Rouzaud Claire, Chosidow Olivier, Brocard Anabelle, Fraitag Sylvie, Scemla Anne, Anglicheau Dany, Bouaziz Jean-David, Dupin Nicolas, Bougnoux Marie-Elisabeth, Hay Roderick, Lortholary Olivier, Lanternier Fanny
Infectious Diseases and Tropical Medicine Department, Necker-Pasteur Infectious Diseases Center, Necker-Enfants malades Hospital, AP-HP, IHU Imagine, Paris Descartes University, Paris, France.
Department of Dermatology, Henri Mondor Hospital, AP-HP, Paris-Est Créteil University, Créteil, France.
Transpl Infect Dis. 2018 Feb;20(1). doi: 10.1111/tid.12799. Epub 2018 Jan 25.
Severe dermatophytosis is described in immunocompromised patients with defective cellular immunity. We report here a large series and a literature review of severe dermatophytosis in solid-organ transplant (SOT) recipients.
The data main source was a national French retrospective study of severe dermatophytosis in SOT recipients between 2010 and 2016. Inclusion criteria were the presence of dermatophytes in skin culture and 1 severity criteria: dermal invasion by dermatophytes (invasive dermatophytosis) or involvement of at least two body sites or >10% of body surface area (extensive dermatophytosis).
A total of 12 patients were included (8 men, median age of 56 years [range: 33-71]). Of the 12 patients, 10 underwent kidney transplantation. The median time from transplantation to severe dermatophytosis diagnosis was 16 months [range: 2-94]. Clinical signs of superficial dermatophytosis were present in 8/12 patients before the emergence of severe dermatophytosis. Nine patients had invasive forms and three extensive ones, and nodules of the lower extremities were found in eight. Trichophyton rubrum was isolated in 11 cases. First-line treatment was terbinafine (7/12), posaconazole (3/12), or topical treatment alone (2/12). Immunosuppressive therapy was reduced in 3 patients because of associated infections. Complete response was obtained for 3/3 and 5/9 patients with extensive or invasive forms, respectively, after a median treatment's duration of 2.5 [range: 1.5-5] months and 7.5 months [range: 4-12]. Unrelated deaths (n = 2) and graft function impairment (n = 3) occurred.
Severe dermatophytosis is a late complication in SOT recipients presenting with lower limb nodules, which might be prevented by prompt treatment of superficial dermatophytosis.
免疫功能低下且细胞免疫缺陷的患者会出现严重皮肤癣菌病。我们在此报告实体器官移植（SOT）受者中严重皮肤癣菌病的一个大样本系列病例及文献综述。
数据的主要来源是一项针对2010年至2016年间法国SOT受者严重皮肤癣菌病的全国性回顾性研究。纳入标准为皮肤培养中存在皮肤癣菌以及1项严重程度标准：皮肤癣菌的真皮侵袭（侵袭性皮肤癣菌病）或累及至少两个身体部位或体表面积>10%（广泛性皮肤癣菌病）。
共纳入12例患者（8例男性，中位年龄56岁[范围：33 - 71岁]）。12例患者中，10例接受了肾移植。从移植到严重皮肤癣菌病诊断的中位时间为16个月[范围：2 - 94个月]。在严重皮肤癣菌病出现之前，12例患者中有8例存在浅表皮肤癣菌病的临床体征。9例为侵袭性类型，3例为广泛性类型，8例发现下肢有结节。11例分离出红色毛癣菌。一线治疗为特比萘芬（7/12）、泊沙康唑（3/12）或仅局部治疗（2/12）。3例患者因合并感染而减少了免疫抑制治疗。广泛性或侵袭性类型的患者分别在中位治疗时间2.5个月[范围：1.5 - 5个月]和7.5个月[范围：4 - 12个月]后，3/3例和5/9例获得完全缓解。发生了2例非相关性死亡和3例移植功能损害。
严重皮肤癣菌病是SOT受者出现下肢结节的晚期并发症，及时治疗浅表皮肤癣菌病可能预防其发生。
