【摘要】 目的 分析2023—2024年武汉市某三甲医院动物源性头癣（tinea capitis）和毳毛癣（tinea vellus）的临床特征、病原学和检查治疗情况，为临床诊断提供可靠的实验室依据。方法 收集2023—2024年武汉市第一医院皮肤科门诊初诊即培养出亲动物性皮肤癣菌的46例头癣、38例毳毛癣及12例头癣合并毳毛癣患者资料，所有患者使用创弘医疗皮肤镜工作站进行皮肤镜及紫外线增强荧光皮肤镜观察，并记录皮肤镜下特征。所有患者按要求随访6个月。结果 96例患者中，男性34例，女性62例，年龄范围为8个月～69岁，中位年龄5(4,9)岁。共分离出65株犬小孢子菌（Microsporum canis）和31株须癣毛癣菌（Trichophyton mentagrophytes）。78例患者符合明确动物接触史定义，接触动物主要为猫，占57.69%(45/78)。57例患者真菌直接镜检结果显示发内型感染，39例患者显示发外型感染；其中犬小孢子菌相对于须癣毛癣菌发外型感染比例较高，差异有统计学意义（χ~2=22.167,P<0.001）。犬小孢子菌与须癣毛癣菌均可引起动物源性头癣及毳毛癣。发病部位方面，与犬小孢子菌相比，须癣毛癣菌更倾向于导致头面颈部感染（χ~2=6.862,P<0.05），而犬小孢子菌更倾向于导致躯干及上肢感染（χ~2=4.873,P<0.05）；皮损形态方面，须癣毛癣菌较犬小孢子菌多表现为单发环状皮损（χ~2=10.267,P<0.05），犬小孢子菌则更常出现多发钱币状皮损（χ~2=10.852,P<0.05）；皮肤镜特征方面，犬小孢子菌感染中锯齿状发或条码状发的检出率显著高于须癣毛癣菌（χ~2=30.553,P<0.05），须癣毛癣菌则更易观察到白色微脓疱（χ~2=9.377,P<0.05），且犬小孢子菌感染的紫外光增强皮肤镜阳性率显著高于须癣毛癣菌感染，差异有统计学意义（χ~2=34.706,P<0.001）。治疗随访发现毳毛癣患者疗程较头癣患者短；普通毳毛癣及头癣患者疗程较脓疱型毳毛癣及脓癣疗程短。结论 犬小孢子菌和须癣毛癣菌是重要的动物源性皮肤癣菌病的病原菌，二者有特异性的寄生宿主。真菌荧光染色联合紫外线增强荧光皮肤镜可以作为动物源性皮肤癣菌病的诊断及疗效评价的重要工具，了解动物源性皮肤癣菌病的致病菌、寄生宿主及紫外线增强荧光皮肤镜特征，有助于该病的早期诊断、规范化治疗及预防。更多还原

【Abstract】 Objective To analyze the clinical characteristics, etiology, diagnostic findings, and treatment of tinea capitis and tinea vellus caused by zoophilic dermatophytes in a tertiary A hospital in Wuhan from 2023 to 2024, aiming to provide reliable laboratory evidence for clinical diagnosis.Methods Data from 46 patients with tinea capitis, 38 patients with tinea vellus, and 12 patients with concurrent tinea capitis and tinea vellus were collected for the study. All patients had zoophilic dermatophytes cultured at their initial visit to the dermatology outpatient department of Wuhan No. 1 Hospital from January2023 to December 2024. All patients underwent dermoscopy and ultraviolet-enhanced fluorescence dermoscopy(UEFD)observations using the Chuanghong Medical Dermoscopy Workstation, and the characteristics under the dermoscopy were recorded. All patients were followed up for 6 months as required.Results Among the 96 patients, 34 were male and 62 were female, with ages ranging from 8 months to 69 years and a median age of 5(4,9) years. A total of 65 Microsporum canis strains and 31 Trichophyton mentagrophytes strains were isolated. Seventy-eight patients met the criteria for documented animal contact history, with cats being the primary source of exposure, accounting for 57.69%(45/78). Direct microscopic examination revealed endothrix infection in 57 patients and ectothrix infection in 39 patients. Among them, the proportion of ectothrix infection caused by Microsporum canis was significantly higher than that caused by Trichophyton mentagrophytes(χ~2=22.167, P<0.001). Both Microsporum canis and Trichophyton mentagrophytes can cause tinea capitis and tinea vellus. Regarding the site of infection, compared with Microsporum canis, Trichophyton mentagrophytes was more likely to cause infections on the head, face,and neck(χ~2=6.862, P<0.05), while Microsporum canis was more likely to cause infections on the trunk and upper limbs(χ~2=4.873, P<0.05). In terms of the morphology of skin lesions, Trichophyton mentagrophytes frequently presented as single ringshaped skin lesions compared with Microsporum canis(χ~2=10.267, P<0.05), while Microsporum canis more commonly manifested as multiple coin-shaped skin lesions(χ~2=10.852, P<0.05). In terms of dermoscopic features, the detection rate of zigzag or barcode-like hair in Microsporum canis infections was significantly higher than in Trichophyton mentagrophytes infections(χ~2=30.553, P<0.05), while white follicular pustules were more frequently observed in Trichophyton mentagrophytes infections(χ~2=9.377, P<0.05). Moreover, the positive rate of UEFD in Microsporum canis infections was significantly higher than in Trichophyton mentagrophytes infections(χ~2=34.706, P<0.001). Treatment follow-up revealed that the treatment duration was shorter for patients with tinea vellus than for those with tinea capitis, and shorter for common tinea vellus and tinea capitis compared to pustular tinea vellus and tinea kerion.Conclusion Microsporum canisand Trichophyton mentagrophytes are important pathogenic fungi of zoophilic dermatophytes, each with distinct primary parasitic hosts. Fungal fluorescence staining combined with UEFD can serve as an important tool for the diagnosis and therapeutic effect evaluation of zoophilic dermatophytes. Understanding the pathogenic fungi, parasitic hosts, and characteristics of UEFD of zoophilic dermatophytes is helpful for the early diagnosis, standardized treatment, and prevention of this disease.更多还原