Aspergillus sydowii による爪真菌症の1例  [in Japanese] A Case of Onychomycosis Caused by Aspergillus sydowii  [in Japanese]

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Abstract

<I>Aspergillus sydowii</I> による爪真菌症はまれであり, 診断が難しい. 今回, 本症を分子生物学的手法により診断し得たので報告する. 53歳女性. 既往歴は特にない. 2010年6月, 約4年前に右第 Ⅰ 趾爪の混濁に気づいていたが, 爪の周囲に痒みを生じて来院した. 右第 Ⅰ 趾爪に混濁肥厚があり, 正常爪に占める混濁部の面積は57.3%であった. 直接鏡検で隔壁がある太い菌糸と黒色の胞子を認め, サブローブドウ糖寒天培地25℃の巨大培養で中央赤褐色, 周囲は灰青緑色の集落, スライド培養で分生子頭に放射状に配列した分生子を認め, <I>Aspergillus</I> 属による爪真菌症が考えられた. 血算 ・ 生化学検査に異常はなかった. 爪から直接 DNA を抽出し, リボゾーム RNA 遺伝子の internal transcribed spacer 領域の DNA 塩基配列の決定を行った結果, <I>A.</I> <I>sydowii</I> と同定した. イトラコナゾール (ITCZ) の最小発育阻止濃度 (MIC) は0.25 μg / ml で有用と考えられたため, ITCZ 400mg / 日1週間内服, 3週間休薬を1クールとして, 3クール繰り返すパルス療法を行った. 治療終了6ヵ月後に正常爪に占める混濁部の面積は17.9%に縮小し, 症状は改善したが, 治療終了9ヵ月後, 混濁部の面積は22.3%に拡大し, 同菌が分離 ・ 同定されため, 再度, ITCZパルス療法を3クール行い, 投与5ヵ月後に症状が消失し治癒した.

Onychomyosis caused by <I>Aspergillus sydowii</I> is rare and difficult to diagnose. We report a case in which this disease was diagnosed by molecular-biological methods. The patient was a 53-year-old woman without any notable past history. She visited our hospital complaining of itching around the right first toenail in June 2010, although she had noticed nail opacification for 4 years. Opaque thickening of the nail, covering 57.3% of the normal nail area, was observed. Direct microscopic examination revealed thick mycelia with septa and black spores. While colonies with a red brown center and a grayish blue-green margin were observed in culture on Sabouraud ' s glucose agar at 25℃, radially arranged conidia in the conidial head were observed in slide culture. Thus, onychomycosis caused by <I>Aspergillus</I> was suspected. There were no blood or biochemical test abnormalities. We directly extracted deoxyribonucleic acid from the nail and analyzed the base sequences of the internal transcribed spacer 1 and 2 regions of the ribosomal ribonucleic acid gene, and identified <I>Aspergillus</I> <I>sydowii</I>. Because the minimal inhibitory concentration of itraconazole (ITCZ) is 0.25μg/ml, we administered pulse therapy with monthly 1-week cycles of oral ITCZ 400 mg / day for 3 consecutive months. The opaque area subsided to 17. 9% of the normal nail by 6 months after treatment completion. However, 3 months later, the opaque area increased again to 22. 3%, and the same fungus was isolated and identified. The 3-month ITCZ pulse therapy was repeated and the symptoms disappeared, with complete cure achieved by 3 months after the second therapy.

Journal

  • Medical Mycology Journal

    Medical Mycology Journal 53(3), 205-209, 2012-07-30

    The Japanese Society for Medical Mycology

References:  20

Codes

  • NII Article ID (NAID)
    10030925655
  • NII NACSIS-CAT ID (NCID)
    AA12518136
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    21856486
  • NDL Article ID
    023920643
  • NDL Call No.
    Z19-348
  • Data Source
    CJP  NDL  J-STAGE 
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