【作者】 苏畅；

【导师】 李珊山；

【作者基本信息】 吉林大学 ， 临床医学， 2008， 硕士

【摘要】 孢子丝菌病是一种由S.s引起的皮肤、皮下组织及其附近的局部淋巴系统的亚急性或慢性感染性疾病。本文通过回顾性分析2006年10月-2007年9月一年内经我院皮肤科诊断的临床资料完整的95例孢子丝菌病病例,就其流行病学、临床及治疗等方面进行综合分析。本次研究结果:1、2006年和2007年孢子丝菌病的临床病例较以往明显增多。农安县和公主岭市的病例数明显高于其周边地区。2、各年龄段均可发病,男女发病无明显差异,以30-59岁之间的中、壮年人为主。职业以农民最多。3、临床类型固定型明显多于淋巴管型,出现1例皮肤播散型。发病部位在不同的临床类型中存在差别,固定型孢子丝菌病以发生在面部居多;12岁以内的儿童孢子丝菌病面部的患病率明显高于成人。5、多数治疗时间在6-8周,碘化钾+伊曲康唑优于碘化钾+特比萘芬。但碘化钾的副作用较伊曲康唑明显。结论:临床表现与多数文献报道有所不同,固定型孢子丝菌病明显多于淋巴管型,儿童和婴儿孢子丝菌病患病比例高于多数报道,出现发生于健康人的皮肤播散型孢子丝菌病。碘化钾仍是主要的治疗药物,碘化钾+伊曲康唑是一种疗效较好的用药方法。孢子丝菌病应引起重视。更多还原

【Abstract】 Sporotrichosis is a subacute or chronic cutaneous and subcutaneous tissue infection caused by the fugus Sporothrix shenckii, which main occurs the exposed part of the body, including face and limbs, characterized by the chronic granuloma lesion. Benjamin Schenck reported the first case of sporotrichosis in 1898, UAS; in 1900 Hekton and Pekins named this pathogen Sporothrix shenckii.S.s is a dimorphic and widely discributed in nature,which can survive and develop at about 25℃and in organic material,for this reason sporotrichosis is considered to be acquired during outdoor leisure and occupational activities that expose frequently to soil and plants, such as farmers, forestry workers and gardeners.Sporotrichosis occurs worldwide, particularly in thoes developing countries in tropical, subtropical and temperate areas. Our country is the largest developing country, most territory of a nation locates temperate areas, and is the disease high epidemic arae. Sporotrichosis can affect all ages, but it used be considered patients were usuually adults less than 30 yeras old, and about 15% of cases were children., but recent 10 yeras research show that regional variation in the age and sex distribution of cases is usually atrributable to different exposure conditions.Transmission occurs,in most cases, through traumatic inoculation of S.s through the skin and subcutaneous.Zoonotic transmission can occur after being scratched or bitten by animals. Although less common transmission may occur through inhalation of the fugus through the upper respiratory tract, with possiblely disseminating to bone and joints systerm, eyes, central nervous system and internal organs, which often occur in immunocompromised individuals, such as diabetes mellitus, tuberculosis, sarcoidosis and HIV infection .Sporotrichosis is the most common, and least severe, of the deep mycoses, it can classify into 4 clinical categories: lymphocutaneous, fixed cutaneous, cutaneous disseminated and extra-cutaneous (systermic sporotrichosis). Lymphocutaneous and fixed cutaneous are the most frequent variants, and lymphocutaneous represent about 75%; cutaneous disseminated and extra-cutaneous variants, and almost always associated to immunouppression of the host. Lesions usually arise in the limbs, howere in children, facial lesions are common. The gold standard for a definitive diagnosis is fungal culture, and histopathology examintion is aslo very important .The treatment of sporotrichosis is a long-term and systermic, includes KI, itraconazol, terbinafine, amphotericin B and hyperthermic treatment.Itraconazol is the treatment of choice in most cases,because of its safety ,easy administration and high efficacy.However, in developing countries, where most endemic areas are located, its high cost is prohibitive and, therefore, KI remains the mainstay of sporotrichosis treatment.Jilin Province is a large agricultrue region, people of agricultrue is above 60%, which is an epidemic highland, especially the date of these recent year reseach showes that the incidence of sporortrichosis obout our province is is increasing. This thesis is to review 95 cases of the diagnosed cutaneous sporotrichosis between Oct. 2006 and Sep. 2007 in our deparment. A integrated analysis about the clinical, pathology, diagnostic charateristics, its causes, prevertion and treatment have been done.In these 95 cases, 40 cases are male,55 cases are female, and the proportion is 1:1.375. The ages ranged from 3 months to 83 yeras old, with an average of 38.79±22.75 years. 88 (92.3%) patients belong to the occupational hazard, including farmer, the childer living in countryside and herdsman. 38 patients related infection to recent penetrating trauma inoculation with plane thorns, wood splineters, contaminated organic material, 1 patients occured after scratched by cat, 2 patients occured after bitten by human and 2 patiens occurted after bitten by mosquito. Clinical manifestation: 60 cases are fixed cutaneous, 34cases are lynphocutaneous, 1 case is cutaneous disseminated. Course of disease from 10 days to 2 years, with an average of 5.7±5.6 months.Localization of lesions: the upper limb is the most commonly affected site, 52 cases (53.6%), followed by face, 40 cases (41.4%), neck 1case, lower limb 2 cases,body 3 cases. Therapy: 10 cases with oral 10%KI 30mL/d, 40 cases with oral 10%KI 30mL/d+itraconazole 200mg/d, 35cases with oral 10%KI 30mL/d+terbinafine 250mg/d, 7 cases with oral itraconazole 200mg/d, 3 cases are babise (<1 year) with oral terbinafine 50mg/d.54 patients attained clinical cure after treamtment 8 weeks. 12 patients appeared side effects of KI, such as gastric disconfort. Follow-up: 58 patients were followed up 1 month, 30 patients were followed up 3 months, 1 ocurred again, 21 patients were followed up 6 months, 1 infected again.The results of the study are: 1. the cases of sporotrichosis in our province is increasing, cases occured from 28 cases of 2004, 51 cases of 2005, increased to 136 cases of 2006 and 119 cases of 2007. The cases of Nongan and Gongzhuling are more than another adjacent areas. 2. Between the male and female there is no significan difference about incidence involing all the ages with the range 30-59 of the highest. The occupation with hazard is farmer. 3. Most clinincal maifestations are fixed cutaneous and lynphocutaneous, 1 case is cutaneous disseminated sporotrichosis. The cases of fixed cutaneous is significan more than lynphocutaneous. The localization of lesions is different between fixed cutaneous and lymphocutaneous (χ~2=8.84, P<0.05). The localization of lesions is different between children and adults (χ~2=18.12, P<0.05), the prevalence of facial lesions is main occured in fixed cutaneous (χ~2=4.94, P<0.05). The prevalence of facial lesions is significantly higher in children than in adults (χ~2=19.04, P<0.01). 4. The treamtnent length is 6-8 weeks, KI+itraconazole is more effective than others, and KI has more side effects than itraconazole.The conclusion from this study: 1. The clinical manifestation are different from classic research, the cases of fixed cutaneous is significan more than lynphocutaneous. The cases of babies are more than most reports. There is a case of cutaneous disseminated ocurred healthy person. 2. KI+itraconazole is an effective treatment method. 3. Sporotrichosis is should be noticed.更多还原