Table of Content

28 October 2020, Volume 15 Issue 5

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Expert forum

Clinical Application of Terbinafine：Expert consensus

Expert group of consensus on the clinical application of Terbinafine

2020, 15(5):  257-261. 

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Original articles

Impact of different culture conditions on the identification of Candida krusei clinical isolates by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system

HUANG Jing-jing, FAN Xin, XIAO Meng, XU Zhi-peng, ZHANG Ge, XU Ying-chun

2020, 15(5):  262-267. 

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Objective To investigate the effects of different culture media, incubation time, culture temperature and gas environment on the identification of Candida krusei by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Methods Twenty-five strains of Candida krusei were collected from 17 hospitals of China Hospital Invasive Fungal Surveillance Net (CHIF-NET) program. Six culture media were tested, including Sabouraud dextrose agar supplemented with chloramphenicol (SDA-C), CHROMagar (CCP), trypticase soy agar supplemented with 5% sheep blood (BAP), chocolate agar supplemented with vancomycin (CAP-VA), China blue lactose rosolic acid agar (CBA/R) and MacConkey agar (MAC). All isolates were identified by sequencing of the rDNA internal transcribed spacer (ITS) region as "gold standard". Isolates were incubated at 28℃ and 35℃ for 24 or 48 hours, with/without 5% CO₂ gas, and then identification was carried out by two MALDI-TOF MS systems. Results All (175/175) isolates incubated for 24 hours and 48 hours were identified correctly by Vitek MS. In comparison, Bruker Biotyper correctly identified 98.86% (173/175) isolates incubated for 24 hours and 87.43% (153/175) isolates incubated for 48 hours. All strains inoculated on SDA-C medium were correctly identified by both MALDI-TOF MS systems, but the accuracy of the species level of identification of which grown on SDA-C at 28℃ is higher than those grown at 35℃. With 48 hours' incubation, the correct identification rates by Bruker Biotyper were higher for strains grown on SDA than other media. Conclusion The correct identification rate of 24-hour incubated strains was higher than the rate of 48-hour incubated strains by Bruker MS. Compared with cultured at 35℃, the identification of Candida krusei strains grown at 28℃ was more accurate. SDA-C was the most suitable media for MALDI-TOF MS identification in our study. The results were reliable for Bruker Biotyper MALDI-TOF MS system with score values of≥1.700.

Efficacy of long pulsed Nd:YAG 1064nm laser for the treatment of distal lateral subungual onychomycosis and effect on the ultrastructural changes of fungi

WANG Ling, JING Dong-yun, WANG Xue-jun, LIU Jun, CAO Yue-qing

2020, 15(5):  268-273. 

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Objective To evaluate the efficacy of long pulsed Nd:YAG 1064nm laser for the treatment of distal lateral subungual onychomycosis and to observe the effect on the ultrastructural changes of fungi. Methods Distal lateral subungual onychomycosis cases with typical clinical manifestations and positive fungal microscopy examination were enrolled into this study, and treated with long pulsed Nd:YAG 1064 nm laser for 12 weeks. Clinical efficacy and mycological clearance were evaluated. The ultrastructural changes of long pulsed Nd:YAG 1064 nm laser in Trichophyton rubrum, Trichophyton interdigitale and Candida albicans were exhibited by scanning electron micrograph(SEM). Results Totally, 30 patients with distal lateral subungual onychomycosis (58 nails) were enrolled. There were 22 nails with nail matrix involvement. The clinical effective rate was 58.62% at 6 months after treatment. At the end of the treatment, the clinical effective rates of the nails without and with nail matrix involvement were 61.11%、9.09%,respectively. At 6 months after treatment, those were 80.56%、22.73%, respectively. There were significant differences,respectively(χ²=15.234、18.825,P<0.001、0.001). The mycological clearance rate was 58.62% at 6 months after treatment. At the end of treatment and 6 months after treatment, there was significant difference in the mycological clearance rate between the nails without and with nail matrix involvement(χ²=21.795、23.895,P<0.001、0.001). The results of SEM exhibited that the ultrastructure of the three strains after laser irradiation was damaged. Conclusion Long pulsed Nd:YAG 1064 nm laser was a safe and effective method for the treatment of distal lateral subungual onychomycosis without nail matrix involvement, and the laser could change the cellular ultrastructure of fungi.

