Brasch J
Klinik für Dermatologie, Venerologie und Allergologie, UKSH, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Deutschland.
Hautarzt. 2012 Nov;63(11):872-6. doi: 10.1007/s00105-012-2382-3.
Under favorable conditions even molds can cause skin infections. Fusarium spp. belong to this group of agents. Onychomycoses due to Fusarium spp. are regularly encountered and cannot be clinically distinguished from nail infections triggered by dermatophytes. They can occur in otherwise healthy persons. Skin lesions caused by Fusarium spp. may be necrotizing, ulcerating, pustular, vasculitis-like, panniculitis-like or granulomatous. Single lesions can develop after fungal inoculation into damaged tissue; multiple ones are often due to a septic dissemination of Fusarium in severely immunocompromised patients. An immediate verification of the agents can be life-saving in such cases. Pathogenic Fusarium spp. should be identified at the species level and need to be tested for their susceptibility to antimycotics. In case of multiple lesions, systemic therapy is required. Many strains of Fusarium spp. are susceptible to amphotericin B, voriconazole and posaconazole; itraconazole and terbinafine may be helpful in certain cases.
在适宜条件下，甚至霉菌也可引起皮肤感染。镰刀菌属就属于这类病原体。由镰刀菌属引起的甲癣很常见，临床上无法与皮肤癣菌引发的指甲感染相区分。它们可发生于其他方面健康的人。镰刀菌属引起的皮肤损害可能是坏死性、溃疡性、脓疱性、血管炎样、脂膜炎样或肉芽肿性的。真菌接种到受损组织后可出现单个损害；多个损害在严重免疫功能低下患者中常因镰刀菌败血症播散所致。在此类病例中，立即明确病原体可能挽救生命。致病性镰刀菌属应鉴定到种水平，并需检测其对抗真菌药的敏感性。出现多个损害时，需要进行全身治疗。许多镰刀菌属菌株对两性霉素B、伏立康唑和泊沙康唑敏感；伊曲康唑和特比萘芬在某些情况下可能有效。
