mycotic infection

Infections caused by fungi

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Fungal infection: Pathogenicity There are more than 300 species of fungi. except Cryptococcus neoformans Besides mushrooms, the medically significant pathogenic fungi are almost all mould 。 According to the different parts of human body, pathogenic fungi are divided into Superficial fungi And deep fungi. Fungal enteritis Of Deep mycosis 。 The superficial fungus (tinea) only invades the skin, hair and finger (toe) nails, while the deep fungus can invade the human skin, mucosa, deep tissue and viscera, and even cause systemic disseminated infection. Deep fungal infection in the gut is fungal enteritis , can exist independently, such as an infant Candida Enteritis, or one of the manifestations of systemic fungal infection, such as AIDS Concurrent dissemination Histoplasmosis 。

TCM disease name

mycotic infection

Foreign name

fungal infection

Common diseases

Skin, hair, finger (toe) nails, human skin mucosa, deep tissues and viscera

Common causes

Superficial and deep fungi

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essential information

TCM disease name: mycotic infection
Foreign name: fungal infection

Common location: Skin, hair and nails, human skin and mucosa, deep tissues and viscera
Common causes: Superficial and deep fungi

pathogeny

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Fungal infectious diseases can be divided into four categories according to the location where fungi invade the human body: superficial mycosis, skin mycosis, subcutaneous tissue mycosis and systemic mycosis; The former two are collectively referred to as Superficial mycosis , the latter two are also called Deep mycosis 。

clinical manifestation

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1. Shallow surface Mycosis

Infection is limited to the skin cuticle The outermost layer of Tissue response When the hair is infected, it only affects the hair surface and rarely damages the hair. It mainly includes: Tinea versicolor 、 Tinea nigra palmaris and Trichonomycosis 。

two Dermatomycosis

The infection affects the stratum corneum and Skin appendage , such as hair, deck, etc., can extensively destroy the structure of these tissues and be accompanied by hosts of different degrees immune reaction ； The most common fungal infection is Dermatophytosis Other fungal infections include Cutaneous candidiasis Etc.

Dermatophytosis can be divided into Tinea pedis (commonly known as "beriberi") Tinea manus 、 Tinea corporis 、 Tinea cruris 、 Onychomycosis as well as Tinea capitis Etc Ringworm disease ； Widely occurring worldwide, it is the most common fungal disease with a high incidence.

3. Subcutaneous mycosis

Infected skin Subcutaneous tissue , including muscles and connective tissue Generally, it will not spread through the blood flow to important organs; However, some infections can spread slowly from the focus to surrounding tissues, such as Mycetoma Etc; Some are along lymph gland Diffusion, such as Sporotrichosis 、 Chromoblastomycosis 。 Subcutaneous fungi in immunocompromised patients have a potential risk of spreading throughout the body.

4. Systemic mycosis

In addition to invading the skin and subcutaneous tissue, it also involves tissues and organs, and even causes disseminated infection, also known as invasive fungal infection. In recent years, with the high efficiency Broad-spectrum antibiotic 、 Immunosuppressant , anti Malignant tumor The widespread use of drugs, organ transplant , conduit technology, and Surgery Further development of other interventional treatments, especially AIDS Occurrence of, conditions Pathogenicity The systemic mycosis caused by fungi is increasing day by day pathogenic bacteria The disease is becoming more and more serious. Mainly including candidiasis 、 Aspergillosis 、 Cryptococcosis 、 Zygomycosis and Penicilliosis marneffei Etc.

inspect

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1. Ask for details History of trauma and History of operation , time and place of injury, treatment after injury, onset time, course of disease development, whether there is tetanus Vaccination history; For female patients, the history of childbirth or abortion should be inquired in detail; In case of a newborn, ask about the delivery history and umbilical cord Handling conditions. There are a few cases of non-destructive injury history, and no obvious Wound 。

2. Check the injured part, wound condition, and whether there is spasm and twitch in the muscles around the wound, pay special attention Rectus abdominis Whether it is stiff. If the wound has Exudate Or fallen tissue block bacteriology Inspection (including smear and Anaerobic bacteria culture ）And Pathological examination 。

diagnosis

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The diagnosis was made according to the medical history, clinical manifestations and examinations.

differential diagnosis

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as Fungal enteritis It should be differentiated from intestinal diarrhea:

one cholera

Pandemic It is rare now, mostly local Epidemic outbreak 。 The patient has severe vomiting, and the vomit is like rice swill water or yellow water. None abdominal pain , No fever , often serious dehydration and microcirculation failure 。 A large number of fish like movements can be seen in the direct microscopic examination of vomitus and diarrhea Vibrio 。

two bacterial dysentery

It occurs all year round, mostly in summer and autumn. The main lesion is colonic Suppurative inflammation 。 The patient vomited less, often had fever, diarrhea with abdominal pain Be quick inside and heavy behind , left lower abdomen tenderness. Stool mixed with pus and blood, which can be seen through microscopic examination red blood cell 、 Purulent cell and macrophage , cultivation has Shigella Growth.