Analysis of fungal pathogens in 625 cases of tinea capitis in Hubei province and surrounding areas

FANG Mei-zhen, LIU Zhong, JIANG Ping, YANG Jing, DONG Bi-lin, ZENG Zhi-liang, CHEN Zun-yi, TONG Zhong-sheng

2020, 15(5):  274-277. 

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Objective To analyze the pathogens and clinical characteristics of tinea capitis cases in Hubei province and surrounding areas during the period 2011 to 2018. Methods The basic information of patients diagnosed as tinea capitis in the mycology laboratory,department of Wuhan first hospital from 2011 to 2018 were retrospectively analyzed. Results A total of 625 patients were diagnosed tinea capitis, include 252 males and 373 females, with onset ages ranging from 1 month to 84 years old. Positive culture: 507 (81.24%) cases, negative culture: 118 (18.76%) cases. Pathogenic fungus was given priority to with Trichophyton violaceum (49.90%), followed by Microsporum canis, Trichophyton mentagrophytes, Trichophyton tonsurans, Trichophyton rubrum, Microsporum gypseum, Microsporum ferrugineum, Trichophyton schoenleinii. Among the culture-positive patients, 80 (15.78%) were adults. The highest prevalence was seen in the 0 to 12 years old group (82.65%). The priority of clinical manifestation was black-dot ringworm (57.99%), tinea alba, kerion, tinea favosa were rare. Conclusion The tinea capitis patients in Hubei province and surrounding areas was concentrated in 0-12 years old. The most common type was black-dot ringworm, mainly caused by Trichophyton violaceum.

Cryptococcal infection of the ribs mimicking malignant tumor: two cases report and literature review

HUANG Jin-bao, LAN Chang-qing, WEN Heng, LIN Qing-hua

2020, 15(5):  278-282. 

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Objective To study the characteristics of cryptococcal infection of the ribs. Method Two cases of cryptococcal infection of the ribs were described and literatures were reviewed. Results Case 1:A 37-old-man with hepatitis B virus carrier was admitted to our hospital complaining of cough, phlegm with blood and right chest pain for one month. A chest CT showed the right 5^th rib destruction with adjacent lumpy soft tissue. The patient was diagnosed with cryptococcal infection of the rib by pathological examination. He received surgery and anti-fungal drug treatment for 4 months and was stable without recurrence during the 3-year follow-up period. Case 2:A 31-old-man with thrombopenia was admitted to our hospital complaining of cough, phlegm with blood for 3 months and chest pain for 2 weeks. A chest CT showed mutiple rib destructions with adjacent lumpy soft tissue in the both sides. The patient was diagnosed with cryptococcal infection of the ribs by pathological examination. He was treated with anti-fungal drug for 6 months and was stable without recurrence during the 2-year follow-up period. Conclusions Solitary cryptococcal infection of the ribs is rare, and it is easily confused with tumor, tuberculosis and other diseases. The diagnosis depends mainly on histopathological examination. The patients can be obtained satisfactory results after treatment.

CT imaging diagnostic analysis of fungal rhino-sinusitis

CHEN Yi-xin, YAN Shi-ling, ZHU Yin-min, FAN Jing-ping, CHEN Xiao-ping, ZHOU En-hui, XUE Xiao-cheng, ZHANG Yi

2020, 15(5):  283-287. 

