1、,主要(zhyo)致病性真菌,浅部真菌(zhnjn)感染（致病性真菌(zhnjn)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）,1,第一页，共八十一页。,浅部感染(gnrn)真菌,表面感染真菌(zhnjn)皮肤癣真菌皮下组织真菌感染,2,第二页，共八十一页。,3,第三页，共八十一页。,表面感染(gnrn)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(dibio)：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。
2、诱发因素为高温多汗,4,第四页，共八十一页。,Malassezia furfur,Tinea versicolor on skin surface(sweat stain)The lesions are small hypopigmented or hyperpigmented maculesMost common site:back,underarm,upper arm,chest,neck Most common in adolescent and young adult males Associated with increased sweating,5,第五页，共八十一页。,Pityr
3、iasis versicolor showing hyperpigmented lesions in a Caucasian and hyphopigmented lesions in an Australian Aborigine,6,第六页，共八十一页。,Culture of Malassezia furfur on Dixons agar(contains glycerol mono-oleate),7,第七页，共八十一页。,Piedraia hortae(何德毛结节(ji ji)菌),It usually affected the scalp hairThe nodules are d
4、arker in color,harder,and more firmly attached to the hairsBlack Piedra,8,第八页，共八十一页。,Piedraia hortae forms a hard superficial pigmented nodule around the hair shaft(在毛干上形成(xngchng)硬的黑色结节，如沙粒状),9,第九页，共八十一页。,Fungal otitis externa,Fungal infection of the external auditory canalCaused by several species
5、 of Aspergillus(most often A.niger),but Candida albicans is also capable of infecting this siteThe major symptoms are itching and feeling of fullness in ear,10,第十页，共八十一页。,11,第十一页，共八十一页。,皮肤癣真菌(zhnjn),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(qnfn)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
6、引起,12,第十二页，共八十一页。,致病性,指（趾）甲 皮肤(p f)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(bngbin)相同部位的病变也可由不同的皮肤癣菌引起,13,第十三页，共八十一页。,14,第十四页，共八十一页。,Tinea pedis caused by T.rubrum.Sub-clinical infection(left)showing mild maceration under the little toe and more severe infection(right)showing extensive maceration of
7、all toe web spaces,Tinea is transmitted via the feet by desquamated skin scales in substrates like carpet and matting.,15,第十五页，共八十一页。,手足癣治疗(zhlio)原则,水疱型温和搽剂和霜剂角化过度(gud)型先角质剥脱剂，再用抗真菌霜剂浸渍糜烂型粉剂收干，抗继发感染，再温和抗真菌,16,第十六页，共八十一页。,Tinea Unguium,usually caused by Trichophyton sp,17,第十七页，共八十一页。,甲癣治疗(zhlio)原则,局部
8、治疗甲涂剂系统(xtng)治疗伊曲康唑，特比萘芬等联合治疗配合拔甲或削甲治疗,18,第十八页，共八十一页。,Tinea Corporis:caused by M.canis,following contact with infectious kittens,19,第十九页，共八十一页。,Tinea Cruris(Jock itch):Infection of the groin,mainly seen in men,20,第二十页，共八十一页。,Tinea Capitis(scalp ringworm),Tinea favosa,发内孢子,21,第二十一页，共八十一页。,Tinea Capit
9、is(scalp ringworm),Tinea alba,发外孢子,22,第二十二页，共八十一页。,Tinea Capitis(scalp ringworm),脓癣,23,第二十三页，共八十一页。,头癣(tu xun)治疗原则,剪发(jin f)洗发搽药服药消毒,24,第二十四页，共八十一页。,Candidiasis of skin,mucous membranes and nails,Predisposing factorsInfancy,pregnancy,old ageDisorders of immune function,e.g.,leukemia,corticosteroid t
10、herapyChemotherapy,e.g.,immunosuppressive,antibioticEndocrine disease,e.g.,diabetes mellitusCarcinoma,25,第二十五页，共八十一页。,念珠菌性间擦疹,好发部位：腋窝、乳房(rfng)下、腹股沟、会阴，多见于婴儿及肥胖者。,26,第二十六页，共八十一页。,Cutaneous candidiasis:including Interdigital candidiasis,diaper candidiasis,paronychia and onychomycosisVulvovaginal candi
11、diasis and balanitis,Interdigital candidiasis,Candidia onychomycosis and paronychia,27,第二十七页，共八十一页。,Oropharyngeal candidiasis:including thrush,glossitis,stomatitis and angular cheilitis,Oral thrush,28,第二十八页，共八十一页。,皮下组织真菌(zhnjn)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(huco)等引起感染。此菌可引起孢子丝菌下疳。此菌也可引起深部感
12、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。,29,第二十九页，共八十一页。,Sporotrichosis,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(mn xng)肉芽肿，使淋巴管形成链状硬结，称为孢子丝菌下疳。,30,第三十页，共八十一页。,ChromomycosisInfections occur in exposed areas,skin lesions become dark,so called chromomycosisRepresentive species:Cladosporium carrianii,
13、Fonsecaea pedrosoi,etc.Are saprophytic fungi,usually enters the body by trauma,31,第三十一页，共八十一页。,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(hu li)肢体象皮肿,32,第三十二页，共八十一页。,Chromomycosis,Chronic verrucous chromoblastomycosis of the hand due to Cladophialophora carrionii,33,第三十三页，共八十一页。,Mycetoma 足分枝(fn zh)菌病,是由多种放线菌或真菌
14、引起的一种(y zhn)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,34,第三十四页，共八十一页。,EumycetomaDark grains
15、Madurella mycetomatisLeptosphaeria senegalensisExophiala jeanselmeiPale grainsFusarium sp.Acremonium sp.Scedosporium apiospermum,ActinomycetomaWhite-yellow grainsActinomadura maduraeNocardia brasiliensisYellow-brown grainsStreptomyces somaliensisRed-pink grainsActinomycetoma pellettieri,35,第三十五页，共八十
16、一页。,深部真菌(zhnjn)感染,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(t men)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。,36,第三十六页，共八十一页。,Characteristics of systemic dimorphic mycoses,Are uncommon,often occurs in endemic areas Most infections are asymptomatic or self-limitingin immune-compromised hosts,infections are often fatalThe pattern of infection are similarRoute of acquisition is inhalation Pulmonary infectionDisseminated infection(Blood,Bo