2025/6/1醫學微生物學--第34章主要病原性真菌皮膚癬菌(Dermatophytes)主要侵犯角化的皮膚、毛發和指（趾）甲等淺部感染的真菌。引起皮膚癬病，包括手癬、足癬、甲癬、頭癬、體癬等。包括表皮癬菌屬、毛癬菌屬、和小孢子菌屬三個屬。第34章主要病原性真菌體癬（Tineacorporis）

：環行紅斑，邊界水泡，搔癢Tineacorporislesionsonthispatient’sabdomenduetothefungusTrichophytonrubrum.

.

Skinscrapingstakenfrompatientsin10%KOH,andshowhyphaeundermicroscope.

fungiqual-a.de

Reversesideof紅色毛癬菌（T.rubrum）colony,showingdeepredpigment

TypicalcigarshapedmacroconidiaofT.rubrumgranulartype.?2006TheUniversityofAdelaideWhite,cottonysurface股癬（Tineacruris）:“jockitch”infectionofthegroin,perianalarea.(Trubrumismostfrequentlyresponsible)指甲癬（Tineaunguium）:infectiononthenailsthatthickened,crumblinganddiscolored.nailscanbeclippedandusedforculture.OnychomycosiscausedbyTrichophytonrubrum.(FromHayRJ:Cutaneousandsubcutaneousmycoses.InAnaissieEJ,McGinnisMR,PfallerMA,editors:Clinicalmycology,NewYork,2003,ChurchillLivingstone.)

2025/6/1醫學微生物學--第34章主要病原性真菌糠秕bi馬拉色菌引起的花斑癬Pityriasis(tinea)versicolorTypicaldepigmentedlesionsseenindark-skinnedindividuals,forexampleinAustralianAborigines.(Pathogen:Malasseziafurfur)?2006TheUniversityofAdelaide

角層癬菌Treatment:Localantifungalcream(咪康唑

miconazole)ororal伊曲康唑

itraconazoleareeffective.

Prevention:保持皮膚干燥，遠離患者及患病動物2025/6/1醫學微生物學--第34章主要病原性真菌

此類真菌一般存在于土壤和植物，經創傷部位侵入人體皮下組織。一般只限局部，也可引起深部感染。

包括:

申克孢子絲菌

第二節皮下感染真菌Classiclymphocutaneousformofsporotrichosisdemonstratingachainofsubcutaneousnodulesalongthelymphaticdrainageofthearm.(FromChandlerFW,WattsJC:Pathologicdiagnosisoffungalinfections,Chicago,1987,ASCPPress.Copyright1987,AmericanSocietyofClinicalPathologists.)申克孢子絲菌可引起孢子絲菌病

也可引起深部感染。2025/6/1醫學微生物學--第34章主要病原性真菌SporothrixschenckiionSabouraud'sdextroseagargrownat25oCcoloniesaremoistandglabrous,withawrinkledandfoldedsurface.

Pigmentationmayvaryfromwhitetocreamtoblack.?2006TheUniversityofAdelaideMicroscopicmorphologyofthemycelialformofSporothrix

schenckiiwhengrownonSabouraud‘sdextroseagarat25oC.

Noteclustersofovoidconidia（分生孢子）

producedsympodiallyonshortconidiophoresarisingatrightanglesfromthethinseptatehyphae.2025/6/1醫學微生物學--第34章主要病原性真菌治療:口服飽和KI溶液,伊曲康唑Prevention:Avoidskinlesion.