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Objective To analyze the CT imaging features of fungal rhino-sinusitis with the clinical symptoms, aimed at improving the diagnostic level for fungal rhino-sinusitis. Methods The data of 84 fungal rhino-sinusitis patients underwent endoscopic sinus surgery from 2014 to 2019 were collected, the correlation between clinical symptoms with subjective and objective scores was integrated, retrospective analysis of CT imaging features of patients with surgical and pathological confirmation was performed. Results The study of 84 cases of CT imaging characteristic features showed that most of the lesions occurred in the maxillary sinus and most cases involved two or more sinuses,the vast majority of the cases were unilateral andinvolvement of bilateral was seldom seen. All cases showed uneven soft tissue shadows, most cases were well-distributed high density calcification shadow in the sinus cavity with the CT value ranged between 71-494 Hu.The bone destruction or thickened of sinus wall could be seen as slight and limited in most of the sinuses, only one case involved intracranial bone destruction. The VAS score of 84 fungal rhino-sinusitis patients was 8.75±3.51 and the Lund-Mackay score was 6.27±3.51. There was significantly correlation between VAS score and Lund-Mackay CT score(r =0.76,P<0.01). Conclusion The study showed that the high density calcification shadow in the lesions of sinus cavity was the typical imaging features for the diagnosis of fungal rhino-sinusitis, moreover, the severity and extent of imaging manifestations were correlated with the degree of symptoms of patients, which would be helpful for comprehensive evaluation in perioperative period to improve the cure rate and quality of life.

Analysis of children superficial fungal infections

CHENG Ying, Chen Dan

2020, 15(5):  288-292. 

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Objective To explore the epidemiological characteristics and influencing factors of superficial fungal infections in children. Methods The superficial fungal examination results of 8343 children aged 0-14 who visited the dermatology department of our hospital from October 2018 to September 2019 were collected, and the superficial fungal infection and morbidity characteristics were analyzed combined with the gender, age, season, temperature and humidity. Results The superficial fungal infection rate of children was 17.20% (1435/8343), including 144 cases of tinea capitis, 235 cases of body ringworm, 27 cases of hand ringworm, 183 cases of onychomycosis, 55 cases of jock itch and 791 cases of tinea pedis, in which the tinea pedis accounted for the highest proportion, reaching 55.12%. According to the chi-square test, the overall detection rate of mycelium in children was higher than that of spores (P<0.001), and the detection rate of spores was higher than that of mycelia in children with tinea capitis (P<0.001), while the detection rates of mycelium were higher than that of spores in children with onychomycosis, tinea cruris and tinea pedis (P<0.001). The rate of superficial fungal infection in males was higher than that in females (P<0.001), children aged 0-3 had the lowest infection rate (P<0.001), and the infection rate was the highest in summer while lowest in winter (P=0.002). There were certain infection sites differences in different genders, ages and seasons. Correlation analysis showed that the rate of superficial fungal infection in children was significantly related to the monthly average temperature. The higher the temperature, the higher the infection rate (P<0.001). There was no correlation between the infection rate in children and relative humidity (P=0.966). Conclusion Superficial fungal infections are one of the important factors that cause children's skin symptoms. The detection rates of mycelium and spores of different types of superficial fungal infections have certain differences. Gender, age, season and temperature are important factors affecting children's superficial fungal infections.

Short articles

Clinical characteristics of 31 AIDS patients with Talaromyces marneffei pneumonia

QIN Ya-qin

2020, 15(5):  293-295. 

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Expert forum

Clinical application of terbinafine in the treatment of superficial mycosis

ZHU Hong-mei, WEN Hai

2020, 15(5):  297-303. 

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Terbinafine is the major antifungal agent usedforthe treatment of superficial mycosis, especially used as a first-line therapeutic choice for dermatophyte infection. In nearly three decades, terbinafine had been proved to be highly effective and safe for onychomycosis, tinea capitis, tinea corporis and cruris, tinea manus and pedis through widely clinical application. It also showed efficiency in some mucocutaneous candidosis cases.