Medical Mycology

[魯國共筆目錄](/f422AdmtSGeEnkS-LwYuqA) # Medical Mycology ###### tags: `共筆` ## Human Mycoses ### Superficial Mycoses(表淺性真菌病) |疾病|病原菌|補充| |:------|:------|:------| |==Pistyriasis versicolor(花班癬)==|==Malassezia furfur(馬拉色氏雷菌)==|又稱++汗斑++| |Tinea Nigra(黑癬)|Hortaea werneckii(威尼克外瓶黴)|| |White Piedra (白色毛幹結節病)|Trichosporon (毛孢子菌屬)|yeast-like fungi| |Black Piedra(黑色毛幹結節病)|Piedraia hortae(何德毛節菌屬)|| ### Cutaneous Mycoses(表皮真菌病) * Dermatophytoses(皮癬菌症) |常見病原菌|癬|補充| |:------|:------|:------| |==Epidermophyton(表皮癬菌屬) Microsporum(小芽孢菌屬) Trichophyton(毛癬菌屬)==|tinea capitis(頭癬) tinea barbae(鬚癬) tinea corporis(體癬) tinea cruris(股癬) ==tinea pedis(足癬)== ==tinea unguium(甲癬)==| 又稱**香港腳** 又稱灰指甲(Onychomycosis)| ### Subcutaneous Mycoses(皮下真菌病) |疾病|病原菌|補充| |:------|:------|:------| |==Lymphocutaneous Sporotrichosis (淋巴皮膚孢子絲菌症)==|Sporothrix schenkii (申克氏孢子菌)|又稱**玫瑰園丁病** 熱雙向性真菌 >室溫:Mold form >37°C:Yeast form| |==Chromoblastomycosis (產色芽生黴菌病)==|Phialophora(瓶黴菌屬) Cladosporium(分枝芽孢菌屬)|==pigmented== fungi| |Eumycotic Mycetoma (真菌足菌腫)|==true fungi==|治療常無法成功| |Subcutaneous Zygomycosis (皮下接合菌症)|Conidiobolus coronatus Basidiobolus ranarum|++entomophthoromycosis++ (長蛙糞黴菌性蟲黴病)| |Subcutaneous Phaeohyphomycosis (皮下黑色真菌症)|**pigmented**, or **dematiaceous**(黑化) fungi || 1. Lymphocutaneous Sporotrichosis(淋巴皮膚孢子絲菌症) * ==皮下結節==(subcutaneous nodules) * 內芽腫(granulomatous) * ++Splendore-Hoeppli phenomenon++ 2. Chromoblastomycosis(產色芽生黴菌病) * 內芽腫(granulomatous) * ==假性上皮瘤樣增生==(Pseudoepitheliomatous hyperplasia) * **花椰菜狀的疣** * 病灶可見古銅色硬化的黴菌成分(copper-colored **sclecrotic bodies**) 3. Eumycotic Mycetoma(真菌足菌腫) * multiple ==abscesses(膿瘡)==, fibrosis, and sinus tracts * ++Splendore-Hoeppli material++ * chlamydoconidia(厚壁孢子) embedded in **cement(水泥)-like substance** 4. Subcutaneous Zygomycosis(皮下接合菌症) * 造成皮膚腫脹或硬化 5. Subcutaneous Phaeohyphomycosis(皮下黑色真菌症) * 通常治療以手術切除為主 ### Systemic Mycoses(全身性真菌病) * 皆具雙型性 > ==Saprobic(腐生)(mold form)==: in **nature** or 25°C > ==Parasitic(寄生)(yeast or spherule form)==: in **tissues** or 37°C > * 地方性 ``` Histoplasma capulatum -> 美國密西西比河、中南美洲 duboisii -> 非洲熱帶地區 Blastomyces dermatitidis -> 美國密西西比河 Paracoccidioides brasiliensis -> 中南美洲、巴西 Coccidioides immitis/posadasii -> 美國西南部、墨西哥北部 Penicilliosis Marneffei -> 東南亞 ``` |疾病|病原菌|補充| |:------|:------|:------| |==Histoplasmosis (組織胞漿菌症)==|Histoplasma capsulatum var. **capulatum** var. **duboisii**|**沒有莢膜** ->肺部與瀰漫性感染 ->皮膚與骨頭病變| |==Blastomycosis (芽生黴菌症)==|Blastomyces dermatitidis|動物中++狗++最容易受感染| |Paracoccidioidomycosis (副球黴菌症)|Paracoccidioides brasiliensis|男性較容易染病 嘴部潰瘍性損害 (ulcerated lesions)| |==Coccidioidomycosis (球黴菌症)==|Coccidioides immitis C. posadasii|地震或地殼開鑿可能導致爆發 ==Arthroconidia==(節生孢子)| |==Penicilliosis Marneffei (馬爾尼菲青黴菌)==|Penicillium marneffei|AIDS-associated pneumonia 