---
# System prepended metadata

title: Medical Mycology
tags: [共筆]

---

[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|
|:------|:------|:------|
|==<font color = "red">Pistyriasis versicolor(花班癬)</font>==|==<font color = "red">Malassezia furfur(馬拉色氏雷菌)</font>==|又稱++汗斑++|
|<font color = "red">Tinea Nigra(黑癬)</font>|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)<br>Microsporum(小芽孢菌屬)<br>Trichophyton(毛癬菌屬)==|tinea capitis(頭癬)<br>tinea barbae(鬚癬)<br>tinea corporis(體癬)<br>tinea cruris(股癬)<br>==tinea pedis(足癬)==<br>==tinea unguium(甲癬)==|<br><br><br><br>又稱**香港腳**<br>又稱灰指甲(<font color = "red">Onychomycosis</font>)|


### Subcutaneous Mycoses(皮下真菌病)
|疾病|病原菌|補充|
|:------|:------|:------|
|==Lymphocutaneous Sporotrichosis<br>(淋巴皮膚孢子絲菌症)==|<font color = "red">Sporothrix schenkii<br>(申克氏孢子菌)</font>|又稱**玫瑰園丁病**<br><font color = "red">熱雙向性真菌</font><br><font size = 2>>室溫:Mold form<br>>37°C:Yeast form</font>|
|==Chromoblastomycosis<br>(產色芽生黴菌病)==|Phialophora(瓶黴菌屬)<br>Cladosporium(分枝芽孢菌屬)|==pigmented== fungi|
|Eumycotic Mycetoma<br>(真菌足菌腫)|==true fungi==|<font color = "red">治療常無法成功</font>|
|Subcutaneous Zygomycosis<br>(皮下接合菌症)|Conidiobolus coronatus<br>Basidiobolus ranarum|++entomophthoromycosis++<br>(長蛙糞黴菌性蟲黴病)|
|Subcutaneous Phaeohyphomycosis<br>(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<font color = "red">雙型性</font>
    >  ==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<br>(組織胞漿菌症)==|Histoplasma capsulatum<br>var. **capulatum**<br>var. **duboisii**|**沒有莢膜**<br>->肺部與瀰漫性感染<br>->皮膚與骨頭病變|
|==Blastomycosis<br>(芽生黴菌症)==|Blastomyces dermatitidis|動物中++狗++最容易受感染|
|Paracoccidioidomycosis<br>(副球黴菌症)|Paracoccidioides brasiliensis|<font color = "red">男性</font>較容易染病<br>嘴部潰瘍性損害<br>(ulcerated lesions)|
|==Coccidioidomycosis<br>(球黴菌症)==|Coccidioides immitis<br>C. posadasii|地震或地殼開鑿可能導致爆發<br>==<font color= "red">Arthroconidia</font>==(節生孢子)|
|==<font color = "red">Penicilliosis Marneffei<br>(馬爾尼菲青黴菌)</font>==|Penicillium marneffei|<font color = "red">AIDS-associated pneumonia</font><br>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<br>AIDS-associated pneumonia|皮下真菌病<br>Lymphocutaneous Sporotrichosis|
###  Opportunistic Mycoses(伺機性真菌病)
|疾病|病原菌|症狀|補充|
|:------|:------|:------|:------|
|==Candidiasis<br>(念珠菌症)==|==Candida albicans<br>(白色念珠菌)==|==<font color = "red">血液與腹腔感染</font>==||
|==Cryptococcosis<br>(隱球菌症)==|Cryptococcus neoformans|==<font color = "red">老人肺炎與腦膜炎==|存在於**鴿糞**中<br>==具寬厚莢膜<br>圓球狀酵母菌==|
|==Aspergillosis<br>(麴菌症)==|Aspergillus fumigatus|肺部性疾病|存在於**土壤<br>或腐敗植物**|
|Zygomycosis<br>(接合菌症)|Mucorales<br>Mortierellales<br>Entomophthorales|==親血管性感染==<br><font size = 1>(angiotropic infcetion)</font><br>**栓塞**與**組織壞死**<br><font size = 1>(embolization and necrosis)</font>||
|Phaeohyphomycosis<br>(黑色真菌症)|dematiaceous<br> hyphae or yeasts|||
|Pneumocystosis<br>(肺囊蟲症)|Pneumocytis jirovecii<br>(卡氏肺囊蟲)|肺炎|Asexual/Sexual<br>==<font color = "red">empty cyst</font>==|
* Candida albicans(白色念珠菌)
    * 症狀
        * 正常人: <font color = "red">鵝口瘡(thrush)</font>, 尿布疹(vaginitis), 甲溝炎
        * 免疫缺乏病人: <font color = "red">食道炎(esophagitis)</font>, 瀰漫性(disseminated)
    * 診斷
        * ==CHROMagar==
            > <font color = "green">綠色: C. albicans</font>
            > <font color = "blue">藍色: C. tropicalis</font>
            > <font color = "pink">粉紅: C. krusei</font>
            > <font color = "purple">淡紫色(mauve): 其他</font>
    * 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<br>(黃麴毒素)|Aspergillus flavus<br>Aspergillus parasiticus|<font color = "red">致癌<br>(carcinogenicity)</font>|汙染花生、穀物|
|Citrinin<br> (橘黴素)|Penicillium<br> Aspergillus|<font color = "red">腎毒素<br>(nephrotoxin)</font>|黃米病|
|Fumonisins<br>(伏馬鐮孢毒素)|Fusarium|<font color = "red">食道癌<br> (Esophageal Cancer)</font>|Fumonisin **B1**|
|Ochratoxin<br>(赭麴毒素)|Penicillium<br> Aspergillus|**巴爾幹半島流行性腎病**<br><font size = 1>chronic, progressive <font color = "red">nephritis</font>(腎炎)</font>|二次代謝產物|
|Trichothecenes<br> (新月毒素)||<font color = "red">抑制蛋白合成</font>|食物與飼料汙染|
* Trichothecenes(新月毒素)
    * 毒素
        > <font color = "red">T-2 toxin</font>
        > Diacetoxyscirpenol(DAS)
        > Deoxynivalenol(<font color = "red">vomitoxin</font>)
        > 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**<br>在細胞膜上打洞|<font color ="red">nephrotoxicity (腎毒性)</font><br>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，<br>多**局部使用**|
|Azoles|==Ketoconazole==<br> (**Imidazole**)|抑制14-α-demethalyse<br>**無法產生ergosterol**<br>使毒性sterols累積|抗真菌劑中最大宗<br>副作用也是最小的|
|Azoles|==Fluconazole==<br> (**Triazole**)|同上|同上|
|Allylamines|Terbinafine|抑制squalene epoxidase<br>**無法產生ergosterol**<br>|++highly lipophilic++<br>會累積於皮膚,指甲,脂肪<br> ==治療皮癬菌症==|
|Echinocandins|Caspofungin|抑制(1,3)-β-D-glycan合成<br>**破壞細胞壁的完整性**||
|Nucleotide|5-Fluorocytosine|**干擾DNA合成**(FdUMP)<br>**干擾蛋白質合成**(FUMP)|<font color ="red">易產生抗藥性</font><br>須搭配其他藥物使用|
|Griseofulvin|Griseofulvin|抑制微管合成<br>=>**抑制有絲分裂**|噁心(nausea), <br>腹瀉, 頭痛, 光敏感性|

