爪白癬は長年治療に難渋する疾患の１つであったが，1990年代に入ってわが国においてもイトラコナゾール，テルビナフィンといった新しい経口抗真菌薬が使用できるようになった．その優れた有効性，安全性から積極的に治療することが可能となり，改めて爪白癬の病態，診断，治療などについて脚光を浴びている．爪白癬はわが国の人口の約10％に罹患者が存在し，特に高齢者ではさらに頻度が高い．今後高齢化社会が益々進むにつれて爪白癬を有しているために肉体的ならびに精神社会的な負担を生じ，老後のQOLを大いに損ねる危険性も予想される．また，爪白癬の病巣が他の病型の白癬や他人に白癬を感染させる感染源となりうる．治療に当たって爪白癬の確定診断を行うことが必須であることはいうまでもないが，単に画一的に内服療法を行うのではなく，外用療法，局所療法を駆使して症例ごとに最良の治療法を探求・選択することが最も重要である．爪白癬に関して今までに優れた成書や総説を始め論文は極めて数多く出版されているが，今回はわが国の実情も踏まえていま一度概説したい．

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The data on visceral mycoses reported in the “ Annual of Pathological Autopsy Cases in Japan ” were analyzed epidemiologically every four years from 1989 to 2005, and in 2007. The frequency rates of visceral mycoses dropped sharply between 1989 (4.5%) and 1994 (3.2%), but by 2001 had risen again and have remained (4.4-4.6%) generally stable since then. The predominant causative agents were Candida and Aspergillus. Although the rate of candidosis showed a gradual decrease, the rate of aspergillosis showed an increase by degrees. Furthermore, the rate of aspergillosis exceeded that of candidosis in 1994, and the difference in the rates between the two conditions apparently further increased until 2001. After 2005, however no changes in this difference were observed. For complicated infections, the incidence of coinfection with Aspergillus and Candida showed a decreasing, and that with Aspergillus and Zygomycetes showed an increasing tendency. Severe infections with Zygomycetes showed a clear increase from 57.4% in 1989 to 88.9% in 2007. Comparing underlying diseases with mycoses in 1989 and 2007, leukemia (including myelodysplastic syndrome) decreased from 26.1% to 18.8% and bacterial infections (including interstitial pneumonia) increased from 11.1% to 22.1%. By age, the highest frequency rate of mycoses was observed in the range of 60-79 years, and the frequency rate of exogenous fungal infections such as aspergillosis, cryptococcosis, zygomycosis and trichosporonosis showed an increasing trend in the less than one-year old group.

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This study aimed to examine the genotype distribution of Candida albicans and the major genotypes involved in superficial candidiasis. The genotypes of C. albicans isolated from the infection sites of patients with superficial candidiasis (referred to as infection isolates) were analyzed by fragment analysis using 4 microsatellite markers (HIS3, CDC3, CAI and CAIII). Genotypes of the infection isolates were compared with those of C. albicans isolated from oral mucosa of non-candidiasis patients (referred to as oral isolates). Isolates of C. albicans showed 4 major genotypes for HIS3/CAI (“ a ” for 148 : 148 / 23 : 23,“ b ” for 148 : 160 / 33 : 41,“ c ” for 148 : 164 / 32 : 41 and “ d ” for 152 : 152 / 18 : 27). The genotypes “ a ”,“ b ” and “ d ” were commonly found in oral (4.7, 8.8 and 7.6%, respectively) and infection (6.6, 9.2 and 15.4%, respectively) isolates. No isolates of genotype “ c ” were isolated from infection sites. The genotype “ a ” was found in the isolates from patients with genitalia candidiasis. Genotyping of multiple isolates from an individual patient showed that C. albicans from infection sites was genetically homogenous as compared with that of oral isolates, even in the same patient with candidiasis.

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最近3年間 (2008.1 - 2010.12) に熊本県の一診療所において Microsporum canis による白癬25例を経験した．当診療所を受診し直接鏡検で真菌要素を認め，真菌培養で M. canis と同定された白癬の25例を対象とした．症例は男性8例，女性17例で女性に多く，年齢は4歳から85歳，平均34.6歳であった．部位は，頭部5例，顔面8例，頚部5例，上肢8例，下肢5例，体幹5例で，露出部に多くみられた．皮疹の数は単発13例，多発12例であった．病型は体部白癬が21例，頭部白癬5例，両者の合併が1例あった．家族内発症を5組10例に認め，同胞2組，母子2組，祖母孫1組であった．動物との接触歴があり，飼育動物が感染源と考えられた症例は24例 (ネコ23例，イヌ1例) で，9例は動物のヘアブラシ培養検査も陽性であった．治療は，単発例には抗真菌剤外用を，頭部白癬と体部白癬の多発例にはイトラコナゾールないし塩酸テルビナフィン2 ～ 14週内服と抗真菌剤外用を行った．M. canis による白癬の報告は近年減少しているが，現在でもネコなどのペットからの感染に注意すべきであると考えた．

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We examined the therapeutic effects of cinnamaldehyde and the potentiation of those effects with cassia and cinnamaldehyde when combined with the food additive methylcellulose against murine oral candidiasis. When 19.5mg/ml of cinnamaldehyde was administered in the oral cavity of Candida infected mice, the oral symptoms were improved. Furthermore, when either a cassia or a cinnamaldehyde preparation in combination with methylcellulose was administered to oral candidiasis-inflicted mice, the therapeutic effects of cassia or cinnamaldehyde potentiated. Methylcellulose itself did not affect the oral symptoms or the viable number of C. albicans cells. GC/MS analysis showed that the dose of cinnamaldehyde remaining in the tongue tissue of mice treated with the cinnamaldehyde-methylcellulose mixture was higher than that in mice administered cinnamaldehyde alone, and also showed that cinnamaldehyde was not detected in the blood of any of the tested mice. These findings suggested that the combination of cassia or cinnamaldehyde and methylcellulose may be a useful prophylactic or therapeutic tool against oral candidiasis.

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Antithrombotic activity of a protease purified from a medicinal mushroom, Ganoderma lucidum, has been evaluated platelet aggregation in vitro and pulmonary thrombosis in vivo. The purified protease exhibited concentration dependent inhibitory effects on platelet aggregation induced by ADP (adenosine diphosphate), with an IC₅₀ value of 2.4 mg/mL. The purified protease protected mice against thrombotic death or paralysis induced by collagen and epinephrine in a dose dependent manner when administered orally. It produced a significant inhibition of thrombotic death or paralysis at 60μg/kg body weight, while aspirin produced a significant inhibition of thrombosis at 10-20 mg/kg body weight. The purified protease also has showed fibrinolytic activity and alters coagulation parameters such as activated partial thromboplastin time (APTT), and thrombin time (TT) in rat platelet. These results suggested that the antithrombotic activity of Ganoderma lucidum protease might be due to antiplatelet activity rather than anticoagulation activity.

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