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脓癣

脓癣(Kerion Celsi)是由皮癣菌感染头皮及毛囊并继发细菌感染的化脓性皮癣菌病,是皮癣菌病的最严重形式。[1] [2] [3] 最常见罹患部位是头皮,但也可发生在暴露于真菌的任何其他部位,如面部(头癣)与上肢(体癣)。脓癣常由白癣或黑点癣发展而来,约80%的脓癣由犬小孢癣菌(Microsporum canis)引起。脓癣必须口服抗真菌药治疗才能痊愈,局部用药无效。脓癣经常被误诊为细菌性脓肿,一旦采用手术切开引流,则会迁延不愈。[4] [5]

脓癣也叫凯氏蜂窝病Kerion英语Kerion Celsi),由古罗马医学家、百科全书编纂家凯尔苏斯率先在他的八卷巨著《医术》(De Medicina英语De Medicina)中描述。

除了皮癣菌外,其他真菌能够导致脓癣。中国广州医院报道隆起曲霉菌(Aspergillus protuberus)引发脓癣。[6]

临床表现

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引起脓癣的真菌多为嗜动物型,少数为嗜人型或嗜地型菌株,因此人类机体对这些皮癣菌感染发生剧烈的炎症性与肉芽肿性反应。脓癣多发生于儿童,尤其是学龄前儿童。最初表现为化脓性毛囊炎,群集性小脓疱融合形成结节或肿块,界限清楚,质地柔软,表面有与毛囊口一致的小脓点。当肿块变大后则呈现蜂窝状或海绵状,挤压时有多孔溢脓现象。如果形成瘘,脓液也可从瘘道流出。可见局部淋巴结肿大。肿块常伴随炎症反应,如红、肿、热、痛。毛发稀疏并脱落,导致秃顶。少数患者会因发烧而全身不适。可能会出现广泛的瘙痒性湿疹样皮疹。[7]

病因

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引起脓癣的真菌多为嗜动物型,少数为嗜人型或嗜地型菌株。这些致病菌株包括犬小孢癣菌(Microsporum canis)、石膏状小孢癣菌(M. gypseum)、 断发毛癣菌(Trichophyton tonsurans)、疣状毛癣菌(T. verrucosum)与下颔毛癣菌(T. mentagrophytes)等。红色毛癣菌(T. rubrum)不是脓癣的常见原因。[8] [9]

诊断

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根据临床表现与体征,可初步作出脓癣的诊断。确诊有赖于显微镜检查和真菌培养,样品为取自患处的刮屑和毛发。同时也应采集细菌拭子作涂片观察和培养。[10]

传染性

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脓癣可以传染到自己身体的其他部位,或任何与其接触的人,如家人、同学、朋友等。不要与他人共用被褥和毛巾。不要接触宠物如猫、狗等,以免通过动物感染家人。梳子和发刷应消毒或丢弃,以防止传染或自我再感染。[11]

治疗

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脓癣必须口服抗真菌药治疗,通常至少要开6-8周的疗程。局部用抗真菌剂无效,因为真菌深深侵入毛囊。灰黄霉素仍为首选,也可使用特比萘芬伊曲康唑。如果存在细菌感染,则需要使用抗生素。含有酮康唑或环吡酮的抗真菌洗发剂有助于降低传染他人的风险。切忌手术切开引流,否则会迁延不愈。[12]

预后

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绝大多数脓癣患者经口服抗真菌药治疗可以痊愈。头发在治疗后会重新长出,但长期得不到医治者可能导致永久性脱发。

参考文献

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  1. ^ 中国头癣诊疗指南工作组. 中国头癣诊断和治疗指南(2018修订版)。中国真菌学杂志 2019年2月 第14卷 第1期 4-6页, Chin J Mycol,Feburary 2019, 14 (1): 4-6. (PDF). 
  2. ^ R Vanbreuseghem, C D Vroey. Systemic opportunistic fungal infections. Postgrad Med J 1979 Sep;55(647):593-4. doi: 10.1136/pgmj.55.647.593. (PDF). 
  3. ^ Uprety, Shraddha; Sharma, Ramesh. Kerion — A Boggy Lump. New England Journal of Medicine. 375 (10): 980.. [2021-02-26]. (原始内容存档于2019-04-09). 
  4. ^ 李若瑜. 脓癣该怎么治疗?-医学微视. [失效連結]
  5. ^ Vikash Paudel,. Surgery of Kerion, a Nightmare for Nondermatologists, Case Reports in Dermatological Medicine, vol. 2020, Article ID 8825912, 3 pages, 2020.. [2021-02-26]. (原始内容存档于2020-12-01). 
  6. ^ Jia, J., Chen, M., Mo, X.; et al. The first case report of kerion-type scalp mycosis caused by Aspergillus protuberus. BMC Infect Dis 19, 506 (2019).. [2021-02-26]. (原始内容存档于2020-12-04). 
  7. ^ L. C. Fuller; F. J. Child; G. Midgley; E. M. Higgins. Diagnosis and management of scalp ringworm. BMJ. 326 (7388): 539–541. doi:10.1136/bmj.326.7388.539.. [2021-02-26]. (原始内容存档于2022-02-21). 
  8. ^ Reyes IAF, Vega DC, Arriaga LFR; et al. Kerion celsi caused by microsporum gypseum: report of two cases and review. J Dermat Cosmetol 2018;2(3):151-157. DOI:10.15406/jdc.2018.02.00066. 
  9. ^ Annemay Chollet, Vincent Cattin, Marina Fratti, Bernard Mignon, Michel Monod. Which Fungus Originally was Trichophyton mentagrophytes? Historical Review and Illustration by a Clinical Case. Mycopathologia (2015) 180:1–5 DOI 10.1007/s11046-015-9893-2.. 
  10. ^ Reyes IAF, Vega DC, Arriaga LFR; et al. Kerion celsi caused by microsporum gypseum: report of two cases and review. J Dermat Cosmetol. 2018;2(3):151-157. DOI:10.15406/jdc.2018.02.00066. 
  11. ^ L Trovato et al (2019). Molecular diagnosis of kerion celsi caused by Trichophyton tonsurans in a Italian child.. [2021-02-26]. (原始内容存档于2018-06-10). 
  12. ^ Hay, R.J. Molecular diagnosis of kerion celsi caused by Trichophyton tonsurans in an Italian child. Med Mycol Case Rep. 2019 Jun; 24: 72–74.. 
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脓癣
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