Table of Content

28 February 2021, Volume 16 Issue 1

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Original articles

A comparative analysis of fluorescent staining and G/GM test of bronchoalveolar lavage fluid in 142 cases

LI Gangrong, BAI Mingming, TAO Chaoxin, YANG Huitao, XU Liya

2021, 16(1):  6-9. 

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Objective To investigate the significance of detection of bronchoalveolar lavage fluid (BALF) by fungal immunofluorescent staining in the diagnosis of pulmonary fungal infection. Methods From January to December 2019, 142 BALF samples sent to our institute were tested by G/GM test and fungal immunofluorescent staining. Results In BALF of 142 cases,52 cases (36.62%) were positive by immunofluorescent staining, 49 cases were positive by G test, and 11 cases were positive by GM test. The positive rate of immunofluorescent staining was significantly higher than that of KOH microscopic examination in 27 cases (19.01%). Conclusion As a fast, convenient, efficient and direct routine detection method of fungi, direct microscopy with immunofluorescent staining was an important supplement for the detection of fungi in lavage fluid samples, and provided a fast detection method for the diagnosis of clinical pulmonary fungal infection.

Diagnosis and treatment of tinea manus and tinea pedis in Chinese primary medical institutions: a nationwide online survey

ZHU Hongmei, WEN Hai

2021, 16(1):  10-13,23. 

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Objectives To investigate the present management of tinea manus and tinea pedis in Chinese primary medical institutions, to analysis the related factors of current condition and provide corresponding measures and strategies. Methods A nationwide online survey was carried out during early 2020. Doctors worked in primary medical institutions of 19 different districts were investigated with a questionnaire. Results Finally 729 doctors completed and submitted the questionnaires. 1About 20% of the primary care physicians showed insufficient understanding of the correlative pathogenic factors of tinea manus and pedis, and about 50% of them had misunderstandings in the affected tissue localization.2Lacking fully conception about the importance of differential diagnosis, less than half of these doctors performed fungal microscopic examination during their management of suspected tinea manus and tinea pedis.3These doctors could recommend topical antifungal drugs correctly, the selection rate of miconazole nitrate cream was more than 80% among the commonly used azoles and acrylamides.4There were 10.70% of those doctors who still recommended topical glucocorticoids wrongly. Conclusions The basic knowledge and standard diagnosis and treatment of tinea manus and tinea pedis need to be improved in primary care physicians. The regularly continue education and routine guidance in differential diagnosis, medical application also might be urgent needs in those doctor group.

The effect of allicin on the morphological transition of Candida albicans

XIONG Yanjing, LI Rongyu, WU Yanhong

2021, 16(1):  14-18. 

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Objective To investigate the effect and mechanism of allicin on morphological transition of Candida albicans. Methods The inverted process of dynamic formation of Candida albicans hyphae was observed under microscope. CLSI-M27-A3 microdilution method was used to detect the minimum inhibitory concentration(MIC)of allicin against Candida albicans. The effect of allicin on the hyphal formation of Candida albicans in Spider liquid medium was observed under inverted microscope. qRT-PCR method was used to measure the expression of hypal related genes HWP1,ALS1,EFG1 and PDE2 of Candida albicans under the effect of allicin. Results Long hyphae began to appear in the Spider liquid medium at 6h. After 24 hours, a large number of hyphal wrapped yeast cells which interlaced tightly could be seen under inverted microscope. The MIC of allicin against to Candida albicans was 25 μg/mL. The growth of Candida albicans hyphae could be significantly inhibited by allicin in concentrations of 25-100 μg/mL in Spider liquid media. qRT-PCR results showed that the expression of hyphae related genes was down-regulated under the effect of allicin in concentrations of 25-100 μg/mL. Conclusion Allicin could significantly inhibit the morphological transition of Candida albicans, and the mechanism may correlate to the regulation of the expression level of the genes which related to hyphal formation.

