Sabota J, Brodell R, Rutecki G W, Hoppes W L
Northeastern Ohio University College of Medicine, Canton, USA.
Clin Infect Dis. 1996 Dec;23(6):1308-10. doi: 10.1093/clinids/23.6.1308.
Trichophyton verrucosum infection, which is acquired from the hide of dairy cattle, is the cause of tinea barbae, a severe pustular eruption on the face and neck. We present the cases of five patients, three of whom had severe pustular tinea barbae and two of whom had eruptions of the forearms. All five patients were dairy farmers. On physical examination, all five patients were afebrile and did not appear toxic. Peripheral leukocyte counts of the three patients with pustular tinea barbae were normal. Gram stain and bacterial cultures of the draining pustules were negative in all three cases. Potassium hydroxide preparation showed hyphae, and cultures yielded T. verrucosum in all three cases. Four patients received therapy with fluconazole, and one received therapy with griseofulvin; in all cases, the lesions healed. T. verrucosum can cause pustular tinea barbae in farmers that may be mistaken for a Staphylococcus aureus infection by clinicians, including infectious disease experts. The answer to a simple question, "Are you a dairy farmer?", may suggest the diagnosis of T. verrucosum in the proper clinical setting.
须癣毛癣菌感染可通过奶牛的皮肤传播，是须癣的病因，表现为面部和颈部严重的脓疱性皮疹。我们报告了5例患者的病例，其中3例患有严重的脓疱性须癣，2例患有前臂皮疹。所有5例患者均为奶农。体格检查时，所有5例患者均无发热，也无中毒表现。3例脓疱性须癣患者的外周血白细胞计数正常。所有3例患者引流脓疱的革兰氏染色和细菌培养均为阴性。氢氧化钾制剂显示有菌丝，所有3例培养均分离出须癣毛癣菌。4例患者接受氟康唑治疗，1例接受灰黄霉素治疗；所有病例的皮损均愈合。须癣毛癣菌可导致农民患脓疱性须癣，临床医生（包括传染病专家）可能会将其误诊为金黄色葡萄球菌感染。在适当的临床环境中，一个简单的问题“你是奶农吗？”可能有助于诊断须癣毛癣菌感染。
