Wendrock-Shiga G, Mechtel D, Uhrlaß S, Koch D, Krüger C, Nenoff P
Hautarztpraxis, Untere Hauptstr. 4a, 09376, Oelsnitz, Deutschland.
Klinik für Hautkrankheiten und Allergologie, Heinrich-Braun-Klinikum gGmbH, Karl-Keil-Str. 35, 08060, Zwickau, Deutschland.
Hautarzt. 2017 Aug;68(8):639-648. doi: 10.1007/s00105-017-4008-2.
Tinea barbae represents a very rare dermatophytosis. We report on a tinea barbae profunda following a journey to Southeast Asia. After travel to Thailand, a businessman was affected by a foudroyant proceeding abscessing infection of the upper lip and beard area. The initial therapy with oral acyclovir and oral ciprofloxacin, which later was changed to ampicillin plus sulbactam, intravenously, was unsuccessful. In a biopsy sample, histologically, with Grocott-Gomori's methenamine silver stain, fungal mycelium was apparent in the tissue. Thereupon, terbinafine 250 mg was given for 4 weeks, topically, a 1% ciclopiroxolamine-containing cream. In fungal culture, T. mentagrophytes were found to grow. Meanwhile, the patient's German wife suffered from a tinea faciei. From skin scrapings from the cheek, T. mentagrophytes was also cultivated. This zoophilic dermatophyte was identical with other zoophilic strains of T. mentagrophytes currently found in Germany, which were also acquired in Thailand. The patient had contact with Thai female sex workers who must be considered as a source of infection of the dermatophytosis. There was no animal contact, neither in Thailand, nor in Germany. The infection chain of the dermatophytosis from Thailand probably reached from a female sex worker via the here described patient to his wife in Germany. This pathway of infection has been known for 1 or 2 years, but until now, in Germany, Switzerland, and Austria exclusively via pubogenital infections (tinea genitalis profunda) due to T. mentagrophytes after journeys to Southeast Asia. For treatment, oral antifungal agents should be used, first of all terbinafine, alternatively fluconazole or itraconazole.
须癣是一种非常罕见的皮肤癣菌病。我们报告一例前往东南亚旅行后发生的深部须癣病例。一名商人在前往泰国旅行后，上唇和胡须部位出现迅速进展的脓肿性感染。最初使用口服阿昔洛韦和口服环丙沙星治疗，后改为静脉注射氨苄西林加舒巴坦，但治疗均未成功。在活检样本中，经组织学检查，用格罗科特-戈莫里乌洛托品银染色法可见组织中有真菌菌丝。随后，局部给予250毫克特比萘芬，持续4周，以及含1%环吡酮胺的乳膏。真菌培养发现须癣毛癣菌生长。与此同时，患者的德国妻子患有面部癣。从脸颊皮肤刮屑中也培养出了须癣毛癣菌。这种亲动物性皮肤癣菌与目前在德国发现的其他亲动物性须癣毛癣菌菌株相同，这些菌株也是在泰国感染的。患者与泰国女性性工作者有接触，她们被认为是皮肤癣菌病的传染源。在泰国和德国，患者均未接触过动物。来自泰国的皮肤癣菌病感染链可能是从一名女性性工作者通过本文所述的患者传播到他在德国的妻子。这种感染途径已经为人所知1或2年了，但直到现在，在德国、瑞士和奥地利，仅在前往东南亚旅行后因须癣毛癣菌引起的深部生殖器感染（深部股癣）中发现。治疗时应使用口服抗真菌药物，首先是特比萘芬，也可选用氟康唑或伊曲康唑。