Clinical characteristics and diagnostic value of KL-6 in Pneumocystis jirovecii pneumonia

CHEN Yanhui, ZHONG Qiaoshi, HANG Yaping, FANG Xueyao, XIAO Yanping, CAO Xingwei, ZHU Hongying, LUO Hong, HU Longhua

2021, 16(1):  19-23. 

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Objective To analyze the prevalence, clinical characteristics and serological markers of pneumocystis jirovecii pneumonia (PJP) patients in this region, and to provide theoretical basis for early prevention and early diagnosis of PJP. Methods A retrospective study of 49 hospitalized patients with PJP from January 2016 to December 2019 in three general hospitals in jiangxi province was conducted. Information was collected regarding patient demographics, clinical manifestations, risk factors, laboratory analyses, radiological images, and treatment outcomes. Results The vast majority of PJP were HIV negative (89.8%) and were predominantly found in middle-aged males. HIV/AIDS, kidney disease (47.7%) and connective tissue disease (29.6%) were the main risk factors for PJP. The main clinical manifestations were dry cough (83.7%), white phlegm, and fever (79.6%), followed by dyspnea. The PJP patients had received glucocorticoid, immunosuppressant and/or chemotherapy in a low dose or for a short duration (<3 months). Biochemical investigations of Neu%, CRP, PO₂, LDH, and KL-6 showed that over 85% of cases exceeded the reference range of indicators. Conclusion HIV-negative patients infected with PJ were increasing, and renal disease and connective tissue disease might be main risk factors. LDH, BG and kl-6 might be used as important auxiliary examinations for PJP patients.

Clinical analysis of 76 pediatric cases of cryptococcal meningitis

LIU Wenhui, CHEN Junhua

2021, 16(1):  24-28. 

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Objective To analyze the clinical features of cryptococcal meningitis in children. Methods Clinical date of 76 children with cryptococcal meningitis were analyzed. Results There were 47 males and 29 females, with an average age of (6.34±3.67) years. The main clinical manifestations were fever (100%), headache (78.95%) and vomiting (81.58%). The etiological test turned out that the positive rate of cerebrospinal fluid ink staining accounted for 60.53% (46 cases), the cryptococcal culture positive rate accounted for 27.63%(21 cases) at the first time. There were 74.19% patients cured after receiving the combined treatment of amphotericin B and 5-fluorocytosine, 62.96% patients cured after receiving the treatment of amphotericin B and fluconazole, but the difference was not statistically significant(P=0.75). Conclusions Crypotococcal meningitis in children was easely misdiagnosed, multiple and repeated lumbar punctures were beneficial to the diagnosis. amphotericin B combined with 5-fluorocytosine was the first choice for antifungal therapy.The key to improve the prognosis was early diagnosis and reduce intracranial pressuer effectively.

The analysis of risk factors and outcomes of peritoneal dialysis-related fungal peritonitis

LI Yi, GUO Jia, WANG Jingshuang, YIN Shupei, ZHAO Jinghong, HUANG Yunjian

2021, 16(1):  29-34. 

