1、1 主要致病性真菌 浅部真菌感染（致病性真菌感染和 条件致病性真菌感染）深部真菌感染（致病性真菌感染和 条件致病性真菌感染）2 浅部感染真菌浅部感染真菌 表面感染真菌 皮肤癣真菌皮肤癣真菌 皮下组织真菌感染 3 4 表面感染真菌表面感染真菌 位置：寄居于人体皮肤和毛干的最表层。因不接触组织细胞，很少引起宿主细胞反应 统称：角层癣菌 代表：秕糠马拉癣菌(Malassezia furfur)症状：由于此菌能产生对黑色素细胞有抑制作用的二羧酸，使花斑癣局部色素减退，如汗渍斑点，俗称汗斑。诱发因素为高温多汗 5 Malassezia furfur Tinea versicolor on skin su
2、rface(sweat stain)The lesions are small hypopigmented or hyperpigmented macules Most common site:back,underarm,upper arm,chest,neck Most common in adolescent and young adult males Associated with increased sweating 6 Pityriasis versicolor showing hyperpigmented lesions in a Caucasian and hyphopigmen
3、ted lesions in an Australian Aborigine 7 Culture of Malassezia furfur on Dixons agar(contains glycerol mono-oleate)8 Piedraia hortae(何德毛结节菌何德毛结节菌)It usually affected the scalp hair The nodules are darker in color,harder,and more firmly attached to the hairs Black Piedra 9 Piedraia hortae forms a har
4、d superficial pigmented nodule around the hair shaft (在毛干上形成硬的黑色结节，如沙粒状)10 Fungal otitis externa Fungal infection of the external auditory canal Caused by several species of Aspergillus(most often A.niger),but Candida albicans is also capable of infecting this site The major symptoms are itching and
5、 feeling of fullness in ear 11 12 皮肤癣真菌皮肤癣真菌 引起皮肤浅部感染 皮肤癣是人类最多见的真菌病 统称：皮肤癣菌，大约40多个种，分属于3个属 嗜角质蛋白，37不能生长，侵犯部位：角化的表皮，毛发，指（趾）甲 病理变化：由真菌增殖及代谢产物刺激宿 主引起 13 致病性 指（趾）甲 皮肤 毛发 毛癣菌属 +表皮癣菌属 +-小孢子癣菌属 -+一种皮肤癣菌可在不同部位引起病变 相同部位的病变也可由不同的皮肤癣菌引起 14 15 Tinea pedis caused by T.rubrum.Sub-clinical infection(left)showing m
6、ild maceration under the little toe and more severe infection(right)showing extensive maceration of all toe web spaces Tinea is transmitted via the feet by desquamated skin scales in substrates like carpet and matting.16 手足癣治疗原则 水疱型温和搽剂和霜剂水疱型温和搽剂和霜剂 角化过度型先角质剥脱剂，再用抗真角化过度型先角质剥脱剂，再用抗真菌霜剂菌霜剂 浸渍糜烂型粉剂收干，抗
7、继发感染，浸渍糜烂型粉剂收干，抗继发感染，再温和抗真菌再温和抗真菌 17 Tinea Unguium usually caused by Trichophyton sp 18 甲癣治疗原则 局部治疗甲涂剂局部治疗甲涂剂 系统治疗伊曲康唑，特比萘芬等系统治疗伊曲康唑，特比萘芬等 联合治疗配合拔甲或削甲治疗联合治疗配合拔甲或削甲治疗 19 Tinea Corporis:caused by M.canis,following contact with infectious kittens 20 Tinea Cruris(Jock itch):Infection of the groin,mainly
8、 seen in men 21 Tinea Capitis(scalp ringworm)Tinea favosa 发内孢子发内孢子 22 Tinea Capitis(scalp ringworm)Tinea alba 发外孢子发外孢子 23 Tinea Capitis(scalp ringworm)脓癣脓癣 24 头癣治疗原则 剪发剪发 洗发洗发 搽药搽药 服药服药 消毒消毒 25 Candidiasis of skin,mucous membranes and nails Predisposing factors Infancy,pregnancy,old age Disorders of
