Medical Mycology Journal
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57 巻 , 3 号
選択された号の論文の10件中1~10を表示しています
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Medical Mycology Journal
Original Article
  • Sumanas Bunyaratavej, Penvadee Pattanaprichakul, Sorachai Srisuma, Cha ...
    57 巻 (2016) 3 号 p. E29-E34
    公開日: 2016/08/31
    ジャーナル フリー
    Background: Potassium hydroxide(KOH)examination is commonly used in dermatological practice. Despite its simplicity, rapidity, and minimal invasiveness, experience in specimen collection, preparation, and interpretation is extremely important. Aims: To determine the ability to interpret KOH examination of six microscopists with different levels of experience within the Department of Dermatology. Methods: Six volunteer microscopists, who have different experiences in KOH examination in terms of specimens per week(SPW), were assigned to prepare and examine 10 unknown slides of skin scrapings. All participants were then paired into three groups and exchanged the slides set to their partner in each group for a second round of slides interpretation. Results: Results of examinations were classified as correct, false negative, false positive, and misinterpretation. The highly experienced microscopists achieved more correct answers than the fairly experienced group in both sessions. There was a significant positive correlation between SPW(r=1.0, Spearman rank, p=0.01)and the correct answers; and a significant negative correlation between SPW and misinterpretation(r= -1.0, Spearman rank, p<0.01), exclusively for the second session. Limitations: A small number of volunteer microscopists was enrolled in this study. Conclusions: Experience in routine slide examination and time spent during examination were significant factors for accurate interpretation of KOH examination. Positive correlation between experience and correct answers, and negative correlation between experience and misinterpretation were particularly observed under limited examination time.
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  • Hiromitsu Noguchi, Masataro Hiruma, Keishi Maruo, Masayoshi Jono, Keis ...
    57 巻 (2016) 3 号 p. E35-E39
    公開日: 2016/08/31
    ジャーナル フリー
    A 68-year-old male plasterer with no history of trauma presented to our clinic in March 2012 with a 16×14-mm ulcer that developed following a crushed small papule on the right anterior chest. In April 2012, the patient was referred to another hospital, where cutaneous cryptococcosis was diagnosed based on discharge culture results. The patient was treated with oral itraconazole at a dose of 150 mg/day for 10 weeks; however, the ulcer remained unchanged and he discontinued the treatment. In May 2014, when he revisited our clinic, the ulcer with crust had grown to 29×13 mm. No regional lymph node swelling was noted. India ink staining showed a yeast-like fungus with a thick, clear capsule. A cream-colored, viscous yeast-like colony was observed on Sabouraud dextrose agar. Genetic testing identified the isolate as Cryptococcus neoformans serotype A. The patient was negative for serum cryptococcal antigen. Neither chest radiography nor computed tomography revealed any abnormalities. The patient had no underlying disease. Oral fluconazole (400 mg/day for 12 weeks) was prescribed, resulting in scar formation. The patient has remained free of relapse for one year to date, since the end of treatment. Localized cutaneous cryptococcosis is not a commonly used disease name overseas. However, 36 cases of this disease have been reported in Japan (since in 1968). We herein report a new case with localized cutaneous cryptococcosis and summarize previously reported cases in Japan.
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  • Norihito Tarumoto, Jun Sakai, Masahiro Kodana, Tohru Kawamura, Hideaki ...
    57 巻 (2016) 3 号 p. E41-E46
    公開日: 2016/08/31
    ジャーナル フリー
    Disseminated cryptococcosis is rare but can often become severe with a poor outcome. Given recent reports that matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) analyser is useful for Cryptococcus species identification, it was applied retrospectively to past cases of disseminated cryptococcosis at our hospital over the past 10 years, and their clinical courses were reviewed. For each case, the retained Cryptococcus spp. were used for identification using both MALDI-TOF MS and genetic sequencing, as well as for drug susceptibility testing. A total of eight cases were found. Cryptococcus spp. were found in cerebrospinal fluid in 3 cases and blood in 5 cases; anti-HIV antibody was either negative or untested. MALDI-TOF MS identified Cryptococcus neoformans as the pathogen in all 8 cases, but genetic testing identified one of these as Cryptococcus curvatus. The outcome was death within 30 days in 5 of the total 8 cases and in 2 of the 3 cases in which C. neoformans was detected in the cerebrospinal fluid, despite regimens and dosages that followed IDSA Guidelines in all 3 cases. Drug susceptibility testing showed no drug resistance that would have affected the therapy. In conclusion, the outcomes were very poor in these drug-susceptible cases, despite treatment in full accordance with standard guidelines. This study confirmed the need to develop newer therapies as well as the high capability of MALDI-TOF MS for the identification of C. neoformans. Genetic testing, however, may be necessary if non-neoformans Cryptococcus is suspected.