一、白假絲酵母菌在免疫力低下、菌群失調等情況下念珠菌可引起皮膚黏膜、內臟、中樞神經等各個部位的感染，稱為念珠菌病，如鵝口瘡、呼吸道炎癥等。第三節機會致病性真菌一般屬機體正常菌群或廣泛分布于土壤、水、空氣中。一生物學性狀1革蘭氏陽性，圓形或卵圓形，以出芽方式繁殖2培養特性，普通培養基生長良好，類酵母型菌落。C.albicans,GramstainpositiveC.albicansonSabouraud'sdextroseagarshowingtypicalcreamcoloured,smoothsurfaced,waxycolonies.25oC二致病性：在免疫力低下、菌群失調時，1.皮膚黏膜感染:可發生于皮膚的潮濕及皺褶部位。鵝口瘡(多見于艾滋病患者，體質虛弱的嬰幼兒)。Oralthrush

(Candidaalbicans).Itisapatchytoconfluent,whitishpseudomembranouslesioncomposedofepithelialcells,yeasts,andpseudohyphae.Virulencefactor:celladhesion,proteases,etal.CDC2.內臟及中樞神經系統感染GrosspathologyofrabbitkidneylesionsduetoexperimentalCandidaalbicansinfection.Rabbitwascortisone-treated.

CDC

三微生物學檢查1直接鏡檢2分離培養與鑒定

芽管Germ-tubes

producedinserumfor3hrsat37oC厚膜孢子ChlamydoconidiaonDifcochlamydosporeagar.

Trypanblueinthemediumisabsorbedstronglybytheseterminalvesicles.

Numeroussmallblastoconidiaandpseudohyphaearealsopresent.?2006TheUniversityofAdelaide2025/6/1醫學微生物學--第34章主要病原性真菌防治原則:去除危險因素，酮康唑。二、

新生隱球菌新生隱球菌存在于人體表，口腔及糞便，也大量存在于干燥的鴿糞中，通過呼吸道感染人類，引起隱球菌病一生物學性狀1形態與結構酵母樣菌體外有肥厚的莢膜菌體常有出芽C.neoformans

ImagecourtesyofJenniferLodge二致病性傳染源：鴿糞傳播途徑：呼吸道該菌為條件感染，發生于肺部，能自愈，嚴重者可爆發型感染，血行播散，致中樞神經系統，導致死亡。TheecologicalnichesofC.neoformansarepigeonandchickendroppings.Buttheyarenotinfected.Theportalofentryistherespiratorysystem,thendisseminatetootherpartsofthebodybutpreferentiallytotheCNS,causingmeningoencephalitis.NohumantohumantransmissionHistopathologyoflungshowswidenedalveolarseptumcontainingafewinflammatorycellsandnumerousyeastsofC.neoformans.Theinnerlayeroftheyeastcapsulestainsred.CDC/Dr.EdwinP.Ewing,Jr.2025/6/1醫學微生物學--第34章主要病原性真菌MRIscansshowingmultiplecryptococcomas[whitemasses]inthebrain.

(CourtesyProf.TaniaSorrell,SydneyNSW).三微生物學檢查1直接鏡檢，墨汁負染2分離培養與鑒定3抗原檢查4動物實驗四防治

鴿糞管理，抗真菌藥物治療C.neoformans

ImagecourtesyofJenniferLodge三、曲霉（Aspergillus）廣泛分布于自然界，引起的疾病包括肺曲霉?。ㄕ婢蛐头吻共　⑶狗窝?、過敏性支氣管肺曲霉病）、全身性曲霉病、毒素中毒、致癌(黃曲霉毒素能誘導肝癌發生)。無有效的預防措施，治療可采用唑類抗真菌藥物。2025/6/1醫學微生物學--第34章主要病原性真菌Aspergilloma(fungalball)foundatpost-morteminthelungofachildwithleukaemia.?2006TheUniversityofAdelaide四、毛霉廣泛存在于自然界的腐生菌，常引起食物發生霉變，是一種條件感染性真菌，感染多發于鼻及耳部，引起壞死性炎癥和肉芽腫，可擴散至全身，引起死亡。MucorrotonpeachPhotocourtesyAgriculture&Agri-FoodCanadaYoungsporangiaofaMucorspp.fungus.Mucorisacommonindoormold,andisamongthefungithatcausethegroupofinfectionsknownaszygomycosis.Theinfectiontypicallyinvolvestherhino-facial-cranialarea,lungs,GItract,skin,orlesscommonlyotherorgansys