主要致病性真菌浅部真菌感染（致病性真菌感染和条件致病性真菌感染）深部真菌感染（致病性真菌感染和条件致病性真菌感染）1 1浅部感染真菌n表面感染真菌n皮肤癣真菌n皮下组织真菌感染2 23 3表面感染真菌n位置：寄居于人体皮肤和毛干的最表层 。因不接触组织细胞，很少引起宿主细 胞反应n统称：角层癣菌 n代表：秕糠马拉癣菌(Malassezia furfur)n症状：由于此菌能产生对黑色素细胞有 抑制作用的二羧酸，使花斑癣局部色素 减退，如汗渍斑点，俗称汗斑。n诱发因素为高温多汗4 4Malassezia furfurnTinea versicolor on skin surface (sweat stain)nThe lesions are small hypopigmented or hyperpigmented maculesnMost common site : back, underarm, upper arm, chest, neck nMost common in adolescent and young adult males nAssociated with increased sweating5 5Pityriasis versicolor showing hyperpigmented lesions in a Caucasian and hyphopigmented lesions in an Australian Aborigine6 6Culture of Malassezia furfur on Dixons agar (contains glycerol mono-oleate)7 7Piedraia hortae (何德毛结节菌)nIt usually affected the scalp hairnThe nodules are darker in color, harder, and more firmly attached to the hairsnBlack Piedra8 8Piedraia hortae forms a hard superficial pigmented nodule around the hair shaft (在毛干上形成硬的黑色结节，如沙粒状)9 9Fungal otitis externanFungal infection of the external auditory canalnCaused by several species of Aspergillus (most often A.niger), but Candida albicans is also capable of infecting this sitenThe major symptoms are itching and feeling of fullness in ear10101111皮肤癣真菌n引起皮肤浅部感染n皮肤癣是人类最多见的真菌病n统称：皮肤癣菌，大约40多个种，分属于3 个属n嗜角质蛋白，37不能生长，侵犯部位：角 化的表皮，毛发，指（趾）甲n病理变化：由真菌增殖及代谢产物刺激宿 主引起 1212致病性指（趾）甲 皮肤 毛发毛癣菌属 + + + 表皮癣菌属 + + -小孢子癣菌属 - + + 一种皮肤癣菌可在不同部位引起病变相同部位的病变也可由不同的皮肤癣菌引起13131414Tinea pedis caused by T. rubrum. Sub-clinical infection (left) showing mild maceration under the little toe and more severe infection (right) showing extensive maceration of all toe web spaces Tinea is transmitted via the feet by desquamated skin scales in substrates like carpet and matting. 1515手足癣治疗原则n水疱型温和搽剂和霜剂n角化过度型先角质剥脱剂，再用抗真 菌霜剂n浸渍糜烂型粉剂收干，抗继发感染， 再温和抗真菌1616Tinea Unguiumnusually caused by Trichophyton sp1717甲癣治疗原则n局部治疗甲涂剂n系统治疗伊曲康唑，特比萘芬等n联合治疗配合拔甲或削甲治疗1818Tinea Corporis:caused by M. canis, following contact with infectious kittens 1919Tinea Cruris (Jock itch): Infection of the groin, mainly seen in men2020Tinea Capitis (scalp ringworm)Tinea favosa发内孢子2121Tinea Capitis (scalp ringworm)Tinea alba发外孢子2222Tinea Capitis (scalp ringworm)脓癣2323头癣治疗原则n剪发n洗发n搽药n服药n消毒2424Candidiasis of skin, mucous membranes and nailsn Predisposing factors Infancy, pregnancy, old age Disorders of immune function, e.g., leukemia, corticosteroid therapy Chemotherapy, e.g., immunosuppressive, antibiotic Endocrine disease, e.g., diabetes mellitus Carcinoma2525念珠菌性间擦疹好发部位：腋窝、乳房下、腹股沟、会阴，多见于婴儿及肥胖者。2626nCutaneous candidiasis : including Interdigital candidiasis, diaper candidiasis, paronychia and onychomycosisnVulvovaginal candidiasis and balanitisInterdigital candidiasis Candidia onychomycosis and paronychia 2727nOropharyngeal candidiasis : including thrush, glossitis, stomatitis and angular cheilitisOral thrush2828皮下组织真菌感染n主要有孢子丝菌和着色真菌n申克孢子丝菌，属腐生性真菌，常因外伤接触 带菌的花草等引起感染。此菌可引起孢子丝菌 下疳。此菌也可引起深部感染。是一种二相性 真菌。n着色真菌感染发生在暴露部位，称着色真菌病 。我国主要有卡氏枝孢霉和裴氏着色芽生菌。2929Sporotrichosis此菌可经微小损伤侵入皮肤，然后沿淋巴管分布，引 起亚急性或慢性肉芽肿，使淋巴管形成链状硬结，称 为孢子丝菌下疳。3030nChromomycosisnInfections occur in exposed areas, skin lesions become dark, so called chromomycosisnRepresentive species: Cladosporium carrianii, Fonsecaea pedrosoi, etc.nAre saprophytic fungi, usually enters the body by trauma3131n经外伤侵入n丘疹n结节n结节融合成疣状或菜花状n斑痕形成影响淋巴回流n肢体象皮肿3232ChromomycosisChronic verrucous chromoblastomycosis of the hand due to Cladophialophora carrionii 3333Mycetoma 足分枝菌病n是由多种放线菌或真菌引起的一种慢性化脓性肉芽肿性疾病 ，主要感染足部，以肿胀、窦道和颗粒为特征。 ncaused by fungi are called eumycetoma (40%)nActinomycetoma is caused by actinomycetes (60%)nIt is characterized by the formation of abscess, which contain large aggregates of fungal or actinomycete filaments known as grains3434nEumycetoma Dark grains Madurella mycetomatis Leptosphaeria senegalensis Exophiala jeanselmei Pale grains Fusarium sp. Acremonium sp. Scedosporium apiospermum Actinomycetoma White-yellow grains Actinomadura madurae Nocardia brasiliensis Yellow-brown grains Streptomyces somaliensis Red-pink grains Actinomycetoma pellettieri3535深部真菌感染n引起深部感染的真菌包括两大类：致病性真菌 与条件致病性真菌n致病性真菌主要有组织胞浆菌、球孢子菌、副 球孢子菌和芽生菌，这些真菌均属二相性。多见 于美洲，我国极少见。它们侵袭深部组织和内脏 以及全身，引起慢性肉芽肿样炎症、溃疡和坏死 。n条件致病性真菌包括有：念珠菌、隐球菌、曲 霉菌与毛霉菌、肺孢子菌等。3636Characteristics of systemic dimorphic mycosesnAre uncommon, often occurs in endemic areas nMost infections are asymptomatic or self-limitingnin immune-compromised hosts, infections are often fatalnThe pattern of infection are similar Route of acquisition is inhalation Pulmonary infection Disseminated infection (Blood, Bone marrow, Brain and CSF, Joint)3737CoccidioidomycosisnCoccidiodes immitis is considered to be the most virulent of fungal pathogens.nRestricted to hot, semi-arid areas of SW USA and Mexico.nGrows in