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    28 August 2020, Volume 15 Issue 4
    Original articles
    The first case of tinea nigra on wrist caused by Hortaea werneckii in Chinese Mainland and literature review
    JI Mei, SHEN Xue-hua, TAN Jing-wen, GAO Zhi-qin, YANG Lian-juan
    2020, 15(4):  193-196,222. 
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    Objective We present the case of tinea nigra on the left wrist caused by Hortaea werneckii (H. werneckii) and review the literature in Chinese Mainland to summary the clinical characteristics of the disease. Method A 39-year-old man was presented with a dark brown asymptomatic plaque on the flexion side of his left wrist for 1 years. Diagnosis was based on mycology and molecular identification. Result A round black colony with flocculent surface grew at the SDA medium after 1 week. The microscopic examination revealed rich, round, oval, brown and septate spores which gathered on both sides and the top of the thickwalled septate hyphae. The result of gene sequencing was H.werneckii. The patient was treated with miconazole bifonazole cream for 2 weeks and cured completely. Conclusion The main clinical location of tinea nigra was the palm. This case is the first of tinea nigra on wrist by H.werneckii in Chinese Mainland. The characteristic morphological features of colony could been observed in microscopic examination and the specie could be identified furtherly by gene sequencing.

    Comparative evaluation of Sensititre YeastOne colorimetric panel with broth microdilution method for in vitro antifungal susceptibility testing of Aspergillus
    LI Ying, WANG He, ZHANG Ge, LIU Wen-jing, XU Ying-chun
    2020, 15(4):  197-201. 
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    Objective To evaluate the consistence of Sensititre YeastOne colorimetric panel and the reference broth microdilution method in in vitro antifungal susceptibility testing (AFST) of Aspergillus. Methods In vitro AFST of 307 Aspergillus isolates were performed by reference CLSI M38-A2 method and Sensititre YeastOne YO10 panel parallelly, and the statistical parameters including essential agreement (EA), category agreement (CA) and error rates between these two methods in Aspergillus AFST were calculated. Results 98.4% (302/307) of Aspergillus isolates were wild type (WT) against tested six antifungal agents revealed by CLSI M38-A2 AFST, while Sensititre YeastOne detected 97.1% (298/307) isolates as totally WT. The EA regarding tested antifungals were over 90% between CLSI M38-A2 method and Sensititre YeastOne in this study except for Itraconazole. The CA of these two methods in Aspergillus AFST was 98.1% (301/307); the very major error (VME) rate and the major error (ME) were 0.3% (1/307) and 1.6% (5/307), respectively. Conclusion Sensititre YeastOne has a satisfied agreement with CLSI reference method in in vitro AFST of Aspergillus, which provides a prospect of applying Sensititre YeastOne into routine AFST of Aspergillus in clinical laboratories.

    Effect of multiple vaginal examinations on vaginal microecology during induced labor
    LUO Xia, CHEN Zhen
    2020, 15(4):  202-205. 
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    Objective To observe the effect of multiple vaginal examinations on vaginal microecology during induced labor. Methods 150 cases of parturients admitted to our hospital from June 2017 to June 2018 were randomly selected as samples to investigate the frequency of vaginal examination during induction of labor in full-term (healthy asymptomatic single pregnancy). They were divided into three groups: group A (examination<2 times), group B (3-6 times), group C (more than 6 times). Vaginal secretions were taken for pH examination and the content of hydrogen peroxide. Detection and bacterial culture, observation under oil microscope after gram staining, vaginal microecology (vaginal flora density, diversity, dominant bacteria, inflammatory reaction status, etc.) were performed to compare the results of three groups of vaginal microecology examination. Results In group A, 8% (4/50) of Candida albicans, 6% (3/50) of Escherichia coli, 0 (0/50) of Gardnerella vaginalis, 0 (0/50) of E.coli, 4% (2/50) of Lactobacillus, 0 (0/50) of Staphylococcus epidermidis, 4% (2/50) of bacterial vaginitis, 4% (2/50) of microecological disorder, 4.01±0.11 of vaginal pH value and 10% of soft birth canal injury rate in group A (5/50), premature rupture of membranes rate was 0 (0/50), neonatal infection rate was 4% (2/50). In the cases of premature rupture of membranes, 0 (0/0) had micro ecological imbalance. In group B, the detection rate of Candida albicans was 16% (8/50), Escherichia coli was 14% (7/50), Gardnerella vaginalis was 10% (5/50), E.coli was 4% (2/50), Lactobacillus was 2% (1/50), Staphylococcus epidermidis was 0 (0/50), bacterial vaginitis rate was 20% (10/50), microecological imbalance rate was 28% (14/50), vaginal pH value (4.08±0.22), soft birth canal damage The injury rate was 26% (13/50), premature rupture of membranes rate was 4% (2/50), neonatal infection rate was 6% (3/50). In the cases of premature rupture of membranes, 100% (2/2) of the patients had microecological disorders. In group C, the detection rate of Candida albicans was 60% (30/50), Escherichia coli was 46% (23/50), Gardnerella vaginalis was 46% (23/50), E.coli was 8% (4/50), Lactobacillus was 0 (0/50), Staphylococcus epidermidis was 2% (1/50), bacterial vaginitis rate was 80% (40/50), microecological imbalance rate was 80% (40/50), vaginal pH value (4.80±0.14), soft birth canal The injury rate was 50% (25/50), premature rupture of membranes rate was 10% (5/50), neonatal infection rate was 12% (6/50). In the cases of premature rupture of membranes, 100% (5/5) of the patients had microecological disorders. Conclusion Multiple vaginal examinations during induced labor can lead to vaginal microecological disorders. Candida albicans infection rate ranks first, followed by Escherichia coli and Gardnerella vaginalis. Vaginal microecological disorders also lead to changes in vaginal pH values, increase the incidence of vaginitis, and increase the possibility of adverse pregnancy outcomes such as premature rupture of membranes.

