ringwormjrtMar

Facial alopecia, 面部秃头scaling and erosions 结痂与侵蚀in a Jack Russell terrier杰克罗素梗,Author: Ross Bond,Editor: 蒿子枫, European Society of Veterinary Dermatology,T. mentagrophytes,Click to reveal the text on this screenClick the forward arrow to jump to the next screen,History 病史- 1,History,10 year-old entire male Jack Russell terrier 10岁未节育公犬Good general health 健康Progressive facial skin disease of 4 months duration持续4个月的进行性面部皮肤病No response to ampicillin and prednisolone对氨苄西林与泼尼松龙无效,History - 2,History,Dog lives in rural environment 住在乡下Lesion began as focal area of erythema and scaling caudal to nasal planum损伤自局部红疹,从后面向鼻结痂Progressed caudally over face despite therapy 尽管治疗,还是从尾向前面部发展,Clinical signs - 1,Signs,Severe skin disease;严重皮肤病 lesion well-demarcated损伤边界清析 Smooth-silvery skin at healing areas rostrally嘴部痊愈的皮肤呈银白色平滑,Alopecia, scaling, erosions秃头症,结痂,侵蚀 Nasal planum unaffected鼻头未被感染,How would youapproach this case?,Signs,What are the next steps you would take? 下一步?Make a list of your principle differential diagnosesDDX?List any samples you would collect采什么样?List any tests you would perform to assist in making a definitive diagnosis要做哪些测试,Tests - 1,Differentials,Principle differential diagnoses 主要鉴别诊断Dermatophytosis皮真菌病Demodecosis蠕形螨Deep pyoderma深部脓皮病Pemphigus foliaceus落叶天疱疮,Tests - 2,Tests,Diagnostic tests诊断测试Skin scrapings刮片Woods light examination伍德灯Fungal and bacterial cultures真菌与细菌培养(Skin biopsy)活检,Results - 1,Tests,No evidence of parasites & fungal elements on microscopy镜下未见寄生虫与真菌No fluorescence on Woods light examination伍德灯未见荧光Fungal growth evident on mycobiotic agar within 7 days of incubation真菌培养需要7天孵化,Results - 2,Tests,White colonies with granular texture颗料状的白色菌落 Dark tan / brown reverse pigment 深咖啡/棕色 背景色,On microscopy, numerous microconidia and thin-walled cigar-shaped macroconidia很多小孢子与薄壁雪茄状大分生孢子 Trichophyton mentagrophytes (granular form)须毛癣菌(颗粒状),Fungal culture: Sabourauds dextrose agar 5 days 沙氏葡萄糖琼脂 五天,What is yourdiagnosis?,Tests,Do the investigations permit a definitive diagnosis? 这可以是最终的诊断吗?Are there any additional investigations which you think may need to be done? 还需要做其它调查吗?,Diagnosis,Tests,Dermatophytosis caused by T. mentagrophytes须毛癣菌引起皮肤真菌病Historical and clinical features strongly suggestive, supported by culture results培养结果验证了病史与临床特征Skin biopsies confirmed hair shaft and follicle invasion by fungal elements皮肤活检证实毛干与毛囊被真菌菌丝入侵,How would you deal with this case?,What is your prognosis?你的诊断是?How will you advise the owner?你给主人的建议是?What treatment would you consider?你的治疗方案是?,Tests,Prognosis,Tests,Prognosis is good诊断很好However, lengthy antifungal therapy is often needed with Trichophyton infections in dogs然而须毛癣菌需要漫长的抗真菌药治疗,Therapy,Therapy,Griseofulvin orally at 50 mg/kg (divided twice daily)灰黄霉素 口服,50mg/kg每天分两次Enilconazole (Imaverol) emulsion applied every 4th day 恩康唑乳剂Good clinical response after 8 weeks of therapy, but repeat cultures still positive8周后有好转但培养阳性Cultures negative and complete clinical response after 12 weeks of treatment, which was withdrawn at this time12周后培养阴性并彻底好转,停止治疗No relapse over a 6 month follow-up period6月后回访未复发,Comment -1,Notes,Owners lesions were present in this case, illustrating the zoonotic potential of canine dermatophytosis这个病中主人也有相似损伤,说明犬皮肤真菌病是动物传染病Jack Russell terriers are predisposed to sylvatic dermatophytosis in the U.K.在英国这种犬易患真菌The peripherally expanding, well-demarcated lesions on the face were suggestive of dermatophytosis向周围扩散,界限清楚,暗示真菌病,Comment -2,Notes,Lesions of dermatophytosis vary in appearance and severity皮肤真菌病损伤在外表与严重性有不同Severely inflamed Trichophyton lesions on the face are misdiagnosed as pemphigus foliaceus严重发炎的面部须毛癣菌病会被误诊为落叶天疱疮Absence of focal crusted lesions (“footprints” of vesic