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 12021/7/20 2021/7/20 星期二星期二浅部感染真菌浅部感染真菌n表面感染真菌n皮肤癣真菌皮肤癣真菌n皮下组织真菌感染2 22021/7/20 2021/7/20 星期二星期二3 32021/7/20 2021/7/20 星期二星期二表面感染真菌表面感染真菌n 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 n统称：角层癣菌 n n代表：秕糠马拉癣菌(Malassezia furfur)n 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 n诱发因素为高温多汗4 42021/7/20 2021/7/20 星期二星期二Malassezia furfurn nTinea versicolor on skin surface(sweat stain)n nThelesionsaresmallhypopigmentedorhyperpigmentedmaculesn nMostcommonsite:back,underarm,upper arm,chest,neck n nMost common in adolescent and young adult males n nAssociated with increased sweating5 52021/7/20 2021/7/20 星期二星期二PityriasisversicolorshowinghyperpigmentedlesionsinaCaucasianandhyphopigmentedlesionsinanAustralianAborigine6 62021/7/20 2021/7/20 星期二星期二Culture of Malassezia furfur on Dixons agar(contains glycerol mono-oleate)7 72021/7/20 2021/7/20 星期二星期二Piedraia hortae(何德毛结节菌何德毛结节菌)n nIt usually affected the scalp hairn nThe nodules are darker in color,harder,and more firmly attached to the hairsn nBlack Piedra8 82021/7/20 2021/7/20 星期二星期二Piedraia hortaeformsahardsuperficialpigmentednodulearoundthehairshaft(在毛干上形成硬的黑色结节，如沙粒状)9 92021/7/20 2021/7/20 星期二星期二Fungal otitis externan nFungal infection of the external auditory canaln nCaused by several species of Aspergillus(most often A.niger),but Candida albicans is also capable of infecting this siten nThe major symptoms are itching and feeling of fullness in ear10102021/7/20 2021/7/20 星期二星期二11112021/7/20 2021/7/20 星期二星期二皮肤癣真菌皮肤癣真菌n n引起皮肤浅部感染n n皮肤癣是人类最多见的真菌病n n统称：皮肤癣菌，大约40多个种，分属于3个属n 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 n病理变化：由真菌增殖及代谢产物刺激宿 主引起12122021/7/20 2021/7/20 星期二星期二致病性 指（趾）甲指（趾）甲 皮肤皮肤 毛发毛发毛癣菌属毛癣菌属 +表皮癣菌属表皮癣菌属 +-+-小孢子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13132021/7/20 2021/7/20 星期二星期二14142021/7/20 2021/7/20 星期二星期二TineapediscausedbyT.rubrum.Sub-clinicalinfection(left)showingmildmacerationunderthelittletoeandmoresevereinfection(right)showingextensivemacerationofalltoewebspacesTineaistransmittedviathefeetbydesquamatedskinscalesinsubstrateslikecarpetandmatting.15152021/7/20 2021/7/20 星期二星期二手足癣治疗原则n n水疱型温和搽剂和霜剂水疱型温和搽剂和霜剂n n角化过度型先角质剥脱剂，再用抗真角化过度型先角质剥脱剂，再用抗真菌霜剂菌霜剂n n浸渍糜烂型粉剂收干，抗继发感染，浸渍糜烂型粉剂收干，抗继发感染，再温和抗真菌再温和抗真菌16162021/7/20 2021/7/20 星期二星期二Tinea Unguiumn nusually caused by Trichophyton sp17172021/7/20 2021/7/20 星期二星期二甲癣治疗原则n n局部治疗甲涂剂局部治疗甲涂剂n n系统治疗伊曲康唑，特比萘芬等系统治疗伊曲康唑，特比萘芬等n n联合治疗配合拔甲或削甲治疗联合治疗配合拔甲或削甲治疗18182021/7/20 2021/7/20 星期二星期二Tinea Corporis:caused by caused by M.canisM.canis,following contact with infectious kittensfollowing contact with infectious kittens 19192021/7/20 2021/7/20 星期二星期二 Tinea Cruris(Jock itch):Infection of the groin,mainly seen in menInfection of the groin,mainly seen in men20202021/7/20 2021/7/20 星期二星期二Tinea Capitis(scalp ringworm)Tinea favosa发内孢子发内孢子21212021/7/20 2021/7/20 星期二星期二Tinea Capitis(scalp ringworm)Tinea alba发外孢子发外孢子22222021/7/20 2021/7/20 星期二星期二Tinea Capitis(scalp ringworm)脓癣脓癣23232021/7/20 2021/7/20 星期二星期二头癣治疗原则n n剪发剪发n n洗发洗发n n搽药搽药n n服药服药n n消毒消毒24242021/7/20 2021/7/20 星期二星期二Candidiasis of skin,mucous membranes and nailsn n Predisposing factorsInfancy,pregnancy,old ageInfancy,pregnancy,old ageDisorders of immune function,e.g.,leukemia,Disorders of immune function,e.g.,leukemia,corticosteroid therapycorticosteroid therapyChemotherapy,e.g.,immunosuppressive,Chemotherapy,e.g.,immunosuppressive,antibioticantibioticEndocrine disease,e.g.,diabetes mellitusEndocrine disease,e.g.,diabetes mellitusCarcinomaCarcinoma25252021/7/20 2021/7/20 星期二星期二念珠菌性间擦疹念珠菌性间擦疹好发部位：腋窝、乳房下、好发部位：腋窝、乳房下、腹股沟、会阴，多见于婴儿腹股沟、会阴，多见于婴儿及肥胖者。及肥胖者。26262021/7/20 2021/7/20 星期二星期二n nCutaneouscandidiasis:includingCutaneouscandidiasis:includingInterdigitalcandidiasisInterdigitalcandidiasis,diapercandidiasis,paronychiaandonychomycosisdiapercandidiasis,paronychiaandonychomycosisn nVulvovaginalcandidiasisandbalanitisVulvovaginalcandidiasisandbalanitisInterdigital candidiasis Candidiaonychomycosisandparonychia27272021/7/20 2021/7/20 星期二星期二n nOropharyngealcandidiasis:includingthrush,glossitis,stomatitisandangularcheilitisOralthrush28282021/7/20 2021/7/20 星期二星期二皮下组织真菌感染皮下组织真菌感染n n主要有孢子丝菌和着色真菌n 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 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。29292021/7/20 2021/7/20 星期二星期二Sporotrichosis此菌可经微小损伤侵入皮肤，然后沿淋巴管分布，引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。为孢子丝菌下疳。30302021/7/20 2021/7/20 星期二星期二n nChromomycosisn nInfections occur in exposed areas,skin lesions become dark,so called chromomycosisn nRepresentive species:Cladosporium carrianii,Fonsecaea pedrosoi,etc.n nAre saprophytic fungi,usually enters the body by trauma31312021/7/20 2021/7/20 星期二星期二n n经外伤侵入n n丘疹n n结节n n结节融合成疣状或菜花状n n斑痕形成影响淋巴回流n n肢体象皮肿32322021/7/20 2021/7/20 星期二星期二ChromomycosisChronicverrucouschromoblastomycosisofthehandduetoCladophialophora carrionii33332021/7/20 2021/7/20 星期二星期二Mycetoma 足分枝菌病足分枝菌病n 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，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。主要感染足部，以肿胀、窦道和颗粒为特征。n