Department of Dermatology, Peking University First Hospital, Beijing, China.
National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
Mycoses. 2021 Apr;64(4):340-348. doi: 10.1111/myc.13212. Epub 2020 Dec 9.
Dermatophyte infections usually present as various types of superficial cutaneous mycoses; on very rare occasions, dermatophytes enter deep into the dermis and cause invasive infections. In this study, we aimed to perform a systematic review of all reported invasive dermatophytosis cases over the past 20 years. We performed systematic searches in PubMed/Medline, EMBASE and Web of Science and identified 123 papers reporting 160 individual cases of invasive dermatophytosis between 2000 and 2020. Our study included 103 (64.4%) males, and the mean age at diagnosis was 43.0 years (range: 3-87 years). The most common predisposing factor was superficial dermatophytosis (56.9%), followed by solid organ transplantation (26.9%), the use of topical immunosuppressants (15.6%), gene mutations (14.4%), diabetes (14.4%) and trauma (6.9%). Trichophyton (T.) rubrum was the most prevalent pathogen (53.1%) responsible for invasive dermatophytosis, followed by T. mentagrophytes (7.5%), Microsporum canis (6.9%), T. tonsurans (5.6%), T. interdigitale (5.0%) and T. violaceum (3.8%). Patients with CARD9 or STAT3 mutations were prone to have mixed infection of two or more dermatophytes, present with eosinophilia and high IgE, and develop disseminated infections. Overall mortality was 7.9%, and the mortality in patients with and without gene mutations was 17.4% and 5.5%, respectively. Most of the normal host patients responded well to oral antifungal agents, while gene-deficient patients usually required lifelong treatment to stabilise their infection status. Our review indicated the importance of preventive treatment of superficial tinea in patients with immunosuppression and gene deficiencies to avoid the development of invasive dermatophytosis.
皮肤癣菌感染通常表现为各种类型的浅表皮肤真菌病；极少数情况下，皮肤癣菌会深入真皮并引起侵袭性感染。在这项研究中，我们旨在对过去 20 年来所有报道的侵袭性皮肤癣菌病病例进行系统回顾。我们在 PubMed/Medline、EMBASE 和 Web of Science 中进行了系统搜索，共确定了 123 篇报道 2000 年至 2020 年间 160 例侵袭性皮肤癣菌病的论文。我们的研究包括 103 例（64.4%）男性，诊断时的平均年龄为 43.0 岁（范围：3-87 岁）。最常见的易感因素是浅表皮肤癣菌病（56.9%），其次是实体器官移植（26.9%）、局部免疫抑制剂使用（15.6%）、基因突变（14.4%）、糖尿病（14.4%）和创伤（6.9%）。红色毛癣菌（T. rubrum）是最常见的病原体（53.1%），导致侵袭性皮肤癣菌病，其次是须癣毛癣菌（7.5%）、犬小孢子菌（6.9%）、断发毛癣菌（5.6%）、趾间毛癣菌（5.0%）和紫色毛癣菌（3.8%）。CARD9 或 STAT3 基因突变的患者易发生两种或两种以上皮肤癣菌的混合感染，表现为嗜酸性粒细胞增多和高 IgE，并发生播散性感染。总死亡率为 7.9%，有基因突变和无基因突变的患者死亡率分别为 17.4%和 5.5%。大多数正常宿主患者对抗真菌药物的口服治疗反应良好，而基因缺陷患者通常需要终身治疗以稳定其感染状态。我们的综述表明，对免疫抑制和基因缺陷患者的浅表癣病进行预防性治疗对于避免侵袭性皮肤癣菌病的发生非常重要。
