老年人甲真菌病临床及致病菌特点分析
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摘要
目的了解老年人甲真菌病临床及致病菌特点,指导老年人甲真菌病的防治。方法前瞻性选取2016年1月至2018年6月首都医科大学附属北京友谊医院皮肤科收治的93例老年甲真菌病患者(437个病甲,老年组)及102例非老年人甲真菌病患者(401个病甲,非老年组),记录并比较两组病甲分型、位置、感染菌种、混合感染情况等。结果老年组437个病甲中,最常见的临床损害为全甲毁损型(TDO) 196个(44. 85%),其次为远端侧位甲下型(DLSO) 174个(39. 82%),白色浅表型(WSO) 30个(6. 87%)。非老年组401个病甲中,最常见的临床损害为DLSO 261个(65. 09%),其次为TDO 74个(18. 45%),近端侧位甲下型(PSO) 21个(5. 24%);老年组患者手足同时感染者为18个(19. 35%),非老年组为9个(8. 82%);老年组与非老年组均以红色毛癣菌为主要致病菌,分别为31株(64. 58%)、28株(68. 29%);老年组5例(5. 38%)培养出两种菌感染,非老年组均为单一菌种感染。结论老年人病甲以TDO为主,且易手足同时感染,红色毛癣菌是其主要致病菌,但较非老年人更易出现混合菌种感染。
Objective To survey the clinical and pathogenic characteristics of onychomycosis in elderly patients and to guide its prevention and treatment in elderly patients with onychomycosis. Methods A total of 93 elderly patients with onychomycosis( elder group,437 infected nails) and 102 non-elderly patients with onychomycosis( non-elderly group,401 infected nails) were selected in the department of dermatology in this hospital during January 2016 to June 2018. The classification,location,infecting strain and mixed infection of nails in these two groups were recorded and compared. Results In 437 infected nails of elderly group,the major clinical type was total dystrophic onychomycosis( TDO)196( 44. 85%),followed by distal lateral subnail onychomycosis( DLSO) 174( 39. 82%),while superficial onychomycosis( WSO) is the most rarest,accounting for 30( 6. 87%). In these 401 infected nails of non-elderly group,the major clinical type was DLSO 261( 65. 09%),followed by TDO 74( 18. 45%),proximal subnail onychomycosis( PSO) is the most rarest,accounting for 21( 5. 24%). The infection rate of both hands and feet were 19. 35%( 18 cases) and 8. 82%( 9 cass) respectively. The main pathogen in these two groups was Trichophyton rubrum,accounting for 31( 64. 58%) and 28( 68. 29%),respectively. The specimens of two kinds of fungal infection were cultured in 5 elderly patients( 5. 38%),and single fungal infection was found in non-elderly patients. Conclusion TDO is the main clinical type in elderly patients,and they are easier to be infected with both hands and feet. The most frequently isolated fungus is Trichophyton rubrum and the elderly patients are more susceptible to be infected by mixed strains.
Objective To survey the clinical and pathogenic characteristics of onychomycosis in elderly patients and to guide its prevention and treatment in elderly patients with onychomycosis. Methods A total of 93 elderly patients with onychomycosis( elder group,437 infected nails) and 102 non-elderly patients with onychomycosis( non-elderly group,401 infected nails) were selected in the department of dermatology in this hospital during January 2016 to June 2018. The classification,location,infecting strain and mixed infection of nails in these two groups were recorded and compared. Results In 437 infected nails of elderly group,the major clinical type was total dystrophic onychomycosis( TDO)196( 44. 85%),followed by distal lateral subnail onychomycosis( DLSO) 174( 39. 82%),while superficial onychomycosis( WSO) is the most rarest,accounting for 30( 6. 87%). In these 401 infected nails of non-elderly group,the major clinical type was DLSO 261( 65. 09%),followed by TDO 74( 18. 45%),proximal subnail onychomycosis( PSO) is the most rarest,accounting for 21( 5. 24%). The infection rate of both hands and feet were 19. 35%( 18 cases) and 8. 82%( 9 cass) respectively. The main pathogen in these two groups was Trichophyton rubrum,accounting for 31( 64. 58%) and 28( 68. 29%),respectively. The specimens of two kinds of fungal infection were cultured in 5 elderly patients( 5. 38%),and single fungal infection was found in non-elderly patients. Conclusion TDO is the main clinical type in elderly patients,and they are easier to be infected with both hands and feet. The most frequently isolated fungus is Trichophyton rubrum and the elderly patients are more susceptible to be infected by mixed strains.