類似結核病| * AIDS-related opportunistic infections > histoplasmosis, cryptococcosis, Penicillium marneffei |Penicillium marneffei|Sporothrix schenckii| |----|----| |酵母菌型態|菌絲型態| |全身性真菌病 AIDS-associated pneumonia|皮下真菌病 Lymphocutaneous Sporotrichosis| ### Opportunistic Mycoses(伺機性真菌病) |疾病|病原菌|症狀|補充| |:------|:------|:------|:------| |==Candidiasis (念珠菌症)==|==Candida albicans (白色念珠菌)==|==血液與腹腔感染==|| |==Cryptococcosis (隱球菌症)==|Cryptococcus neoformans|==老人肺炎與腦膜炎==|存在於**鴿糞**中 ==具寬厚莢膜 圓球狀酵母菌==| |==Aspergillosis (麴菌症)==|Aspergillus fumigatus|肺部性疾病|存在於**土壤 或腐敗植物**| |Zygomycosis (接合菌症)|Mucorales Mortierellales Entomophthorales|==親血管性感染== (angiotropic infcetion) **栓塞**與**組織壞死** (embolization and necrosis)|| |Phaeohyphomycosis (黑色真菌症)|dematiaceous hyphae or yeasts||| |Pneumocystosis (肺囊蟲症)|Pneumocytis jirovecii (卡氏肺囊蟲)|肺炎|Asexual/Sexual ==empty cyst==| * Candida albicans(白色念珠菌) * 症狀 * 正常人: 鵝口瘡(thrush), 尿布疹(vaginitis), 甲溝炎 * 免疫缺乏病人: 食道炎(esophagitis), 瀰漫性(disseminated) * 診斷 * ==CHROMagar== > 綠色: C. albicans > 藍色: C. tropicalis > 粉紅: C. krusei > 淡紫色(mauve): 其他 * 治療 * 1^st^ line medical: ==fluconazole== * 2^nd^ line medical: ==amphotericinB== or Caspofungin (Echinocandin) * Aspergillosis(麴菌症) * Allergic bronchopulmonary aspergillosis(過敏性支氣管肺麴病) 對於麴菌有過強的免疫反應(Th2↑↓)，而有**氣喘**的現象 * Pulmonary aspergilloma(肺麴菌瘤) 麴菌球產生於因肺結核等傷害造成的空洞中，無明顯症狀，但有時會引發**大量咳血** * Invasive aspergillosis(侵襲性麴菌病) 由肺部擴散到全身，甚至到腦部造成**出血性腦梗塞** --- ### Mycotoxins and Mycotoxicoses (黴菌毒素) |毒素|黴菌|毒性|補充| |----|----|----|----| |Aflatoxins (黃麴毒素)|Aspergillus flavus Aspergillus parasiticus|致癌 (carcinogenicity)|汙染花生、穀物| |Citrinin (橘黴素)|Penicillium Aspergillus|腎毒素 (nephrotoxin)|黃米病| |Fumonisins (伏馬鐮孢毒素)|Fusarium|食道癌 (Esophageal Cancer)|Fumonisin **B1**| |Ochratoxin (赭麴毒素)|Penicillium Aspergillus|**巴爾幹半島流行性腎病** chronic, progressive nephritis(腎炎)|二次代謝產物| |Trichothecenes (新月毒素)||抑制蛋白合成|食物與飼料汙染| * Trichothecenes(新月毒素) * 毒素 > T-2 toxin > Diacetoxyscirpenol(DAS) > Deoxynivalenol(vomitoxin) > Fusarenon-X * 疾病 * **發霉穀物中毒(Moldy grain intoxication)** * **食物中毒性白血球缺乏症(Alimentary toxic aleukia, ATA)** > T-2 toxin和DAS導致 --- ## Antifungal antibiotics |種類|藥物名|機轉|補充| |----|----|----|----| |Polyenes|==Amphotericin B==|**bind Ergosterol** 在細胞膜上打洞|nephrotoxicity (腎毒性) 不能口服，需**靜脈注射**| |Polyenes|Nystatin|在細胞膜上打洞|因全身毒性太大， 多**局部使用**| |Azoles|==Ketoconazole== (**Imidazole**)|抑制14-α-demethalyse **無法產生ergosterol** 使毒性sterols累積|抗真菌劑中最大宗 副作用也是最小的| |Azoles|==Fluconazole== (**Triazole**)|同上|同上| |Allylamines|Terbinafine|抑制squalene epoxidase **無法產生ergosterol** |++highly lipophilic++ 會累積於皮膚,指甲,脂肪 ==治療皮癬菌症==| |Echinocandins|Caspofungin|抑制(1,3)-β-D-glycan合成 **破壞細胞壁的完整性**|| |Nucleotide|5-Fluorocytosine|**干擾DNA合成**(FdUMP) **干擾蛋白質合成**(FUMP)|易產生抗藥性 須搭配其他藥物使用| |Griseofulvin|Griseofulvin|抑制微管合成 =>**抑制有絲分裂**|噁心(nausea), 腹瀉, 頭痛, 光敏感性|