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Objective To evaluate the incidence, pathogenic fungi, treatment and prognosis of peritoneal dialysis-associated fungal peritonitis (FP). Methods The clinical data of 18 cases of FP in the peritoneal dialysis center of the Second Affiliated Hospital of the Army Medical University from January 2010 to October 2019 were retrospective analyzed. The clinical data, treatment methods and outcomes of all FP patients were recorded and compared with those of 113 cases of no fungal peritonitis. Results Three hundred and eighty nine cases of peritoneal dialysis-related peritonitis were reviewed, FP accouted for 4.6%. There were 6 cases (33.3%) of Candida albicans, 5 cases (27.8%) of Candida parapsilosis, 3 cases (16.7%) of Candida famata, 2 cases (11.1%) of Candida smooth, 1 case of Candida tropical (5.6%) and 1 case of Candida krusei(5.6%). Compared to no fungal peritonitis group, The FP group showed the longer duration of peritoneal dialysis (P<0.001), higher rate of previous antibiotic use (P<0.001), lower serum albumin (P<0.001), higher c-reactive protein (P<0.001), higher intact parathyroid hormone (P<0.001) and higher phosphorus (P<0.001). Logistic regression analysis showed that the longer duration of peritoneal dialysis, antibiotic use within 1 month, hypoalbuminemia and high c-reactive protein were risk factors for FP (P<0.05). Among the 18 FP patients, 14 patients (77.8%) were removed the catheter to maintenance hemodialysis and 4 patients (22.2%) died. The technique failure rate of peritoneal dialysis and mortality in FP group was significantly higher than that in no fungal peritonitis group. Conclusion Long term peritoneal dialysis, previous use of antibiotics, hypoalbuminemia and high c-reactive protein were high risk factors for FP. FP was a serious complication of peritoneal dialysis and a major cause of technical failure. Early catheter removal after diagnosis could reduce the mortality of FP.

A retrospective analysis of the global cases caused by Exophiala dermatitidis

ZHU Xinlin, HONG Nan, ZHANG Chao, CAI Liangqi, LI Xinhua, DENG Shuwen, PAN Weihua, CHEN Min, LIAO Wanqing

2021, 16(1):  35-43. 

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Objective To analyze the epidemiological trends and clinical characteristics of global cases caused by Exophiala dermatitidis, and to provide a scientific basis for improving the clinical diagnosis and treatment of E. dermatitidis infections. Methods Using the method of literature review and meta-analysis to analyze the nationality, gender, age, risk factors, onset organs, clinical manifestations, diagnosis, treatment and prognosis for epidemiological and clinical characteristics of E. dermatitidis worldwide. Results E. dermatitidis infections could occur in immunocompetent and immunocompromised hosts. The gender ratio of the patients was 1.10:1.00, The most common age of onset was ranging from 51~60 years old. The lung (27.90%, 17/61) was the most frequently-affected organ, but the most common sites are different between in different regions. Approximately half (47.54%) of the patients had various underlying diseases or risk factors. Diagnosis of E. dermatitidis infections mainly relied on culture and molecular identification. For systemic infections caused by E. dermatitidis, combination of itraconazole and terbinafine were recommended. Conclusion The incidence of E. dermatitidis infections has increased recently. The most commonly-affected organs in systemic infections are lungs, and the diagnosis mainly depends on culture. Strengthening the antifungal susceptibility monitoring and the investigation of epidemiology for E. dermatitidis are crucial to improve the diagnosis and treatment of E. dermatitidis infections.

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A case of bullous pemphigoid complicated with cutaneous alternariosis

DU Xiaoqing, MA Yuxin, YAO Limin, CHENG Yan

2021, 16(1):  44-45,50. 

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A male patient of seventy was diagnosed as bullous pemphigoid 11 months ago in another hospital and then treated with "methylprednisolone and cyclosporine" for a long time. There were multiple dark red nodules and ulcers on both of his forearms and hands for more than half a month. It was confirmed as Alternaria by fungal microscopic examination and culture of skin ulcer necrosis. Finally, the lesions basically disappeared after voriconazole treatment.

A case of refractory sporotrichosis

DONG Jiazheng, LIANG Guanzhao, XU Xiulian, LIU Weida

2021, 16(1):  48-50. 

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We report a case of refractory sporotrichosis due to the abuse of oral glucocorticoid. A 61-year-old female patient had a stab wound on the right wrist and was diagnosed as sporotrichosis. After antifungal treatment for six months, her condition deteriorated and came to our hospital for treatment. Fungal microscopy, culture, molecular biology detection and the pathological examination were performed and the results support the diagnosis of sporotrichosis. When asking about the medical history, it was found that the patient had the habit of taking oral glucocorticoid tablets on a daily basis. The patient was instructed to stop the glucocorticoid and take oral itraconazole for 4 months and was successfully cured eventually.