引文
[1] Azambuja CV,Pimmel LA,Klafke GB,et al. Onychomycosis:clinical,mycological and in vitro susceptibility testing of isolates of Trichophyton rubrum[J]. An Bras Dermatol,2014,89(4):581-586.
[2] Sigurqeirsson B,Baran R. The prevalence of onychomycosis in the global population:a literature study[J]. J Eur Acad Dermatol Venereol,2014,28(11):1480-1491.
[3]陈宝珊,梁雅晶,杨声显,等.澳门特别行政区老年人群足趾甲真菌病的流行病学研究[J].临床皮肤科杂志,2016,45(1):20-22.
[4]王爱平,余进,万喆,等.国内多中心甲真菌病病原菌流行病学调查[J].中国真菌学杂志,2015,10(4):197-202.
[5]龚子鉴,赖维.特殊人群甲真菌病的流行病学研究现状[J].中国真菌学杂志,2006,1(1):60-62.
[6] Gupta AK,Sibbald G,Lynde CW,et al. Onychomycosis in children:prevalence and treatment strategies[J]. J Am AcadDermatol,1997,36(3 Pt1):395-402.
[7] Gupta AK. Onychomycosis in the elderly[J]. Drugs Aging,2000,16(6):397-407.
[8]廉翠红,张书岭. 785例甲真菌病分析[J].实用诊断与治疗杂志,2008,22(3):168-172.
[9] Singal A,Khanna D. Onychomycosis:Diagnosis and management[J].Indian J Dermatol Venereol Leprol,2011,77(6):659-672.
[10] Ribeiro CS,Zaitz C,Framil VM,et al. Descriptive study of onychomycosis in a hospital in So Paulo[J]. Braz J Microbiol,2015,46(2):485-492.
[11] Bianca Maria Piraccini,Aurora Alessandeini. Onychomycosis:A Review[J]. J Fungi(Base),2015,1(1):30-34.
[12]尹颂超,张云青,谭永芳,等. 805例甲真菌病真菌培养结果分析[J].中国真菌学杂志,2013,8(4):214-216.
[13]马国群,戴唯. 761例甲真菌病病原菌分离培养分析[J].中华医院感染学杂志,2011,21(3):617-618.
[14] Scher RK,Rich P,Pariser D,et al. The epidemiology,etiology,and pathophysiology of onychomycosis[J]. Semin Cutan Med Surq,2013,32(2 Suppl 1):S2-4.
[2] Sigurqeirsson B,Baran R. The prevalence of onychomycosis in the global population:a literature study[J]. J Eur Acad Dermatol Venereol,2014,28(11):1480-1491.
[3]陈宝珊,梁雅晶,杨声显,等.澳门特别行政区老年人群足趾甲真菌病的流行病学研究[J].临床皮肤科杂志,2016,45(1):20-22.
[4]王爱平,余进,万喆,等.国内多中心甲真菌病病原菌流行病学调查[J].中国真菌学杂志,2015,10(4):197-202.
[5]龚子鉴,赖维.特殊人群甲真菌病的流行病学研究现状[J].中国真菌学杂志,2006,1(1):60-62.
[6] Gupta AK,Sibbald G,Lynde CW,et al. Onychomycosis in children:prevalence and treatment strategies[J]. J Am AcadDermatol,1997,36(3 Pt1):395-402.
[7] Gupta AK. Onychomycosis in the elderly[J]. Drugs Aging,2000,16(6):397-407.
[8]廉翠红,张书岭. 785例甲真菌病分析[J].实用诊断与治疗杂志,2008,22(3):168-172.
[9] Singal A,Khanna D. Onychomycosis:Diagnosis and management[J].Indian J Dermatol Venereol Leprol,2011,77(6):659-672.
[10] Ribeiro CS,Zaitz C,Framil VM,et al. Descriptive study of onychomycosis in a hospital in So Paulo[J]. Braz J Microbiol,2015,46(2):485-492.
[11] Bianca Maria Piraccini,Aurora Alessandeini. Onychomycosis:A Review[J]. J Fungi(Base),2015,1(1):30-34.
[12]尹颂超,张云青,谭永芳,等. 805例甲真菌病真菌培养结果分析[J].中国真菌学杂志,2013,8(4):214-216.
[13]马国群,戴唯. 761例甲真菌病病原菌分离培养分析[J].中华医院感染学杂志,2011,21(3):617-618.
[14] Scher RK,Rich P,Pariser D,et al. The epidemiology,etiology,and pathophysiology of onychomycosis[J]. Semin Cutan Med Surq,2013,32(2 Suppl 1):S2-4.