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[热带及与旅行相关的皮肤真菌病:第1部分:皮肤癣菌病]

[Tropical and travel-related dermatomycoses: Part 1: Dermatophytoses].

作者信息

Nenoff P, Reinel D, Krüger C, Grob H, Mugisha P, Süß A, Mayser P

机构信息

Haut- und Laborarzt/Allergologie, Andrologie, Tätigkeitsschwerpunkt: Tropen- und Reisedermatologie (DDA), Labor für medizinische Mikrobiologie, Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Straße des Friedens 8, 04579, Mölbis, Deutschland,

出版信息

Hautarzt. 2015 Jun;66(6):448-58. doi: 10.1007/s00105-015-3623-z.

Abstract

Today, tropical and travel-related dermatomycoses must be increasingly anticipated to present in dermatological offices and clinics. Skin infections due to dermatophytes or other fungi may occur after a journey in countries with a high prevalence for the respective causative fungal pathogen, e.g., tinea corporis due to Trichophyton soudanense. Otherwise, more frequently, single infections and even localized outbreaks due to "exotic" or "imported" pathogens of dermatophytoses occur. These epidemics are observed in childcare facilities in Germany and in other European countries. Source of infection are immigrants from Africa and sometimes from Asian countries. Furthermore, African children, and sometimes also adults, are often only asymptomatic carriers of such anthropophilic dermatophytes. Outbreaks of dermatophyte infections with one and more affected children and also adult staff and teachers due to Trichophyton violaceum or Microsporum audouinii in kindergartens and schools are not a rarity these days. Further tropical and travel-associated dermatophytes are Trichophyton tonsurans, Trichophyton schoenleinii, and Trichophyton concentricum. Tinea capitis should be treated in a species-specific manner. Griseofulvin is the treatment of choice for infections due to Microsporum species. In contrast, tinea capitis due to Trichophyton species has to be treated by terbinafine, however, because the agent is not approved for children in Germany, only after receiving written consent of parents. Alternatives are fluconazole and itraconazole. Onset and aggravation of tinea pedis during travel has its origin in a preexisting neglected fungal infection of the feet. In the tropics, exacerbations and secondary bacterial complications of tinea pedis develop under distinctly promoting conditions.

摘要

如今,在皮肤科诊所和门诊中,热带地区及与旅行相关的皮肤真菌病的出现频率越来越高。在某些致病真菌病原体高发的国家旅行后,可能会发生皮肤癣菌或其他真菌引起的皮肤感染,例如苏丹毛癣菌引起的体癣。此外,更常见的是,由皮肤癣菌病的“外来”或“输入性”病原体引起的单个感染甚至局部暴发。在德国和其他欧洲国家的儿童保育设施中观察到了这些疫情。感染源是来自非洲以及有时来自亚洲国家的移民。此外,非洲儿童,有时还有成年人,往往只是这类亲人性皮肤癣菌的无症状携带者。如今,幼儿园和学校中因紫色毛癣菌或奥杜盎小孢子菌导致一个或多个儿童以及成年教职员工感染皮肤癣菌的情况并不罕见。其他与热带地区和旅行相关的皮肤癣菌还有断发毛癣菌、石膏样毛癣菌和同心性毛癣菌。头癣应根据特定菌种进行治疗。灰黄霉素是治疗小孢子菌属感染的首选药物。相比之下,毛癣菌属引起的头癣必须用特比萘芬治疗,不过由于该药物在德国未被批准用于儿童,只有在获得家长书面同意后才能使用。替代药物有氟康唑和伊曲康唑。足癣在旅行期间的发作和加重源于先前被忽视的足部真菌感染。在热带地区,足癣会在明显有利的条件下加重并引发继发性细菌并发症。

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