    Analysis of filamentous fungi isolations from clinical laboratories in Hebei province
    ZHAO Ying, LI Zhi-rong, ZHAO Jian-hong, LI Fang, DONG Ai-ying, LIU Jin-lu, GUO Yan-yan, XIE Shou-jun, WU Xiang-kun, GUO Xiu-hua, WANG Jian-sheng, ZHANG Jin-yan, LI Dong-qing, WEI Hong-lian, SUN Yan, ZHAO Wen-shen, REN Hong-tao, GUO Ying-hui, XIAO Meng, XU Ying-chun, XU Xiao-lin, WANG Jun-shuang, YANG Wen-hang
    2020, 15(4):  206-212. 
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    Objective To investigate the current status of filamentous fungal infections in 15 tertiary teaching hospitals in Hebei province from 2016 to 2017, and to understand the epidemiological characteristics of filamentous fungal infections in Hebei. Methods Filamentous fungi were collected and counted. Sabouraud Dextrose Agar (SDA) and lactophenol cotton blue staining were used for culture and direct microscopic screening and preliminary identification. Vitek MS was used for re-identification of all the strains and ITS and/ or calmodulin sequencing analysis was used to identify the strains which were rare or hard to identify. Results A total of 225 filamentous fungi were collected in 15 tertiary teaching hospitals from 2016 to 2017. Among them, 133 strains of Aspergillus fumigatus (59.11%), 28 strains of Aspergillus flavus /Aspergillus oryzae (12.44%), 18 strains of Aspergillus niger (8.00%), 6 strains of Aspergillus sydowii (2.67%), 6 strains of Aspergillus nidulans (2.67%), and 34 strains of other filamentous fungi (15.11%). Specimen types included sputum (203, 90.22%), ear canal secretion (10, 4.44%), bronchoalveolar lavage fluid (4, 1.78%), and 8 other types (3.56%). The accurate identification rate (148/225) was 65.78%, and the mis-identification rate (77/225) was 34.22%. Conclusion The most common filamentous fungal infection pathogen were Aspergillus spp., mainly Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger. The mis-identification rate of traditional identification methods is higher than 30%. Using mass spectrometry method combined with ITS /CAM sequencing analysis could effectively improve the identification accuracy of filamentous fungi and provide precise etiological basis for clinical treatment.

    Investigation of vaginal fungal infections in non-pregnant women
    HUANG Li, GONG Hao, ZHANG Chun-lian, FANG Cai-yun
    2020, 15(4):  213-217. 
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    Objective To understand the vaginal fungal infections in non-pregnant women and to analyze its association with other pathogenic microbial infections. Methods The clinical data of 354 non-pregnant women who underwent comprehensive examination of vaginal microbes were retrospectively analyzed, and the differences in the incidence rates of vaginal fungal infections were analyzed under different ages, educational levels, genital hygiene habits, sexual habits and other vaginal pathogenic microbial infections. Results A total of 102 cases (28.81%) of the 354 women were found to have vaginal fungal infections, and 115 fungi strains were isolated, and mainly were Candida albicans, Candida glabrata and Candida tropicalis. There was a statistically significant difference in the vaginal fungal infection rates among women with different educational levels, frequency of underwear replacement, habit of hygienic pad, frequency of vaginal washing, application history of oral contraceptives and infection of vaginal bacteria and mycoplasma/chlamydia (P<0.05). However, there was no statistically significant difference in vaginal fungal infection rate among women of different ages, underwear materials, frequency of sexual life, condom use habits and vaginal trichomoniasis infection (P>0.05). Conclusion Vaginal fungal infection in non-pregnant women is associated with a variety of factors. It is necessary to carry out systematic and comprehensive health education for the corresponding high-risk groups, and to pay attention to the early screening of fungal infections in patients with other positive vaginal pathogenic microbes.

    The clinical characteristics of tineacapitis caused by Trichophyton rubrum and the literature review of the recent 10 years
    YANG Hong, GAO Zhi-qin, CHEN Jian, REN Hong-jin, CAI Qing, TAN Jing-wen, LIU Xiao-ping, DAI He-jun, YANG Lian-juan
    2020, 15(4):  218-222. 
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    Objective The clinical characteristics of tinea capitis caused by Trichophyton rubrum were studied by the clinical analysis of 4 cases and the literature review of the recent 10 years. Methods According to clinical and mycology manifestation, 4 cases of tinea capitis caused by T. rubrum were diagnosed. We summarized their clinical characteristics, and review of the literatures in recent 10 years. Results The first 3 cases were preschool children, the fourth case was elderly female, and only 1 case had pet contact history. The three children's patients suffered from different degrees of tinea pedis and onychomycosis and were used to scratching feet; The fourth case suffered from diabetes mellitus and onychomycosis more than 10 years. The results of the fungal culture of the infected hair and nails scales were all T. rubum. After standardized oral antifungal drug treatment, all 4 patients were cured within 4-8 weeks. Literature review found that in the last 10 years, the frenquency of T. rubrum in tinea capitis was 0.6%-15.8% in domestic literature, and 0.8%-28.8% in English literature. The clinical manifestations were diverse, including erythema scale, alopecia, exudation and other lesions, kerion and black spots. Conclusion Tinea capitis caused by T. rubrum is not uncommon. Close contact infection with family members suffering from superficial fungal disease and self infection is an important mode of transmission of T. rubrum. Only by raising the awareness of different clinical forms of tinea capitis and using fungal examination as a routine examination method can help us to confirm more cases of tinea capitis.

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