week treatment, the mycological cure rates were 94.7％, 87.8％ and 82.6％, global effective rates 89.5％, 81.6％ and 63.0％, respectively for the 1-week terbinafine group, 4-week miconazole group and 1-week miconazole group. On week 12, the mycological relapse rates in 1-week terbinafine, 4-week miconazole and 1-week miconazole group were 13％, 14％ and 21％ respectively, and the incidence of adverse reaction was 2.38％, 2.38％ and 3.57％, respectively. ConclusionsAs far as the efficacy and recurrence in patients are concerned, the 1-week terbinafine cream regimen is similar to the 4-week miconazole cream regimen for the treatment of interdigital tinea pedis.

Association of mannose binding lectin genetic polymorphisms with cryptococcosis / 中华传染病杂志

Objective To describe the distribution of mannose binding lectin (MBL) genetic polymorphisms in non-acquired immunodeficiency syndrome (AIDS) patients with cryptococcosis in China and to verify the association of MBL polymorphisms with susceptibility to cryptococcosis.Methods The case-controlled genetic association study was conducted and 167 non-AIDS patients with cryptococcosis and 208 healthy controls were recruited. Genome DNA was extracted from the peripheral blood and MBL gene was amplified by polymerase chain reaction (PCR). Six singlenucleotide polymorphisms ( SNP) of MBL gene were sequenced. The association of MBL polymorphisms with susceptibility to cryptococcosis were analyzed. The comparison between patients and controls was performed by chi square test or Fisher's exact test. The differences of MBL plasma concentrations between groups with different MBL genotypes were compared by single factor variance analysis. Results There were no differences between patients and controls in terms of MBL genotype frequencies, haplotypes and genotypes (all P>0. 05). Compared with healthy control, the deficient MBL-producing genotypes were strongly associated with cryptococcal meningitis (16. 5% vs 8. 7%,χ2=4.25, P=0.0392, OR = 2.09), particularly in patients without underlying immunocompromised conditions (21. 4% vs 8. 7%, χ2 =7. 15, P = 0. 0075, OR = 2. 88). Individuals with MBL deficiency genotypes showed significantly higher rates of central nervous system (CNS) cryptococcal infection rather than non-CNS cryptococcosis (16. 5% vs 3. 1%, Fisher's exact test, P = 0. 010, OR = 6. 13).The difference was even more significant in the immunocompetent patients (21. 4% vs 4. 0%, P =0.009, OR= 6. 55). Conclusion MBL deficiency is associated with cryptococcal meningitis and may play a role in CNS Cryptococcus infection.

Analysis on the characteristics of 35 patients with uncommon central nervous system fungal infections / 中华传染病杂志

Objective To analyze the clinical features of patients with uncommon fungal infections in central nervous system (CNS).Methods Thirty-five patients with uncommon CNS fungal infections who were admitted to Huashan Hospital from 1997 to 2010 were retrospectively reviewed.The pathogens,symptoms and signs.treatments of patients were evaluated.The data were analyzed by rank sum test and Fisher'S exact test.Results Twenty-nine of the 35 patients met the definition criteria of prover CNS fungal infections,while the other 6 had probable diagnosis.Predisposing factors were found in 86% of all patients.The most common pathogens were Aspergillus and Candida species.The symptoms and signs commonly occurred including fever(22 cases),headache(19 cases), cranial neuropathy(12 cases),and meningeal irritation sign(12 cases).High white blood cell count,high protein level,and low glucose level were the main findings of cerebrospinal fluid (CSF) analysis.Patients with cerebral aspergillosis were more frequently accompanied with immunocompromised conditions, and they often got CNS aspergillosis from hematogenous dissemination or direct extension of paranasal sinus infection.Cerebral granuloma and abscess were the common clinical characteristics of CNS aspergillosis.Cerebral candidiasis often arose from neurosurgical surgery or traumatic brain injury,and these patients were usually presented with meningitis.All patients were treated with antifungal drugs and (or) surgical intervention and 77%(27/35) of the patients achieved complete or partial responses. Antifungal agents combined with surgical resection might improve outcome of patients with CNS aspergillosis; while removal or replacement of drainage tubes in combination with antifungal treatment showed satisfactory efficacy in patients with cerebral candidiasis who usually had shunt manipulation. Conclusions The incidence of CNS fungal infection, such as cerebral aspergillosis and candidiasis, is increasing. Early diagnose and therapeutic intervention are crucial for improving outcome.

