头癣毛癣菌引起的角斑一例,Pediatrics International

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头癣毛癣菌引起的角斑一例
Pediatrics International ( IF 1.0 ) Pub Date : 2020-08-01 , DOI: 10.1111/ped.14279
Beatrice Tonin ₁ , Davide Geat ₁ , Giampiero Girolomoni ₁

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一名 5 岁健康男孩因头皮损伤 3 周病史到我科就诊，儿科医生已对其进行全身和局部抗生素治疗（口服阿莫西林 50 mg/kg，每天服用莫匹罗星）软膏每天两次，持续 10 天）没有任何改善。体格检查发现圆形红斑硬皮斑块伴脓性分泌物，包围头皮前部的毛干（图 1a、b）。拔毛试验呈阳性。触诊时病灶有压痛，双侧颈侧淋巴结轻度肿大，无发热。这个男孩和他的父母和两个哥哥住在一起，他们都身体健康。他们没有宠物。常规实验室检查，包括全血细胞计数、C 反应蛋白、和血沉，均在正常范围内。用氢氧化钾制备的儿童病变皮肤刮屑显示存在真菌菌丝。因此诊断为 Kerion，并给予 12 周口服灰黄霉素治疗（每天 20 毫克/千克）以及每周 3 次酮康唑洗发水，减少渗出并逐渐愈合病变。后来从培养物中分离出毛癣菌。Kerion celsi 是头癣的一种罕见的炎症和化脓表现，由对皮肤癣菌感染的强烈免疫反应引起。嗜人性和嗜动物性皮肤癣菌是头癣的最常见原因。在美国、英国、加拿大、巴西、法国和日本，毛癣菌是头癣的主要原因。犬小孢子菌是俄罗斯、欧洲中部和南部以及澳大利亚的主要病原体，而疣状毛癣菌是土耳其头癣最常见的病原体。在西非，最常见的原因是 Microsporum audouinii 和 Trichophyton soudanense。Kerion 通常发生在头皮上；然而，它也可能出现在身体的任何部位，包括眉毛、胡须和外阴。诊断依赖于真菌培养，但需要较长的孵育时间（2-3 周）并且经常观察到假阴性。在临床怀疑有脓疱疮的培养阴性患者中，组织学分析对诊断非常有价值。聚合酶链反应 (PCR) 是一种更新更快的技术，但在许多机构中并不可用。口服抗真菌治疗是主要的治疗方法。灰黄霉素是首选的治疗选择，小孢子菌感染为 8 周，红癣菌感染为 12-18 周。其他抗真菌药如特比萘芬、伊曲康唑和氟康唑具有相似的有效率。对严重炎症患者辅助口服皮质类固醇（例如 0.5-1 mg/kg 泼尼松 1 周）的有效性存在争议。由于其与其他皮肤病头皮状况的惊人相似性，脓疱疮最初常常被误诊为细菌性脓肿（因为两者都表现为化脓性）严重炎症患者使用 5–1 mg/kg 泼尼松一周）是有争议的。由于其与其他皮肤病头皮状况的惊人相似性，脓疱疮最初常常被误诊为细菌性脓肿（因为两者都表现为化脓性）严重炎症患者使用 5–1 mg/kg 泼尼松 1 周）是有争议的。由于其与其他皮肤病头皮状况惊人的相似性，脓疱疮最初常常被误诊为细菌性脓肿（因为两者都表现为脓性

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A case of kerion celsi caused by Trichophyton tonsurans

A 5-year-old otherwise healthy boy presented to our department due to a 3-week history of a painful scalp lesion, which had already been treated by a pediatrician with systemic and topical antibiotic therapy (oral amoxicillin 50 mg/kg daily and mupirocin ointment twice a day for 10 days) with no improvement. The physical examination revealed a roundish, erythematous crusty plaque with purulent discharge, enclosing the hair shafts of the frontal region of the scalp (Fig. 1a,b). The hair pull test was positive. The lesion was tender at palpation, and there was also modest bilateral latero-cervical lymphadenopathy without fever. The boy lived with his parents and two older brothers, all of whom were in good general health. They had no pets. Routine laboratory examinations, including complete blood count, C-reactive protein, and erythrocyte sedimentation rate, were all within the normal range. Potassium hydroxide preparation of skin scrapings from the child’s lesion revealed the presence of fungal hyphae. Kerion was therefore diagnosed and oral griseofulvin therapy (20 mg/ kg daily) was given for 12 weeks along with ketoconazole shampoo three times a week, with reduction of the exudation and gradual healing of the lesion. Trichophyton tonsurans was later isolated from the culture. Kerion celsi is a rare inflammatory and suppurative manifestation of tinea capitis, resulting from an intense immune response to the dermatophytic infection. Anthropophilic and zoophilic dermatophytes are the most frequent causes of tinea capitis. In the USA, UK, Canada, Brazil, France, and Japan, Trichophyton tonsurans is the primary cause of tinea capitis. Microsporum canis is the predominant causative organism in Russia, central, and southern Europe and Australia, while Trichophyton verrucosum is the most frequent responsible agent of tinea capitis in Turkey. In West Africa, the most common causes are Microsporum audouinii and Trichophyton soudanense. Kerion commonly occurs on the scalp; however, it may also arise on any part of the body including the eyebrow, beard and vulva. The diagnosis relies on fungal culture, yet long incubation times (2–3 weeks) are needed and false negatives are frequently observed. In culture-negative patients where kerion is clinically suspected, histologic analysis can be very valuable for diagnosis. Polymerase chain reaction (PCR) is a newer and more rapid technique, but it is not available in many institutions. Oral antifungal therapy is the mainstay of treatment. Griseofulvin is the first therapeutic choice, for 8 weeks in Microsporum infections and 12–18 weeks for Trychophytum infections. Other antifungal agents such as terbinafine, itraconazole, and fluconazole have similar efficacy rates. The usefulness of adjunctive oral corticosteroids (e.g. 0.5–1 mg/kg of prednisone for one week) in patients with severe inflammation is controversial. Because of its striking similarity with other dermatologic scalp conditions, kerion is often initially misdiagnosed as a bacterial abscess (as both show purulent

更新日期：2020-08-01

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