Al-Hatmi Abdullah M S, Bonifaz Alexandro, Tirado-Sánchez Andrés, Meis Jacques F, de Hoog G Sybren, Ahmed Sarah A
CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands.
Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands.
Mycoses. 2017 Mar;60(3):204-212. doi: 10.1111/myc.12590. Epub 2016 Dec 7.
Recently, mycetoma was added to the World Health Organization's list of neglected tropical disease priorities. Fusarium as a genus has been reported to cause eumycetoma, but little is known about the species involved in this infection and their identification. In this study, molecular tools were applied to identify Fusarium agents from human eumycetoma cases. The partial translation elongation factor 1-alpha (TEF-1α) gene was used as diagnostic parameter. Two additional cases of eumycetoma, due to F. keratoplasticum and F. pseudensiforme, respectively, are presented. A systematic literature review was performed to assess general features, identification, treatment and outcome of eumycetoma infections due to Fusarium species. Of the 20 reviewed patients, the majority (75%) were male. Most agents belonged to the F. solani species complex, ie F. keratoplasticum, F. pseudensiforme, and an undescribed lineage of F. solani. In addition, F. thapsinum, a member of Fusarium fujikuroi species complex was encountered. The main antifungal drugs used were itraconazole, ketoconazole and amphotericin B, but cure rates were low (15%). Partial response or relapse was observed in some cases, and a case ended in amputation. Clinical management of eumycetoma due to Fusarium is complex and combination therapy might be required to increase cure rates.
最近，足菌肿被列入世界卫生组织重点关注的被忽视热带病名单。据报道，镰刀菌属可引起真菌性足菌肿，但对于引发这种感染的菌种及其鉴定了解甚少。在本研究中，应用分子工具从人类真菌性足菌肿病例中鉴定镰刀菌病原体。部分翻译延伸因子1-α（TEF-1α）基因被用作诊断参数。本文还介绍了另外两例分别由角膜塑形镰刀菌和假拟形镰刀菌引起的足菌肿病例。进行了一项系统性文献综述，以评估镰刀菌属引起的真菌性足菌肿感染的一般特征、鉴定、治疗及转归。在纳入综述的20例患者中，大多数（75%）为男性。大多数病原体属于茄病镰刀菌种复合体，即角膜塑形镰刀菌、假拟形镰刀菌，以及一个未描述的茄病镰刀菌谱系。此外，还发现了藤仓镰刀菌种复合体的成员—塔斯马尼亚镰刀菌。主要使用的抗真菌药物为伊曲康唑、酮康唑和两性霉素B，但治愈率较低（15%）。部分病例观察到部分缓解或复发，有1例最终截肢。镰刀菌引起的真菌性足菌肿的临床管理较为复杂，可能需要联合治疗以提高治愈率。