The polymorphism of cytochrome P_(450)2C19 gene in pafients with invasive fungal infections / 中华内科杂志

Objective To investigate the polymorphism profile of cytochrome P_(450)2C19 (CYP2C19) in Chinese patients with invasive fungal infections. Methods Two major single nucleotide polymorphism loci of the CYP2C19 gene (CYP2C19 * 2 and CYP2C19 * 3) were genotyped with PCR and restriction fragment length polymorphism (PCR-RFLP) in 134 patients with invasive fungal infections and 134 healthy volunteers. Allele frequencies and the proportions of metabolizer phenotypes were compared. Results In patients with invasive fungal infections, CYP2C19 * 1, CYP2C19 * 2 and CYP2C19 * 3 alleles showed frequencies of 58.2%, 36.6% and 5.2%. In healthy volunteers, the frequencies of CYP2C19 * 1, CYP2C19 * 2 and CYP2C19 * 3 were 63.4% , 34. 3% and 2. 2%. There was no significant difference in allele frequencies between the two groups. Of the patients with invasive fungal infections, 33. 6% were homozygous extensive metabolizers, 50.0% heterozygous extensive metabolizers and 16.4% poor metabolizers. Of the healthy volunteers, 40.3% were homozygous extensive metabolizers, 48.5% heterozygous extensive metabolizers and 11. 2% poor metabolizers. The proportions of metabolizer phenotypes were similar between the two groups. Conclusions Significant CYP2C19 polymorphism was detected in both groups. Approximately two thirds of the Chinese patients were either heterozygous extensive metabolizers or poor metabolizers. The genetic polymorphism may have important effect on drug metabolism in these patients

Clinical features and antifungal therapeutic effects of 154 patients with cryptococcal meningitis / 中华传染病杂志

Objective To study the clinical features and antifungal therapeutic effects in nonacquired immune deficiency syndrome(AIDS)patients with cryptococcal meningitis. Methods One hundred and fifty-four non-AIDS patients with cryptococcal meningitis admitted to Huashan Hospital, Fudan University from 1997 to 2007 were reviewed retrospectively. Clinical characteristics, initial antifungal therapies and outcome of these patients were analyzed. Continuous variables were analyzed using t test and categorical variables were compared by X~2 test or Fisher's exact test. Kaplan-Meier survival curves of different therapies were compared with log-rank test. Results Fifty-one patients (33.12%)had one or more predisposing factors. Headache, fever, meningeal irritation, vomiting and altered mental status were common clinical symptoms and signs during the course of diseases. The positive rates of cerebrospinal fluid(CSF)smear, CSF culture and detection of CSF cryptococcal capsular polysaccharide antigen were 88.44%,78.95%and 100.00%,respectively.Twelve cases were excluded because treatment durations were less than 7 days, including 9 died,2 discharged against medical advice due to illness exacerbation and 1 lost after against medical advice discharge. The remaining 142 patients were evaluated for therapeutic effects. The effective rates in amphotericin B (AmB)group, fluconazole group and AmB plus fluconazole group were 78.3%(36/46),33.3%(8/24)and 76.0%(38/50),respectively. The therapeutic effects in AmB group and AmB plus fluconazole group were superior to fluconazole group(X~2=13.6354,12.5509;P＜0.01).Eleven patients were lost during 1-year follow-up. The attributable and overall mortality in the remaining 143 patients were 19.58% and 28.67%,respectively.The 1-year survival rates in AmB group and AmB plus fluconazole group were significantly higher than that in fluconazole group. Conclusions The mortality of non-AIDS cryptococcal meningitis is still high,which is closely correlated with initial antifungal therapies. AmB alone or combined with flucytosine is related to both higher successful response and higher survival rate, while the efficacy of initial fluconazole alone or combined with flucytosine is poor.

Establishment of identification database of six common dermatophytes using Biolog automatic analyzer for microbes / 中华皮肤科杂志

Objective To investigate the application prospect of Biolog automatic analyzer for microbes in the identification of common dermatophytes. Methods Clinical isolates of dermatophyte were identified to species level based on phenotypes and DNA sequence. The strains of Trichophyton rubrum, Trichophyton mentagrophyte, Trichophyton tonsurans, Microsporum canis, Microsporum gypseum and Epidermophyton floccosum were inoculated into FF microplates, and the utilization of 95 different carbon sources were recorded.The growth and reaction spectrum of these strains were described and identification database was set up. Results There was a great difference in the utilization of carbon sources among different fungal species. The utilization of raffinose could differentiate Trichophyton mentagrophyte and Trichophyton tonsurans from the other four Trichophyton. Sebacic acid could differentiate Trichophyton mentagrophyte from Trichophyton tonsurans.Meanwhile, Trichophyton rubrum could be differentiated from Microsporum gypseum, Epidermophyton floccosum and Microsporum canis by utilization of fumarate and succinate. Microsporum gypseum could be identified by use of alanine and phenylalanine. The utilization of dextrin could distinguish Epidermophyton floccosum from Microsporum canis. Conclusion The Biolog automatic analyzer for microbes has the ability to identify common dermatophytes to species level based on their specific phenotype.

