主要病原性真菌

皮肤癣菌(Dermatophytes)主要侵犯角化的皮肤、毛发和指（趾）甲等浅部感染的真菌。引起皮肤癣病，包括手癣、足癣、甲癣、头癣、体癣等。包括表皮癣菌属、毛癣菌属、和小孢子菌属三个属。主要病原性真菌1精选课件体癣（Tineacorporis）

：环行红斑，边界水泡，搔痒Tineacorporislesionsonthispatient’sabdomenduetothefungusTrichophytonrubrum.www.hudlegekontoret.no.

Skinscrapingstakenfrompatientsin10%KOH,andshowhyphaeundermicroscope.

fungiqual-a.de

2精选课件Reversesideof红色毛癣菌（T.rubrum）colony,showingdeepredpigmentwww.hudlegekontoret.noTypicalcigarshapedmacroconidiaofT.rubrumgranulartype.©2006TheUniversityofAdelaideWhite,cottonysurface3精选课件股癣（Tineacruris）:“jockitch”infectionofthegroin,perianalarea.(Trubrumismostfrequentlyresponsible)4精选课件指甲癣（Tineaunguium）:infectiononthenailsthatthickened,crumblinganddiscolored.nailscanbeclippedandusedforculture.OnychomycosiscausedbyTrichophytonrubrum.(FromHayRJ:Cutaneousandsubcutaneousmycoses.InAnaissieEJ,McGinnisMR,PfallerMA,editors:Clinicalmycology,NewYork,2003,ChurchillLivingstone.)

5精选课件糠秕bi马拉色菌引起的花斑癣Pityriasis(tinea)versicolorTypicaldepigmentedlesionsseenindark-skinnedindividuals,forexampleinAustralianAborigines.(Pathogen:Malasseziafurfur)©2006TheUniversityofAdelaide

角层癣菌6精选课件Treatment:Localantifungalcream(咪康唑

miconazole)ororal伊曲康唑

itraconazoleareeffective.

Prevention:保持皮肤干燥，远离患者及患病动物7精选课件

此类真菌一般存在于土壤和植物，经创伤部位侵入人体皮下组织。一般只限局部，也可引起深部感染。

包括:

申克孢子丝菌

第二节皮下感染真菌8精选课件Classiclymphocutaneousformofsporotrichosisdemonstratingachainofsubcutaneousnodulesalongthelymphaticdrainageofthearm.(FromChandlerFW,WattsJC:Pathologicdiagnosisoffungalinfections,Chicago,1987,ASCPPress.Copyright1987,AmericanSocietyofClinicalPathologists.)申克孢子丝菌可引起孢子丝菌病

也可引起深部感染。9精选课件SporothrixschenckiionSabouraud'sdextroseagargrownat25oCcoloniesaremoistandglabrous,withawrinkledandfoldedsurface.

Pigmentationmayvaryfromwhitetocreamtoblack.©2006TheUniversityofAdelaideMicroscopicmorphologyofthemycelialformofSporothrix

schenckiiwhengrownonSabouraud‘sdextroseagarat25oC.

Noteclustersofovoidconidia（分生孢子）

producedsympodiallyonshortconidiophoresarisingatrightanglesfromthethinseptatehyphae.10精选课件治疗:口服饱和KI溶液,伊曲康唑Prevention:Avoidskinlesion.11精选课件

一、白假丝酵母菌在免疫力低下、菌群失调等情况下念珠菌可引起皮肤黏膜、内脏、中枢神经等各个部位的感染，称为念珠菌病，如鹅口疮、呼吸道炎症等。第三节机会致病性真菌一般属机体正常菌群或广泛分布于土壤、水、空气中。12精选课件一生物学性状1革兰氏阳性，圆形或卵圆形，以出芽方式繁殖2培养特性，普通培养基生长良好，类酵母型菌落。C.albicans,Gramstainpositivewww.fnplzen.cz/mykoatlas/kvasinky/C_albicans_mi_gram_1b.jpgC.albicansonSabouraud'sdextroseagarshowingtypicalcreamcoloured,smoothsurfaced,waxycolonies.25oC13精选课件二致病性：在免疫力低下、菌群失调时，1.皮肤黏膜感染:可发生于皮肤的潮湿及皱褶部位。鹅口疮(多见于艾滋病患者，体质虚弱的婴幼儿)。Oralthrush