9、 immune function,e.g.,leukemia,corticosteroid therapy Chemotherapy,e.g.,immunosuppressive,antibiotic Endocrine disease,e.g.,diabetes mellitus Carcinoma 26 念珠菌性间擦疹念珠菌性间擦疹 好发部位：腋窝、乳房下、好发部位：腋窝、乳房下、腹股沟、会阴，多见于婴儿腹股沟、会阴，多见于婴儿 及肥胖者。及肥胖者。27 Cutaneous candidiasis:including Interdigital candidiasis,diaper cand
10、idiasis,paronychia and onychomycosis Vulvovaginal candidiasis and balanitis Interdigital candidiasis Candidia onychomycosis and paronychia 28 Oropharyngeal candidiasis:including thrush,glossitis,stomatitis and angular cheilitis Oral thrush 29 皮下组织真菌感染皮下组织真菌感染 主要有孢子丝菌和着色真菌 申克孢子丝菌，属腐生性真菌，常因外伤接触带菌的花草等引
11、起感染。此菌可引起孢子丝菌下疳。此菌也可引起深部感染。是一种二相性真菌。着色真菌感染发生在暴露部位，称着色真菌病。我国主要有卡氏枝孢霉和裴氏着色芽生菌。30 Sporotrichosis 此菌可经微小损伤侵入皮肤，然后沿淋巴管分布，引此菌可经微小损伤侵入皮肤，然后沿淋巴管分布，引起亚急性或慢性肉芽肿，使淋巴管形成链状硬结，称起亚急性或慢性肉芽肿，使淋巴管形成链状硬结，称为孢子丝菌下疳。为孢子丝菌下疳。31 Chromomycosis Infections occur in exposed areas,skin lesions become dark,so called chromomycosi
12、s Representive species:Cladosporium carrianii,Fonsecaea pedrosoi,etc.Are saprophytic fungi,usually enters the body by trauma 32 经外伤侵入 丘疹 结节 结节融合成疣状或菜花状 斑痕形成影响淋巴回流 肢体象皮肿 33 Chromomycosis Chronic verrucous chromoblastomycosis of the hand due to Cladophialophora carrionii 34 Mycetoma 足分枝菌病足分枝菌病 是由多种放线菌
13、或真菌引起的一种慢性化脓性肉芽肿性疾病，主要感染足部，以肿胀、窦道和颗粒为特征。caused by fungi are called eumycetoma(40%)Actinomycetoma is caused by actinomycetes(60%)It is characterized by the formation of abscess,which contain large aggregates of fungal or actinomycete filaments known as grains 35 Eumycetoma Dark grains Madurella mycet
14、omatis Leptosphaeria senegalensis Exophiala jeanselmei Pale grains Fusarium sp.Acremonium sp.Scedosporium apiospermum Actinomycetoma White-yellow grains Actinomadura madurae Nocardia brasiliensis Yellow-brown grains Streptomyces somaliensis Red-pink grains Actinomycetoma pellettieri 36 深部真菌感染深部真菌感染
15、引起深部感染的真菌包括两大类：致病性真菌与条件致病性真菌 致病性真菌主要有组织胞浆菌、球孢子菌、副球孢子菌和芽生菌，这些真菌均属二相性。多见于美洲，我国极少见。它们侵袭深部组织和内脏以及全身，引起慢性肉芽肿样炎症、溃疡和坏死。条件致病性真菌包括有：念珠菌、隐球菌、曲霉菌与毛霉菌、肺孢子菌等。37 Characteristics of systemic dimorphic mycoses Are uncommon,often occurs in endemic areas Most infections are asymptomatic or self-limiting in immune-co
16、mpromised hosts,infections are often fatal The pattern of infection are similar Route of acquisition is inhalation Pulmonary infection Disseminated infection(Blood,Bone marrow,Brain and CSF,Joint)38 Coccidioidomycosis Coccidiodes immitis is considered to be the most virulent of fungal pathogens.Restricted to hot,semi-arid areas of SW USA and Mexico.Grows in the soil,but inhalation of a single spore can initiate infection.In infected tissues,C.immitis appears as a mixture of endospores and spheru