Subcutaneous Phaeohyphomycosis Caused by Curvularia clavata: The First Case Report in China / 中华皮肤科杂志

Objective To report a case of subcutaneous phaeohyphomycosis caused by Curvularia clavata in China. Methods The skin specimen was collected, and examined by KOH preparation, fungus culture and histopathology. Results A 17-year-old male farmer had dull red, warty and well-defined plaques with some ulceration on his face and his left upper arm for nine years and a history of trauma of his face before the appearance of the lesions. General examination did not reveal abnormal findings except the skin lesions. KOH direct examination showed septate hyphae with irregular branches. On the culture medium the colonies were black in color. Under microscope the conidia were borne singly or in groups at the tip or at the sides of the conidiophores, they were light brown to brown, smooth, straight or slightly curved and clavate, measuring 15 ~ 30 ?m long and 6 ~ 12 ?m thick, with 3 ~ 4 septates. Histopathology showed a granulomatous response. PAS staining showed irregularly swollen or toruloid conidia with branched hyphae. The isolated strain was identified as Curvularia clavata Jain. Conclusion It is the first case report of subcutaneous phaeohyphomycosis caused by Curvularia clavata in China.

In Vitro Efficacy of Ravuconazole and Fluconazole Against Clinical and Environmental Isolates of Cryptococcus neoformans / 中华皮肤科杂志

0.05). Conclusion It is encouraging that ravuconazole is effective against clinical and environmental isolates of C. neoformans, whether the isolates were sensitive to fluconazole or not.

Granulomatous Skin Lesion Due to Hot-resistant Trichophyton rubrum and Its Variation in Molecular Biology / 中华皮肤科杂志

Objective To investigate the mycologic features and variation in gene sequence of a hot-resistant Trichophyton rubrum which caused granulomatous skin lesion.Methods The isolate was identified by routine and polymerase chain reaction(PCR)technique.Ribosomal conserved sequence and trs-1(tandem repetitive subelement)sequence in the ribosomal non-transcribed spacer(NTS)were determined.Results The hot-resistant isolate was identified as T.rubrum by routine and PCR technique.The trs-1sequence variation in rDNA NTS was found in the strain.Conclusion The trs-1sequence variation suggests that this strain be one of isotypic variants of T.rubrum,which has much higher pathogenicity to cause granulomatous skin lesion,or sequence variation of the strain may be the result of adapting itself to environmental change(37℃),which needs further studies.

Genotyping of Candida albicans Isolated from Different Body Sites of Women Suffering from Candi-dal Vulvovaginitis / 中华皮肤科杂志

Objective To study the distribution of genotypes of Candida albicans isolated from different body sites of patients with candidal vulvovaginitis(CVV).Methods PCR was designed to amplify group I intron-containing region in25S rDNA of Candida albicans.The strains of Candida albicans could be classified into three genotypes:genotype A(~450bp),B(~840bp)and C(~450bp and~840bp),on the basis of different ranges of bands of amplicons.Results Sixty women with CVV were recruited,of whom54were caused by Candida albicans.Among the54patients39had non-recurrent CVV and15had recurrent CVV(RCVV).Candida albicans could be isolated simultaneously from different body sites in32of54patients,including19(19/39)with non-RCVV and13(13/15)with RCVV.A total of92strains of Candida albicans were isolated from vagina,tongue and anus in54patients with CVV.Eighty strains of genotype A,8of genotype B and4of genotype C were found.The same genotypes of Candida albicans in different body sites were identified in24patients,and the different genotypes were identified in8patients.Conclusion Genotype A is predominant in CVV.The other two genotypes(B and C)are not commonly seen,and mainly isolated from non-vaginal sites.The colonization of Candida albicans in the non-vagina sites is more frequent in RCVV than that in CVV,and the intestinal reservoir theory may play a role in the relapse of RCVV.

Discrepancy of clinical isolates of Candida rugosa between genotype and phen otype / 中华传染病杂志

Objective To compare discrepancy between genotype and pheotype of th e clinical isolates of Candida rugosa. Methods The fung us-specific universal prim ers derived from the internal transcribed spacer (ITS) region of fungal rDNA wer e used for amplification. Genomic DNA purified from the thirteen clinical isolat es of non-C. Albicans was amplified by PCR. The purified PCR product was cloned into pBluescript Ⅱ KS(+) T vector and sequenced by Sanger's dideoxy chain terminatio n composition method. The two isolates were evaluated against CHROM Candida medi um and API 20C AUX. Results The two isolates of Candida rugosa were evaluated as Candida tropicalis by CHROM Candida medium and API 20C AUX. Conclusio ns Discrep ancy between genotype and phenotype of the two clinical isolates of Candida ru gosa was confirmed.