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  • Rumi Suzuki, Alimu Yikelamu, Reiko Tanaka, Ken Igawa, Hiroo Yokozeki, ...
    57 巻 (2016) 3 号 p. E47-E57
    公開日: 2016/08/31
    ジャーナル フリー
    Sporotrichosis is a fungal infection caused by the Sporothrix species, which have distinct virulence profiles and geographic distributions. We performed a phylogenetic study in strains morphologically identified as Sporothrix schenckii from clinical specimens in Japan, which were preserved at the Medical Mycology Research Center, Chiba University. In addition, we examined the in vitro antifungal susceptibility and growth rate to evaluate their physiological features. Three hundred strains were examined using sequence analysis of the partial calmodulin gene, or polymerase chain reaction(PCR)method using newly designed species-specific primers; 291 strains were Sporothrix globosa and 9 strains were S. schenckii sensu stricto (in narrow sense, s. s.). S. globosa strains were further clustered into two subclades, and S. schenckii s. s. strains were divided into three subclades. In 38 strains of S. globosa for which antifungal profiles were determined, 4 strains (11%) showed high minimal inhibitory concentration (MIC) value for itraconazole. All tested strains of S. schenckii s. s. and S. globosa showed low sensitivity for amphotericin B. These antifungals are used for treatment of sporotrichosis when infection is severe. S. schenckii s. s. grew better than S. globosa; wherein S. globosa showed restricted growth at 35℃ and did not grow at 37℃. Our molecular data showed that S. globosa is the main causal agent of sporotrichosis in Japan. It is important to determine the antifungal profiles of each case, in addition to accurate species-level identification, to strategize the therapy for sporotrichosis.
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Short Report
  • Harunari Shimoyama, Chikako Nakashima, Midori Hase, Yoshihiro Sei
    57 巻 (2016) 3 号 p. E59-E61
    公開日: 2016/08/31
    ジャーナル フリー
    A 41-year-old man visited our dermatology clinic because an eruption, which was resistant to steroid ointment treatment, had appeared on his right forearm. An oval, soybean-sized erythematous infiltrated lesion with scales and crusts was located in the central part of the extensor surface of the right forearm and showed partial erosion with attached yellow crusts. The lesion had an impetigo-like appearance. Fungal elements were confirmed from the scales by KOH examination and the fungus was identified as Trichophyton tonsurans by fungal culture and molecular method. Clinical features of T. tonsurans infection vary, wherein some patients have strong inflammatory manifestations, while others remain as asymptomatic carriers. Especially at the early stage of the infection, diagnosis is difficult because it is often misdiagnosed as eczema. We report a case of T. tonsurans infection that had impetigo-like appearance. We also studied the mechanism of the disease.
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  • Chikako Suzuki, Midori Hase, Harunari Shimoyama, Yoshihiro Sei
    57 巻 (2016) 3 号 p. E63-E66
    公開日: 2016/08/31
    ジャーナル フリー
    Topical or systemic antifungal therapy was administered to patients diagnosed with Malassezia folliculitis during the 5-year period between March 2007 and October 2013. The diagnosis of Malassezia folliculitis was established on the basis of characteristic clinical features and direct microscopic findings (10 or more yeast-like fungi per follicle). Treatment consisted of topical application of 2% ketoconazole cream or 100 mg oral itraconazole based on symptom severity and patients’ preferences. Treatment was given until papules flattened, and flat papules were examined to determine whether the patient’s clinical condition had “improved” and the treatment had been “effective”. The subjects were 44 patients (35 men, 9 women), with a mean disease period of 25±15 days. In regard to the lesion site, the frontal portion of the chest was the most common, accounting for 60% of all patients. The mean period required for improvement was 27±16 days in 37 patients receiving the topical antifungal agent and 14±4 days in the 7 patients receiving the systemic antifungal agent. The results were “improved” and the treatment was “effective” in all patients. Neither treatment resulted in any adverse reactions. Although administration of oral agents has been recommended for the treatment of Malassezia folliculitis, this study revealed that beneficial results are safely obtained with topical antifungal therapy alone, similar to those of systemic antifungal agents.
