Sporothriosis
Introduction
Introduction to sporotrichosis Sporotrichosis is a chronic infection of the skin caused by the saprophytic fungus S. serrata, subcutaneous tissue and lymphatic vessels nearby, and can even spread to the whole body, causing systemic damage. S. sporogenes are present in roses. Barberry and sphagnum and other woodland coverings. Gardeners, gardeners, agricultural workers and woodworkers are most often infected. basic knowledge The proportion of sickness: 0.004% - 0.005% Susceptible people: no specific population Mode of infection: contact spread Complications: Epididymitis Diabetes Mastitis
Cause
Cause of sporotrichosis
(1) Causes of the disease
Sporotrichosis is a chronic infection of the skin, subcutaneous tissue and nearby lymphatic vessels caused by Schenck spores. S. serrata is a saprophytic organism found in soil, wood and plants. Biphasic fungi, ie yeast type in human body, hyphal type in human body, belonging to fungal phylum, subfamily genus, genus Trichosporium, plexus spores, plexus spores, in smear Upper Gram staining can be seen in neutrophils or large mononuclear cells with Gram-positive oval bodies, which can be grown on glucose agar medium for 2 to 3 days at room temperature.
(two) pathogenesis
The bacteria are present in the soil and on the plants. Spores are implanted through the skin trauma, and can also invade the oral mucosa, cause infection through the digestive tract, and invade the lungs through the respiratory tract or spread to the internal organs and bones through the blood.
After 1 week to several weeks after infection, a tough, painless subcutaneous nodule occurs in the invasive site, showing a reddish color, no adhesion to the skin, nodules, softening, pale purple, purplish purple, later ulceration, outflow A small amount of viscous pus, after the formation of scars, secondary to the lymphatic cast of the skin or self-inoculation, multiple nodules appear in distant parts, system damage caused by blood dissemination, can violate bones, joints, eyes , mucosa, lung, heart muscle, liver, spleen, kidney, glands and central nervous system.
Prevention
Sporotosis prevention
This is a deep mycosis caused by spores, mainly invading the skin, and occasionally invading the mucous membranes, lungs, meninges and other internal organs. Before the onset, the skin often has a history of trauma, and then contact with the soil or plants with bacteria, the bacteria From the damaged skin into the human body, about 1 to 3 weeks, it will cause scorpion-like damage in the initial invasive part, generally no pain, no fever, ulceration after ulceration, not much pus; can also be pimples , sputum lesions, plaques, cauliflower-like pseudo-tumors, etc., damage can be fixed in one place for a long time, or spread up along the lymphatic vessels, resulting in a series of similar damage, several to dozens of arranged in strips, generally the upper limbs The incidence of the disease is the most, followed by the lower limbs. In recent years, the face is also quite common. Very few can invade the blood, causing widespread dissemination of the skin and internal organs, and pus in the extrusion damage for culture, often separating the pathogens. Can determine the diagnosis, iodide has special effects on this disease, generally use 10% potassium iodide solution, 10ml each time, three times a day, orally, the course of treatment is from February to March, local thermotherapy can play an auxiliary role, prevent skin Skin trauma is very important to prevent this disease. The dressings replaced by patients should be burned to avoid polluting the environment and infect others. In the high-risk areas of this disease, publicity should be done.
Complication
Sporozoite complications Complications Epididymitis Diabetes mastitis
Can be complicated by nephritis, testicular epididymitis, mastitis, diabetes and so on.
Symptom
Symptoms of sporotrichosis common symptoms meningitis erythema squamous subcutaneous cyst papule joint swelling scar pustules
According to the invasion site of spores and the resistance of the body, sporotrichosis can be divided into the following types:
1. Skin lymphoid type is the most common type of sporotrichosis, which occurs in the limbs. In recent years, it has increased in the face, and the limbs are more common in the right upper limb. It can be in the forearm, the back of the hand or the finger. The calf or ankle is often unilateral and has a history of trauma. Since the patient has been exposed to bacteria or plants, the first lesion can appear 8 to 20 days after infection, and the incubation period can be as long as 6 months. Starting from a round, tough, painless subcutaneous nodule, the surface is reddish and does not adhere to the epidermis. Thereafter, the nodules gradually swell to the skin, the surface is purplish red, and finally black and necrotic, forming ulcers; ulcer surface There is a thin pus, covered with thick sputum, and after 1 to 2 weeks, the new nodules spread along the direction of the lymphatic vessels. The centripetality is arranged in a string, the number is more or less, and the pitch is long and short, usually under the armpit. Or before the inguinal lymph nodes are invaded, the condition stops developing. A few patients with lymph node involvement may develop suppurative necrosis. If it occurs on the face, it is often at the tip of the nose, and the base of the nose develops to the cheeks. This type rarely causes blood to spread, often seen in the old Damage healing, new damage Continue to happen.