PCR fingerprinting discriminating between Candida albicans and Candida dubliniensis / 中华传染病杂志

Objective To develop a rapid PCR fingerprinting for discriminating between Candida albicans and Candida dubliniensis isolates. Methods Genomic DNA purified from the two species was amplified by single primer PCR. Oligonucleotide of the minisatellite-specific core sequence of the wild-type phage M13 (5′-GAGGGTGGCGGTTCT-3′) was used as primer and the amplified products were analyzed by gel electrophoresis and microfluidic DNA chip assays. Results Of 17 candida isolates, the PCR fingerprinting generated five strain-specific bands for C. albicans and C. dubliniensis respectively, allowing identification to species level between them. The other bands were minor different in their species. By microfluidic DNA chip, the DNA fragments in size of amplified products for the C. dubliniensis were 960,1177,1297,1495,1797 bp and for the C. albicans 653,1323,1531,2021,2875 bp. Conclusions C. albicans and C. dubliniensis have distinguishable pattern by PCR fingerprinting using the single primer. The microfluidic DNA chip is proposed here as a simple, rapid and highly reproducible tool, especially for the epidemiological investigation.

Skin Verrucous Hyperplasia Caused b y Epidermophyton floccosum and Candida ciferrii:a Case Report / 中华皮肤科杂志

Several years after trauma,a patien t suffered from skin verrucous hyperplasia for more than 30years,accompanied by ulcer occasio nally,on the feet,ankles and legs su ccessively.Mycological examinati on(9times)had been done before treatment.Slig ht septate hyphae and /or spores were demonstrated by direct mi-croscopy(5times);and yellowish green colony grew on S abouraud agar at 25℃for 2times,it wa s identified as Epidermophyton floccosum.Yeast -like colony grew on Sabourau d agar at 25℃for 5times,it was identi fied as Candida ciferrii by API.After treatment,Candida ciferrii could still be detected by mycologic al examination(6times),but no Epidermophyton floccosum was found.Slight septate hyphae were demonstrated in stratum spinosum,stratum granulosum and stratum corneum by histopathological examination.Isolated or clustered blastospores,spores and chlamydospores were demonstrated in stratum c orneum by histopathological examin ation.Therefore,it was concluded that the skin verrucous hyperplasia in this c ase is caused by mixed infection of Epidermophyton floccosum and Candida ciferrii.The patient was treated with flucon azole capsule 50mg daily for5weeks,followed by terbinafine tab let 250mg daily for 36weeks,and then250mg twice daily for 18weeks.In the 5th week of terbinafine therapy,a part of the lesions on the shin of left leg healed.No further therapeutic effect was observed.

Phaeohyphomycosis Caused by Chaetomium Globosum: First Case Report in China / 中华皮肤科杂志

A 13 year old male farmer suffered from cutaneous and nail phaeohyphomycosis for five years is reported in this paper. The lesions were dull red, nodules and well defined plaques with ulcerations, mainly on the face, extremities, palmar and plantar surfaces and buttocks. Some of them were covered with thick greyish black crusts. General examination did not reveal abnormal findings except the skin lesions. Histopathology showed granulomatous response with numerous light brown septate branching hyphae. The colonies were greyish brown on SDA and PDA at 25℃ and 37℃ with brownish black ascomata. The ioslated strain was identified as Chaetomium globosum based on the morphological features of ascomata, ascomal hairs and ascospores.

Rapid Identification of Candida albicans and Candida dubliniensis Isolates With Two Specific Probes Si-multaneously / 中华皮肤科杂志

Objective To develop a microtitration plate en zyme immunoassay to differentiate Candida albicans from Candida dubliniensis isolates using two specific probes s imultaneously.Methods The fun-gus-specific universal primers derived from the internal transcribed s pacer region of fungal rDNA were labeled with biotin,while the C.albicans or C.dubliniensis specific capture probes were coated on the microplates.Genomic DNA purified from the two species was amplified by PCR.The biotinylated p roducts were captured by the probes coated on the microplates.The A 405 value was finally determined by the c olorimetric assay.Results The two species of Candida could be detected specifically.Out of 108clinical isolates originally identified as C.albicans on the basis of germtube formation,two isolates were positive for C.dubliniensis and negative for C.albicans.The other106isolates were positive for C.albicans and negative for C.dubliniensis.Conclusions Two-specific-probe hybridization method is rapid and re liable for differentiating C.albicans from C.dubliniensis.