滑囊腔/关节腔穿刺液直接镜检有助于无绿藻致感染性滑囊炎/关节炎的早期诊断

中国真菌学杂志　 2023, Vol. 18 　Issue (3): 216-220.

滑囊腔/关节腔穿刺液直接镜检有助于无绿藻致感染性滑囊炎/关节炎的早期诊断

谢新哲, 鲁莎, 蔡文莹, 张军民, 李家豪, 林莉, 席丽艳

中山大学孙逸仙纪念医院皮肤科, 广州 510120

收稿日期:2022-08-02 出版日期:2023-06-28 发布日期:2023-07-08
通讯作者: 鲁莎,E-mail:lush7@mail.sysu.edu.cn E-mail:lush7@mail.sysu.edu.cn
作者简介:谢新哲,男(汉族),本科,住院医师.E-mail:xiexzh9@mail.sysu.edu.cn
基金资助:
国家自然科学基金(82172289)

Direct microscopy of fluid aspirated from bursa or joint is helpful for early diagnosis of protothecal bursitis or protothecal arthritis

XIE Xinzhe, LU Sha, CAI Wenying, ZHANGJunmin, LI Jiahao, LIN Li, XI Liyan

Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China

Received:2022-08-02 Online:2023-06-28 Published:2023-07-08

摘要/Abstract

摘要： 目的探讨滑囊腔/关节腔穿刺液直接镜检对于无绿藻致感染性滑囊炎/关节炎的早期诊断价值及临床应用。方法报道我科2022年3月发现的1例小型无绿藻致感染性指间关节炎病例的检查经过,并回顾1964年1月1日至2022年5月31日之间在PubMed、中国知网及万方数据库上发表的无绿藻致感染性滑囊炎/关节炎病例的主要病原学检查方法。通过比较不同患者主要病原学检查方法的异同点,探讨滑囊腔/关节腔穿刺液直接镜检的早期诊断价值。结果经删选,最终纳入符合研究目的的文章18篇(21例病例)。病原学检查的主要方法为真菌培养、组织病理,而真菌直接镜检常常被忽略。在22例患者中,只有2例患者同时行真菌直接镜检和真菌培养检查,18例患者行真菌培养检查但未行真菌直接镜检,其余2例患者未行真菌直接镜检及真菌培养检查而依靠病理检查结果进行诊断。结论滑囊腔/关节腔穿刺液直接镜检有助于无绿藻致感染性滑囊炎/关节炎的早期诊断,但临床缺乏正确应用,值得引起重视并推广。

关键词: 滑囊腔穿刺液, 关节腔穿刺液, 直接镜检, 无绿藻, 感染性滑囊炎, 感染性关节炎

Abstract: Objective To investigate the early diagnosis value and clinical application of direct microscopy of fluid aspirated from bursa or joint for diagnosing protothecal bursitis or protothecal arthritis. Methods In this paper, we reported a case of Prototheca wickerhamii infective interdigital arthritis admitted in our department in March 2022, and then we reviewed the literatures about protothecal bursitis or protothecal arthritison published in PubMed, CNKI and Wanfang Database from January 1, 1964 to May 31,2022. We analyzed the main etiological examination methods in different patients and the early diagnostic value of direct microscopy of fluid aspirated from bursa or joint. Results After selection, 18 articles (21 cases) conforming to the aim of the study were included. The main etiological examination methods included fungal culture and histologic examination, while fungal direct microscopy was often ignored.Among the 22 patients, only 2 patients underwent both direct microscopy and fungal culture, 18 patients underwent fungal culture without direct microscopy, and the remaining 2 patients were diagnosed by histologic examination without direct microscopy and fungal culture. Conclusions Direct microscopy of fluid aspirated from bursa or joint is helpful for early diagnosis of protothecal bursitis or protothecal arthritis.It deserves attention and promotion caused it lacks properly clinical application.

Key words: fluid aspirated from bursa, fluid aspirated from joint, direct microscopy, prototheca, infectious bursitis, infectious arthritis

中图分类号:

R 519.5

谢新哲, 鲁莎, 蔡文莹, 张军民, 李家豪, 林莉, 席丽艳. 滑囊腔/关节腔穿刺液直接镜检有助于无绿藻致感染性滑囊炎/关节炎的早期诊断[J]. 中国真菌学杂志, 2023, 18(3): 216-220.

XIE Xinzhe, LU Sha, CAI Wenying, ZHANGJunmin, LI Jiahao, LIN Li, XI Liyan. Direct microscopy of fluid aspirated from bursa or joint is helpful for early diagnosis of protothecal bursitis or protothecal arthritis[J]. Chinese Journal of Mycology, 2023, 18(3): 216-220.

