Department of Dermatology and Venerology, First Hospital of Jilin University, Changchun, China.
Instrument Center, State Key Laboratory for Zoonotic Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, China.
Mycoses. 2024 Jan;67(1):e13671. doi: 10.1111/myc.13671. Epub 2023 Nov 27.
Hyperthermia is a common monotherapy for sporotrichosis, but only in patients with special conditions, such as pregnancy and nursing. However, hyperthermia has not been used more widely for sporotrichosis in clinical practice.
PATIENTS/METHODS: An HIV-positive adult male with lymphocutaneous sporotrichosis caused by Sporothrix globosa that did not respond to conventional itraconazole therapy lasting >2 months received adjunctive therapy with local hyperthermia. To simulate the effects of heat exposure on the growth and morphology of Sporothrix spp. in vitro, S. globosa, S. schenckii and S. brasiliensis were exposed to intermittent heat (42°C) for 1 h a day for 7 or 28 days and observed under transmission electron microscopy.
Itraconazole combined with local hyperthermia significantly improved the lesions, and the patient was successfully cured of sporotrichosis, with no recurrence after 2 years of follow-up. Cultures of Sporothrix spp. treated with 7 days of daily heat exposure in vitro showed obvious decreases in colony diameters, but not numbers, compared with untreated cultures (p < .001). After 28 days of heat exposure in vitro, Sporothrix spp. were unable to thrive (p < .001), and ultrastructural alterations, including loose cell wall structure, incomplete cell membrane, disrupted vacuoles and fragmented nuclei, were noticeable.
Our case findings and in vitro experiments on Sporothrix spp., together with a literature review of previous sporotrichosis cases, suggest that hyperthermia has a clinical role as a treatment adjunct. Large-scale clinical trials are required to examine the utility of hyperthermia in various forms of cutaneous sporotrichosis.
发热是治疗孢子丝菌病的常用单一疗法，但仅适用于妊娠和哺乳期等特殊情况的患者。然而，在临床实践中，发热并未更广泛地用于孢子丝菌病。
患者/方法：一名 HIV 阳性的成年男性患有由 S. globosa 引起的淋巴管皮肤孢子丝菌病，对持续超过 2 个月的常规伊曲康唑治疗无反应，接受了局部热疗辅助治疗。为了模拟热暴露对 Sporothrix spp. 在体外生长和形态的影响，将 S. globosa、S. schenckii 和 S. brasiliensis 暴露于间歇性热（42°C）中，每天 1 小时，持续 7 或 28 天，并在透射电子显微镜下观察。
伊曲康唑联合局部热疗显著改善了病变，患者成功治愈孢子丝菌病，2 年随访后无复发。体外 7 天每日热暴露处理的 Sporothrix spp. 培养物的菌落直径明显减小，但菌落数量没有减少（p<.001）。体外 28 天热暴露后，Sporothrix spp. 无法茁壮成长（p<.001），并且可以观察到明显的超微结构改变，包括疏松的细胞壁结构、不完整的细胞膜、空泡破裂和核碎裂。
我们的病例发现和 Sporothrix spp. 的体外实验，以及对以前孢子丝菌病病例的文献回顾表明，发热作为一种治疗辅助具有临床作用。需要进行大规模的临床试验来检查发热在各种形式的皮肤孢子丝菌病中的效用。
