Hu Yongxuan, Huang Xiaowen, Lu Sha, Hamblin Michael R, Mylonakis Eleftherios, Zhang Junmin, Xi Liyan
Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Rd, Guangzhou, 510120, China.
Mycopathologia. 2015 Feb;179(1-2):103-9. doi: 10.1007/s11046-014-9828-3. Epub 2014 Nov 1.
Chromoblastomycosis, a chronic fungal infection of skin and subcutaneous tissue caused by dematiaceous fungi, is associated with low cure and high relapse rates. Among all factors affecting clinical outcome, etiological agents have an important position. In southern China, Fonsecaea pedrosoi and Fonsecaea monophora are main causative agents causing Chromoblastomycosis. We treated one case of chromoblastomycosis by photodynamic therapy (PDT) of 5-aminolevulinic acid (ALA) irradiation combined with terbinafine 250 mg a day. The lesions were improved after two sessions of ALA-PDT treatment, each including nine times, at an interval of 1 week, combined with terbinafine 250 mg/day oral, and clinical improvement could be observed. In the following study, based on the clinical treatment, the effect of PDT and antifungal drugs on this isolate was detected in vitro. It showed sensitivity to terbinafine, itraconazole or voriconazole, and PDT inhibited the growth. Both the clinic and experiments in vitro confirm the good outcome of ALA-PDT applied in the inhibition of F. monophora. It demonstrated that combination of antifungal drugs with ALA-PDT arises as a promising alternative method for the treatment of these refractory cases of chromoblastomycosis.
着色芽生菌病是一种由暗色真菌引起的皮肤和皮下组织的慢性真菌感染，其治愈率低且复发率高。在影响临床结局的所有因素中，病原体占有重要地位。在中国南方，裴氏着色真菌和卡氏枝孢霉是引起着色芽生菌病的主要病原体。我们采用5-氨基酮戊酸（ALA）光动力疗法（PDT）联合每天250毫克特比萘芬治疗1例着色芽生菌病。经过两个疗程的ALA-PDT治疗（每个疗程包括9次，间隔1周），联合每天口服250毫克特比萘芬后，皮损有所改善，临床症状可见好转。在接下来的研究中，基于临床治疗，在体外检测了PDT和抗真菌药物对该分离株的作用。结果显示其对特比萘芬、伊曲康唑或伏立康唑敏感，且PDT可抑制其生长。临床和体外实验均证实ALA-PDT在抑制卡氏枝孢霉方面效果良好。这表明抗真菌药物与ALA-PDT联合应用是治疗这些难治性着色芽生菌病病例的一种有前景的替代方法。