参考文献

[1] TINDALL J P,FETTER B F.Infections caused by achloric algae (protothecosis)[J].Arch Dermatol,1971,104(5):490-500.
[2] NOSANCHUK J S,GREENBERG R D.Protothecosis of the olecranon bursa caused by achloric algae[J].Am J Clin Pathol,1973,59(4):567-573.
[3] GROCOTT R G,HUFFAKER A K,WHITE C B.Protothecal bursitis: A case from Panama[J].Lab Med,1979,10(2):89-96.
[4] Ahbel D E,Alexander A H,Kleine M L,et al.Protothecal olecranon bursitis. A case report and review of the literature[J].J Bone Joint Surg Am,1980, 62(5):835-836.
[5] KAPICA L.First case of human protothecosis in Canada:laboratory aspects[J].Mycopathologia,1981,73(1):43-48.
[6] HOLCOMB H S 3RD,BEHRENS F,WINN W C JR,et al.Prototheca wickerhamii-an alga infecting the hand[J].J Hand Surg Am,1981,6(6):595-599.
[7] VERNON S E,GOLDMAN L S.Protothecosis in the southeastern United States[J]. South Med J,1983,76(7):949-950.
[8] COCHRAN R K,PIERSON C L,SELL T L,et al.Protothecal olecranon bursitis: treatment with intrabursal amphotericin B[J].Rev Infect Dis,1986,8(6): 952-954.
[9] NARYSHKIN S,FRANK I,NACHAMKIN I.Prototheca zopfii isolated from a patient with olecranon bursitis[J].Diagn Microbiol Infect Dis,1987,6(2): 171-174.
[10] DE MONTCLOS M,CHATTÉ G,PERRIN-FAYOLLE M,et al.Olecranon bursitis due to Prototheca wickerhamii, an algal opportunistic pathogen[J].Eur J Clin Microbiol Infect Dis,1995,14(6):561-562.
[11] PASCUAL J S,BALOS L L,BAER A N.Disseminated Prototheca wickerhamii infection with arthritis and tenosynovitis[J].J Rheumatol,2004,31(9): 1861-1865.
[12] CURBELO A,PANKEY G A.A man presenting with nodules on hands and elbows[J]. Clin Infect Dis,2009,48(8):1114-1115,1160-1161.
[13] PEDNEKAR M,CHANDRA P A,MARGULIS Y,et al.Protothecal olecranon bursitis: an unusual algal infection[J].Am J Med Sci,2011,342(5):424.
[14] VAN DEN BOSSCHE D,DE HAAN R,VAN DER WERFF TEN BOSCH J,et al.Case report: Infrapatellar bursitis caused by Prototheca wickerhamii[J].Med Mycol Case Rep,2012,1(1):13-16.
[15] KNOX J,COLOE S V,PERERA C,et al.Prototheca wickerhamii olecranon bursitis successfully treated with adjunctive systemic itraconazole[J]. Pathology,2015,47(4):388-391.
[16] RAMÍREZ I,NIETO-RíOS J F,OCAMPO-KOHN C,et al.Protothecal bursitis after simultaneous kidney/liver transplantation:a case report and review[J]. Transpl Infect Dis,2016,18(2):266-274.
[17] 凌宝殿,胡蓉,黄俊云,等.威克海姆无绿藻致手指关节腱鞘炎1例并文献复习[J].临床检验杂志,2017,35(10):792-793.
[18] RAMANAN P,VIRK A,BOLAND J M,et al.Photo quiz: It's a concrete jungle out there[J].J Clin Microbiol,2018,56(8):e02417-16.
[19] RAMANAN P,VIRK A,BOLAND J M,et al.Answer to August 2018 photo quiz[J]. J Clin Microbiol,2018,56(8):e02418-16.
[20] YAGNIK K,BOSSÉ R,REPPUCCI J,et al.Case report: olecranon bursitis due to Prototheca wickerhamii in an immunocompromised patient[J].Am J Trop Med Hyg,2019,100(3):703-705.
[21] KATWILAT P,CHONGTRAKOOL P,MUANGSOMBOON S,et al.Prototheca wickerhamii prepatellar bursitis in an immunocompetent woman: A case report[J].J Mycol Med,2019,29(4):361-364.
[22] DAVIES R R,SPENCER H,WAKELIN P O.A case of human protothecosis[J]. Trans R Soc Trop Med Hyg,1964,58(5):448-451.
[23] TODD J R,KING J W,OBERLE A,et al.Protothecosis: report of a case with 20-year follow-up,and review of previously published cases[J]. Med Mycol, 2012,50(7):673-689.
[24] WANG F,FENG P,LIN Y,et al.Human cutaneous protothecosis:a case report and review of cases from China's mainland, Hong Kong, and Taiwan[J]. Mycopathologia,2018,183(5):821-828.