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作者信息

Feuilhade de Chauvin M

机构信息

Laboratoire de mycologie, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.

出版信息

Ann Dermatol Venereol. 2018 Oct;145(10):623-632. doi: 10.1016/j.annder.2018.05.006. Epub 2018 Aug 22.

Abstract

Dermatomycoses are dermatological infections very commonly encountered in private dermatological practice since they affect up to one third of the population. However, the symptoms are very often shared by other skin infections and disorders and may be highly atypical. It is thus impossible to make a diagnosis with any certainty on clinical grounds alone. For this reason, mycological diagnosis is essential to either confirm or rule out dermatomycosis, and is unavoidable when antifungal therapy is required for the treatment of ringworm of the scalp or beard, or for onychomycosis. It is also vital where therapy guided by the clinical appearance of lesions has failed or in the event of recurring skin lesions. Confirmation of mycosis enables antifungals to be initiated and a negative test warrants investigation for other underlying causes for the lesions seen. However, regardless of the mycological diagnostic technique employed, the quality of the results depends chiefly on the quality of sampling of the infected site, but also on the expertise of the microbiologist. Standard mycological testing remains the most informative, the least expensive and the sole examination capable of isolating the causative fungus irrespective of the type of mycosis, such as dermatophytosis, scytalidiosis, mould-induced ungual infection, candidiasis, or infections due to Malassezia sp. This is the only examination able to identify epidemiological variations. All other more recent techniques are either based upon simple demonstration of the fungal elements involved, without identification of the fungal species in question, or else they are reliant upon a fungal database that is generally highly incomplete.

摘要

皮肤真菌病是皮肤科私人诊所中非常常见的皮肤病感染,因为它们影响多达三分之一的人口。然而,这些症状常常与其他皮肤感染和疾病相同,而且可能非常不典型。因此,仅根据临床症状无法确定诊断。出于这个原因,真菌学诊断对于确诊或排除皮肤真菌病至关重要,在治疗头皮或胡须癣或甲癣需要抗真菌治疗时,或者在病变的临床表现指导下的治疗失败或皮肤病变复发的情况下,真菌学诊断是必不可少的。真菌病的确诊能够开始使用抗真菌药物,而检测结果为阴性则需要对所见病变的其他潜在原因进行调查。然而,无论采用何种真菌学诊断技术,结果的质量主要取决于感染部位采样的质量,也取决于微生物学家的专业知识。标准真菌学检测仍然是最具信息性、最便宜且唯一能够分离致病真菌的检查,无论真菌病的类型如何,如皮肤癣菌病、赛多孢子菌病、霉菌引起的甲感染、念珠菌病或马拉色菌属感染。这是唯一能够识别流行病学差异的检查。所有其他更新的技术要么基于所涉及真菌成分的简单显示,而不识别相关真菌种类,要么依赖于通常非常不完整的真菌数据库。

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