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日本医真菌学会雑誌
総説
  • 田代 将人, 泉川 公一
    57 巻 (2016) 3 号 p. J103-J112
    公開日: 2016/08/31
    ジャーナル フリー
    肺アスペルギルス症は死亡率が高く,重要な深在性真菌症である.しかし,抗アスペルギルス活性をもつポリエン系,アゾール系,キャンディン系のなかでも,経口投与が可能な抗真菌薬はアゾール系に限られ,日本では慢性肺アスペルギルス症の外来治療には,イトラコナゾール (ITCZ),ボリコナゾール (VRCZ) の2種類のアゾール系薬しか使用できない.したがって,アゾール耐性アスペルギルスの出現は臨床的な脅威となる可能性がある.われわれは,日本においてもアゾール耐性のA. fumigatusが臨床現場において存在すること,その耐性機序はアゾール標的分子の変異が原因であること,ITCZ長期投与によりCYP51AのG54変異が誘導され,ITCZ耐性株が産生されることを明らかとした.現在の日本において,複数のアゾールに耐性を示す株は臨床的にも環境においてもまれであり,アスペルギルス症の初期治療において耐性株の存在を考慮する状況ではない.しかし,アゾール耐性株は世界的な拡がりがみられる問題であり,今後も臨床分離株および環境株の継続的調査が必要である.
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  • 西本 勝太郎
    57 巻 (2016) 3 号 p. J113-J116
    公開日: 2016/08/31
    ジャーナル フリー
    真菌症の診断は,皮膚科領域において重要な部分であるにもかかわらず,その教育は十分に行われていないとの指摘がある.皮膚病診療において必要な医真菌学的知識の取得や,技術的な支援をどのように行うべきかを,研修の各時期について検討した.
    皮膚科専門医への研修期間を通じて強調すべきものが,皮膚真菌症の診断技術を上げることによって得られる,患者側と医療側双方の利益を確認させることであり,これには単なる治療効果のみならず,現行の保険制度における技術の評価,報酬まで含ませるべきである.
    全国的には,原因菌種の同定から治療に際しての適切な助言を与えられる数ヵ所の施設を整備し,機関誌などを通じて周知させることである.このような施設での,専門的な研修コースも学会としての取り組みの1つとしたい.現在行われている地域ごとの研修会や講演会と同時に,医真菌症の専門医として現場からの要請に応えて技術的な助言と支援のできる,地域に密着した身近な相談窓口となる医師の推薦も必要である.
    皮膚科医としての研修を始めた初期の段階の医師に対し,まず真菌症に興味をもたせることが第一にすべきことである.このためには,単に真菌症についての解説のみならず,皮膚疾患のなかにおける真菌症の位置づけ,真菌学的検査によって得られる成果などとともに,自然界における真菌の生態までを含めた解説も必要となる.
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  • 冲中 敬二
    57 巻 (2016) 3 号 p. J117-J123
    公開日: 2016/08/31
    ジャーナル フリー
    2000年以降複数の新規抗真菌薬が登場したものの,カンジダ血流感染症は依然予後が悪く,大きな問題となっている.早期の治療開始が予後を改善することが判明しているものの,カンジダ感染症は早期の診断が困難であり,死亡率が高い.カンジダ血症はがん患者,特に血液腫瘍,造血幹細胞移植患者における罹患率が高く,急性白血病の寛解導入時や造血幹細胞移植時には抗真菌薬の予防内服も推奨されている.血液領域ではnon-albicans Candidaの検出が多く,ガイドラインでは好中球減少期患者の治療薬としてエキノキャンディンが推奨されている.しかし,近年Candida glabrataを中心にエキノキャンディン耐性株の報告があり,その出現とエキノキャンディン曝露歴との相関が示唆されている.このため,重症例や難治例などでは薬剤感受性試験の実施を検討する必要がある.また,抗真菌薬のantifungal stewardshipの推進も必要である.
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