three Amebic dysentery

Mainly distributed. The patients often have hidden onset of disease, and the severity of diarrhea varies, Toxemia Less, abdominal pain and tenesmus are not obvious, quite similar to fungal enteritis. However, feces and pus and blood are not mixed, and typical cases are Jam Like, fishy smell, microscopic examination mainly shows red blood cells, and phagocytosis of red blood cells can be seen Amoeba trophozoite And Shaco Redden crystal. Sigmoidoscopy revealed scattered intestinal mucosa ulcer The edge is neat, hyperemia is prominent, and the mucosa between ulcers is normal. Ulcer can be seen on smear or biopsy Trophozoite 。

four paratyphoid fever

Vice- Typhoid fever C can submit gastroenteritis Type I attack, but the course of disease is short, prognosis Good, usually recover in 3-5 days. Typhoid and paratyphoid A and B High fever Systemic toxemia is the main symptom, which may be accompanied by abdominal pain, but diarrhea is less. Typhoid fever or Paratyphoid bacillus Growth can be diagnosed.

five Localized enteritis

Crohn's disease, or Crohn's disease, usually has a long history, and there is an obvious phenomenon of alternate onset and remission. X-ray barium meal It shows that the lesions are mainly at the end of the ileum, with line shaped shadows with incomplete edges. The lesions are distributed in segments, with dilated intestinal flexure between them, which is the so-called leakage sign.

six Ulcerative colitis

clinical manifestation For recurrent diarrhea Pyogenic stool , may be accompanied by fever. The pathological changes Sigmoid colon The rectum is the most serious, or the whole colon is involved. Enteroscopy It can be seen that the intestinal mucosa is congested, edematous and ulcerative, and the mucosa is fragile and easy to bleed. Fecal culture No pathogenic bacteria grow. X-ray barium meal display of advanced cases Pouch of colon Disappeared, the intestinal tube is Lead pipe Sample change.

7. Difficult to distinguish Clostridium nature enteritis

Both of them often appear after the application of antibiotic treatment. Clostridium difficile often causes Pseudomembrane Sexual enteritis is characterized by necrotic inflammation deep in the colonic mucosa with exudative spots or large pseudomembranes. Etiology Detection can identify.

8. Other diarrhea

Anaphylaxis diarrhea Eating fish, shrimp or contacting allergen History, having similar drug-induced diarrhea in the past Cathartic History; Enzyme deficiency Sexual diarrhea Hereditary disease family history 。 It is not difficult to identify through detailed inquiry of medical history and examination of fecal etiology.

treatment

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With the exception of tinea capitis and onychomycosis, most fungal infections have mild symptoms and are often treated with antifungal creams. Many effective antifungal creams can be purchased from pharmacies without prescription. Generally, antifungal powder is not used. The active ingredients of antifungal drugs are Miconazole 、 Clotrimazole 、 Econazole and Tong Kangzuo Etc.

Generally, the cream is applied twice a day, and the treatment lasts until Skin lesion 7-10 days after regression. If the cream is stopped too soon, the infection is not eliminated, rash It will recur again.

The antifungal cream will not be effective until a few days after use, during which time it can be used corticosteroid Frost relief itch And pain. Severe or stubborn infection, available Griseofulvin Treatment for several months, sometimes with antifungal cream. Oral administration of griseofulvin is very effective, but it can cause side effects, such as headache 、 Gastrointestinal dysfunction , photosensitivity, edema and Leukopenia Etc. After discontinuation of griseofulvin, the infection may recur. Ketoconazole can also be used to treat skin fungal infection. Like griseofulvin, oral ketoconazole has serious side effects, including liver damage.

Keeping the infected part clean and dry will help to inhibit fungal reproduction and promote skin healing. The infected area should be washed frequently with soap and water, and spread after drying talc 。 Avoid using corn flour Because it can promote the growth of fungi.

If there is exudate from fungal infection, it may be accompanied by bacterial infection. Antibiotics are needed. Apply antibiotic cream or take antibiotics orally. dilution Aluminium acetate Solution or Whitefield ointment can also be used to make xerosis cutis 。

prevention

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1. Keep skin dry and clean.

2. Wear loose clothes.

3. Avoid sharing hair brushes, combs and towels because they may contain Dermatophyte colony of bacteria Clip.

4. To avoid beriberi, spare shoes should be used and changed every 2 or 3 days.

5. Select Natural fiber Clothing of products, such as cotton and silk Skin respiration 。

six diabetes The patient should control the blood sugar level.

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