2. Localized skin type
Also known as fixed sporotrichosis, it is characterized by multiple lesions fixed in the initial site, does not invade nearby lymph nodes, and the morphology of the lesions is variable, often divided into the following subtypes:
1 nodular subtype: occurs in the thinner parts of the skin's stratum corneum, such as the wrist, arm, neck, dark red nodules, the surface may have desquamation, if there is ulceration, overlying thick sputum;
2 granuloma subtype: manifested as granulomatous lesions, chronic proliferative lesions, may be associated with exudation of scars;
3 infiltrated plaque subtype: is a larger plaque, diameter 2 ~ 3cm, higher than the leather surface, dark purple red, the substrate is infiltrated, the surface is uneven;
4 satellite subtype: often a nodular or granulomatous lesion, surrounded by needles to mung bean large red papules, satellite-like;
5 subtype: occurs in thicker corners, such as the hands, the back of the foot, the fingertips, such as the common horny hyperplasia;
6 cyst subtype: manifested as a subcutaneous cyst;
7 acne subtype: skin lesions are papules, pustules, superficial, occur in the eyelids, neck, back of the hand;
8 erythema scale subtype: skin lesions such as psoriasis or rosacea, fixed sporozoites damage manifestations vary, easily misdiagnosed.
3. The skin mucosa is often secondary to disseminated lesions in the body. It occurs in the mouth, throat, nose, and begins with erythema. It can be ulcerated or purulent afterwards. It can form granuloma, papilloma-like damage, and pain. The nearby lymph nodes can be swollen and painful.
4. Extra-cutaneous and disseminated
1 bone, periosteum and synovial sporozoites are mostly caused by subcutaneous tissue lesions affecting the periosteum, synovial membrane, often involving bone, can occur in the metacarpal, metatarsophalangeal and ulna, femur, etc., joint sporotrichosis can cause joint swelling , restricted movement, with joint cavity effusion, positive puncture culture;
2 eyes and its accessory sporotrichosis often have no other parts of sporotrichosis, mostly primary infections, can affect the eyelids, lacrimal sac, conjunctiva, skin lesions for ulcer or gum swelling damage;
3 systemic sporotrichosis is rare, can be spread by blood, affecting the skin, bones or muscles, and even cause nephritis, orchitis, epididymitis, mastitis, even spread to the liver, spleen, pancreas, thyroid and myocardium, This type often occurs in patients with diabetes, sarcoidosis and long-term treatment with corticosteroids;
4 spores of meningitis is rare, headache, dizziness, mental symptoms can occur, cerebrospinal fluid culture can have spores growth, cerebrospinal fluid cell number and protein volume increased;
5 Pneumocystis filariasis is rare, mostly occurs in alcoholics, can present miliary necrosis or cavities, also can have hilar lymph nodes, bronchial lymph node lesions.
Mainly based on the history of trauma in the history of the disease; work in the soil, wood, plants, cactus and other contact history; clinical manifestations of typical skin lesions, plus laboratory examination and pathological examination for comprehensive diagnosis, of which laboratory examination is the most important, clinical practice Attention must be paid to the following aspects: when vitamin B is added, it can promote the production of pigments.
1 non-pigmented spores must be distinguished from Candida, according to the spores of bifidobacteria, colony morphology, color, microscopic conidia arranged under the plum-shaped shape, it is not difficult to identify;
2 histopathology is specific, typically visible cigar bodies and stellates.
Examine
Examination of sporotrichosis
Experimental inspection:
1 specimen collection: pus or blood collected from skin damage black spots and unbroken nodules, other sputum, blood, bone marrow, cerebrospinal fluid or skin living tissue, visceral tissue;
2 When directly inspecting, the spores are easily confused with other structures. Especially when the number of spores is small, it is often difficult to identify, so it should be cultured to confirm the diagnosis;
3 In the Sabouraud agar medium, the colony morphology was the same at 37 ° C and 25 ° C, but the strains in the partial fixed spores of the spores could not grow at 37 ° C, preferably in two incubators for cultivation;
4 When the medium is added to penicillin, it can stimulate the growth of spores.
Histopathology:
Mainly for suppurative granulomatous reaction, found in skin nodules and affected lymph nodes, in typical nodular lesions, there may be a characteristic arrangement: the central purulent layer contains neutrophils, surrounding the epithelioid cells and The "tuberculosis-like" layer of multinucleated giant cells is a "syphilitic-like" layer of lymphoid cells and plasma cell tissue. When PAS is stained, a radial eosin substance is sometimes surrounded around the fungal spores to form a "stellate". ".
Diagnosis
Diagnosis and diagnosis of sporotrichosis
It should be differentiated from rabbit fever, anthrax and other bacterial diseases. Generally, from the clinical point of view, the incidence of each disease is more urgent, and the bacteria and serological tests can also be identified; for other fungal diseases such as coloring fungal diseases, sprouting Bacterial disease, foot edema, paraspora fungus and granulomatous trichomoniasis can be identified by clinical and laboratory tests of fungi, syphilis, skin tuberculosis, pyoderma, horse sputum, bromine The rash can be identified by clinical combined fungal examination and serological examination. In addition, it should be differentiated from sarcoidosis, tumor, acne, actinomycosis, rosacea, sarcoma and leishmaniasis.
