Blömer R-H, Keilani N, Faber A, Rodeck B, Krüger C, Uhrlaß S, Gräser Y, Nenoff P
Klinik für Kinderheilkunde u. Jugendmedizin, Niels-Stensen-Kliniken, Marienhospital Osnabrück.
Hautarzt. 2012 Aug;63(8):648-52. doi: 10.1007/s00105-012-2326-y.
A 28-month-old boy developed a cutaneous and subcutaneous lesion of the scalp together with alopecia. Treatment with sulfadiazine silver ointment and oral administration of cefaclor failed. The boy lived on a farm where cows and calves were present. He presented with a 5 cm erythematous, erosive, edematous, and sharply defined lesion with yellow crusts and circumscribed alopecia on the temporoparietal scalp. Peripheral hairs were easily epilated. Swabs from the wound revealed cMRSA (community acquired methicillin-resistant Staphylococcus aureus, Panton Valentine Leukocidin [PVL] toxin negative). There was no improvement after treatment with cefuroxime intravenously over 3 days. Therapy was changed to vancomycin and fosfomycin. Because of the purulent abscess, surgical incision was performed. PCR (polymerase chain reaction)-Elisa assay detected Trichophyton (T.) interdigitale-DNA from wound secretion and skin biopsy. Because of the clinical and molecular diagnosis of tinea capitis, oral antifungal therapy with fluconazole 5 mg kg(-1) body weight was started, along with cotrimoxazole and fosfomycin for the cMRSA. After 4 weeks incubation, the causative agent T. verrucosum was grown on culture and its identity confirmed by sequencing of the "internal transcribed spacer" (ITS) region of the ribosomal DNA. After 4 weeks of fluconazole, the lesion was nearly healed.
一名28个月大的男孩头皮出现皮肤及皮下损伤并伴有脱发。使用磺胺嘧啶银软膏治疗及口服头孢克洛均无效。该男孩生活在一个有奶牛和小牛的农场。他颞顶头皮出现一个5厘米大小的红斑、糜烂、水肿且边界清晰的损伤，伴有黄色结痂及局限性脱发。周边毛发很容易拔除。伤口拭子检测出社区获得性耐甲氧西林金黄色葡萄球菌（cMRSA，Panton Valentine白细胞毒素[PVL]阴性）。静脉注射头孢呋辛3天治疗后无改善。治疗改为万古霉素和磷霉素。因出现脓性脓肿，进行了手术切开。聚合酶链反应（PCR）-酶联免疫吸附测定法从伤口分泌物和皮肤活检中检测出指间毛癣菌DNA。由于临床及分子诊断为头癣，开始口服氟康唑，剂量为5毫克/千克体重，同时使用复方新诺明和磷霉素治疗cMRSA。经过4周培养，致病病原体疣状毛癣菌在培养基上生长，并通过核糖体DNA“内转录间隔区”（ITS）区域测序确认其身份。使用氟康唑4周后，损伤几乎愈合。