(Candidaalbicans).Itisapatchytoconfluent,whitishpseudomembranouslesioncomposedofepithelialcells,yeasts,andpseudohyphae.Virulencefactor:celladhesion,proteases,etal.CDC14精选课件2.内脏及中枢神经系统感染GrosspathologyofrabbitkidneylesionsduetoexperimentalCandidaalbicansinfection.Rabbitwascortisone-treated.

CDC

15精选课件三微生物学检查1直接镜检2分离培养与鉴定

芽管Germ-tubes

producedinserumfor3hrsat37oC厚膜孢子ChlamydoconidiaonDifcochlamydosporeagar.

Trypanblueinthemediumisabsorbedstronglybytheseterminalvesicles.

Numeroussmallblastoconidiaandpseudohyphaearealsopresent.©2006TheUniversityofAdelaide16精选课件防治原则:去除危险因素，酮康唑。17精选课件二、

新生隐球菌新生隐球菌存在于人体表，口腔及粪便，也大量存在于干燥的鸽粪中，通过呼吸道感染人类，引起隐球菌病一生物学性状1形态与结构酵母样菌体外有肥厚的荚膜菌体常有出芽C.neoformans

ImagecourtesyofJenniferLodge18精选课件二致病性传染源：鸽粪传播途径：呼吸道该菌为条件感染，发生于肺部，能自愈，严重者可爆发型感染，血行播散，致中枢神经系统，导致死亡。TheecologicalnichesofC.neoformansarepigeonandchickendroppings.Buttheyarenotinfected.Theportalofentryistherespiratorysystem,thendisseminatetootherpartsofthebodybutpreferentiallytotheCNS,causingmeningoencephalitis.Nohumantohumantransmission19精选课件HistopathologyoflungshowswidenedalveolarseptumcontainingafewinflammatorycellsandnumerousyeastsofC.neoformans.Theinnerlayeroftheyeastcapsulestainsred.CDC/Dr.EdwinP.Ewing,Jr.20精选课件MRIscansshowingmultiplecryptococcomas[whitemasses]inthebrain.

(CourtesyProf.TaniaSorrell,SydneyNSW).21精选课件三微生物学检查1直接镜检，墨汁负染2分离培养与鉴定3抗原检查4动物实验四防治

鸽粪管理，抗真菌药物治疗C.neoformans

ImagecourtesyofJenniferLodge22精选课件三、曲霉（Aspergillus）广泛分布于自然界，引起的疾病包括肺曲霉病（真菌球型肺曲霉病、曲霉肺炎、过敏性支气管肺曲霉病）、全身性曲霉病、毒素中毒、致癌(黄曲霉毒素能诱导肝癌发生)。无有效的预防措施，治疗可采用唑类抗真菌药物。23精选课件Aspergilloma(fungalball)foundatpost-morteminthelungofachildwithleukaemia.©2006TheUniversityofAdelaide24精选课件四、毛霉广泛存在于自然界的腐生菌，常引起食物发生霉变，是一种条件感染性真菌，感染多发于鼻及耳部，引起坏死性炎症和肉芽肿，可扩散至全身，引起死亡。MucorrotonpeachPhotocourtesyAgriculture&Agri-FoodCanadaYoungsporangiaofaMucorspp.fungus.Mucorisacommonindoormold,andisamongthefungithatcausethegroupofinfectionsknownaszygomycosis.Theinfectiontypicallyinvolvestherhino-facial-cranialarea,lungs,GItract,skin,orlesscommonlyoth