婴幼儿皮肤黏膜念珠菌病临床特点及其病原菌体外药敏分析

中国真菌学杂志　 2020, Vol. 15 　Issue (2): 97-100.

婴幼儿皮肤黏膜念珠菌病临床特点及其病原菌体外药敏分析

阚思玥¹, 蔡晴¹, 金云², 陈伟³, 胡素泉³, 杨连娟¹, 刘维达³

1. 上海市皮肤病医院, 上海 200050;
2. 江西省皮肤病专科医院, 南昌 330001;
3. 中国医学科学院皮肤病研究所, 南京 210042

收稿日期:2019-04-22 出版日期:2020-04-28 发布日期:2020-04-28
通讯作者: 蔡晴,E-mail:18930863761@126.com;刘维达,E-mail:liumyco@hotmail.com E-mail:18930863761@126.com;liumyco@hotmail.com
作者简介:阚思玥,女(汉族),硕士,住院医师.E-mail:1158321903@qq.com
基金资助:
国家自然科学基金（81602770，81573063），上海市卫计委课题（20164Y0248）

Study on mucocutaneous candidiasis in infants: the clinical characteristics and in vitro susceptibility of pathogenic yeasts

KAN Si-yue¹, CAI Qing¹, JING Yun², CHEN Wei³, HU Su-quan³, YANG Lian-juan¹, LIU Wei-da³

1. Shanghai Dermatology hospital, Department of Mycology, Shanghai 200050, China;
2. Jiangxi Dermatology hospital, Department of Mycology, Nanchang 330001, China;
3. Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China

Received:2019-04-22 Online:2020-04-28 Published:2020-04-28

摘要/Abstract

摘要：

目的分析并探讨婴幼儿皮肤黏膜念珠菌病的临床特点，检测其病原菌对常用抗真菌药物的体外敏感性。方法入选105例0~3岁皮肤黏膜念珠菌病的患儿，均经临床表现及真菌学检查确诊，用调查表收集患儿有关资料，统计并分析患儿的临床特点。用科玛嘉显色培养基及API20AU测试卡鉴定菌种。参照CLSI酵母菌检测方案M27-A3测定菌株对咪康唑、益康唑、酮康唑、联苯苄唑及特比萘芬等5种药物的体外敏感性。结果 105例婴幼儿皮肤黏膜念珠菌病年龄分布为0.4~36个月，平均10.67个月，以1岁以内感染最多（75%）。皮损位于尿布区最多，其次为颈部及腋下。共分离念珠菌189株，菌种鉴定显示白念珠菌最多（81.5%），其次为近平滑念珠菌（10.6%）和光滑念珠菌（3.2%）。咪康唑和酮康唑对白念珠菌的MIC₉₀值最小（0.25 μg/mL）。酮康唑和益康唑对所有菌株包括非白念珠菌的MIC₉₀值分别为0.25 μg/mL和2 μg/mL。联苯苄唑和特比萘芬对白念珠菌的MIC₉₀值最大（16 μg/mL），对非白念珠菌的MIC₉₀值分别为8 μg/mL和16 μg/mL。结论婴幼儿皮肤黏膜念珠菌病的年龄分布以1岁内为主，皮损主要位于尿布区、颈部和腋下等温暖潮湿部位。白念珠菌仍是婴幼儿皮肤黏膜念珠菌病中最常见的菌种，非白念珠菌中以近平滑念珠菌为主。咪康唑和酮康唑是治疗婴幼儿皮肤黏膜念珠菌病较好的外用药选择，尤其是酮康唑。

关键词: 婴幼儿, 皮肤黏膜念珠菌病, 临床特点, 体外药敏试验, 抗真菌药

Abstract:

Objective To analyze and investigate the clinical characteristics of mucocutaneous candidiasis in infants, and to determine in vitro antifungal susceptibility of pathogenic yeasts. Method 105 patients with clinical and mycological diagnosis of mucocutaneous candidiasis, aged from 0~3 years old, were enrolled. Meanwhile, the questionnaires of related data from patients were collected and analyzed. The strains were identified by CHROMagar medium and API20AU test card. Antifungal susceptibility testing was performed according to CLSI documents M27-A3, using 5 drugs including miconazole, econazole, ketoconazole, bifonazole and terbinafine. Results The subjects were between 0.4 and 36 months old (average age, 10.67 months old), and most of them were within one year old (75%). Skin lesions were mainly found in the diaper area, followed by neck and armpit. 189 strains were isolated from those patients; 81.5% were C.albicans, 10.6% were C.parapsilosis, 3.2% were C.glabrata. Miconazole and ketoconazole showed the lowest MIC₉₀ (0.25 μg/mL) against C.albicans. The MIC₉₀ of Ketoconazole and econazole among all strains including non-albicans Candida were 0.25 μg/mL and 2 μg/mL respectively. Bifonazole and terbinafine showed the highest MIC₉₀ (16 μg/mL) against C.albicans, and the MIC₉₀ among non-albicans Candida were 8 μg/mL and 16 μg/mL respectively. Conclusion Mucocutaneous candidiasis was more frequent in infants within one year old. The lesions mainly located in the warm and humid areas such as the diaper area, neck and armpit. C.albicans was still the predominant species of mucocutaneous candidiasis in infants, while C.parapsilosis was the main species in non-albicans Candida. Miconazole and ketoconazole, especially ketoconazole, were better external drug s for the treatment of mucocutaneous candidiasis in infants.

Key words: infants, mucocutaneous candidiasis, clinical characteristics, in vitro susceptibility test, antifungal drugs

中图分类号:

R519.3

阚思玥, 蔡晴, 金云, 陈伟, 胡素泉, 杨连娟, 刘维达. 婴幼儿皮肤黏膜念珠菌病临床特点及其病原菌体外药敏分析[J]. 中国真菌学杂志, 2020, 15(2): 97-100.

KAN Si-yue, CAI Qing, JING Yun, CHEN Wei, HU Su-quan, YANG Lian-juan, LIU Wei-da. Study on mucocutaneous candidiasis in infants: the clinical characteristics and in vitro susceptibility of pathogenic yeasts[J]. Chinese Journal of Mycology, 2020, 15(2): 97-100.

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