皮膚科 王修含醫生

Part I: 十八銅人陣

一定要會認的黴菌，共十八隻黴菌，其它菌種請參閱Part II

DERMATOPHYTES

Trichophyton mentagrophytes: 葡萄藤(microconidia) + 雪茄(Macroconidia)

Trichophyton rubrum: 停在電線桿上的小麻雀(microconidia) + 球棒(Macroconidia)

Epidermophyton floccosum: 兔耳朵

Microsporum canis: 末端尖，似鳥嘴，尖刺壁，9-12格

Microsporum gypseum: 末端鈍，圓頭，無刺，壁較薄，3-6格

NON-DERMATOPHYTES

Mucor: 燈泡

Rhizopus: 有樹根的燈泡

Scopulariopsis: 串起來的糖葫蘆

Aspergillus spp.: 圓頭—戴放射狀皇冠

Penicillium spp.: 數根手指—戴放射狀皇冠  à 若gross colony為紅色，答案應寫Penicillium marneffei

Alternaria: 串聯的圓三角狀手榴彈

Curvularia: 並聯的(各自獨立的)橢圓手榴彈

   (ps. Bipolaris: 並聯的圓形手榴彈)

Cladosporium: 樹枝狀麻花小辮子

Blastomyces dermatitidis: (引起blastomycosis)

25℃  mycelial form—solitary pyriform conidia

  37℃  yeast form—fractile wall + broadly based budding

Pseudallescheria boydii: 大飯團+散落一地的小米粒 (此為sexual state)

(Scedosporium apiospermum: 末端結出一顆顆的水晶項鍊。此為asexual state)

Fusarium: 堆在一起的鐮刀

Cunninghamella: 圓形新娘捧花，胖胖的柄

Acremonium: 偏一邊的新娘捧花，細柄   (ps. Exophiala jeanselmei: 也是偏一邊的捧花，但柄稍胖)

Part II: 少林羅漢堂 (進階選修)  (依字母順序排列)

Bipolaris: 並聯的圓形手榴彈 (D/D: Alternaria & Curvularia)

Chrysosporium: terminal conidia in short chain + branches set at 45∘ (cf. dermatophytes大多為90∘分枝)

Coccidioides immitis: alternate arthroconidia + spherule

Exophiala jeanselmei: 偏一邊的捧花，但柄稍胖 (D/D: Cunninghamella & Acremonium)

Exophiala werneckii: bicelluar yeasts with a rugose (多皺紋的) process at one end

Exophiala spinifera: spike-like annelids produced on conidiophores several cells long

Fonsecaea pedrosoi: conidia in successive ranks + conidial structure of the Rhinocladiella type

Fonsecaea compactum: conidia oval to round with broad attachment points

Geotrichum: 魚肝油小藥丸

Histoplasma capsulatum:

   mycelial form (filamentous form): 許多有刺的氣球

   yeast form: 就是yeasts (較無特色)

Madurella mycetomatis: toruloid (似串珠菌狀) hyphae and chlamydospores + black grain in tissue

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MICROSPORUM

Microsporum audouinii: “怪異末路黑道人”

  形狀怪異且中間凹入的Macroconidia + terminal Chlamydia + anthropophilic (人類)

  「黑道」者：即台語的audo…

   D/D Microsporum canis: rice grain test (+) (米飯加壓會長M.canis，但不長M.audouinii)

Microsporum cookei: “廚房地面的厚壁扁豆”

  cookei—“廚房”，geographic，外形似扁豆，厚壁

D/D  M. gypseum— M. cookei格數比較多

          M. canis— M. cookei的Macroconidia兩端不尖(較圓)，且壁上無刺 (not echinulate cell wall)

Microsporum ferrugineum: “鐵竹竿人”

  Ferrugineum— “鐵色、鐵銹”之意，hyphae deformed or straight, with prominent “bamboo” septa

  Slide culture下只看到一堆「竹竿」(hyphae)，很直，有厚度，且不產孢

(找不到microconidia & Macroconidia才是典型的M. Ferrugineum)

  anthropophilic

Microsporum nanum: “山豬的娜娜扭蛋”

       Macroconidia 似扭蛋，geophilic and zoophilic (通常與swine有關) à “山豬” (geo- & zoo-philic)

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Paecilomyces: 雞爪+鐵鍊 (phialides with thinly tapered apices and chains of oval conidia)

Paracoccidioides brasiliensis:

   25℃  mycelial form—hyphae with some arthroconidia

     37℃  yeast form—yeast with multiple buds (輪船的舵)

Phialophora verrucosa: 花瓶上開花

Rhinocladiella: ellipsoidal conidia arranged in a plume-like series at the apex of a conidiophore

Scytalidium: 長長的鐵鍊

   Scytalidium dimidiatum: brown arthroconidia

   Scytalidium hyalinum: hyaline arthroconidia

Sporothrix schenckii

25℃  mycelial form—hyaline conidia in rosettes, hyaline or brown thick-walled conidia fomed along the hyphae

     37℃  yeast form—ovoid or elongated yeasts, producing one or several buds

Syncephalastrum: 放射狀的太陽 (無phalide or metula) 須與Aspergillus 鑑別診斷

   (此菌尚無感染人類或動物的報告)

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TRICHOPHYTON

Trichophyton concentricum: sterile hyphae，無microconidia，也無Macroconidia

Trichophyton equinum: 已歸併至Trichophyton rubrum……太好了！又可以少背一隻菌了

Trichophyton megninii: 已歸併至Trichophyton rubrum

Trichophyton schoenleinii: “人類的學校有吊燈” (anthropophilic-schoen…(school)-chandelier)

hyphae in the form of “favic chandeliers (樹枝形吊燈)”，末端似樹蛙小指頭

Trichophyton soudanense:”蘇丹反身分枝人”

 “蘇丹(soudan…)反身分枝(reflexive branching)人(anthropophilic)”

        Hyphae with reflexive branching, that is, nearby branches pointing in opposing directions.

Trichophyton tonsurans: “數噸的氣球人”

        “數噸(tonsuranS)”        “人(anthropophilic)”

microconidia形狀較亂，不規則，有些地方拉長，出現「氣球」狀的東西

Macroconidia: sinuous (彎曲的、迂迴的) macroconidium

Trichophyton verrucosum: “牛疣算盤珠有鼠尾巴”

       臨床上，此病為長在牛身上的疣狀物，再傳染至人體。(zoophilic)

        有許多似算盤的珠子(chains of chlamydospores)

        Macroconidia: rat-tail shaped macroconidia。microconidia: 與T. rubrum不易區別

Trichophyton violaceum: “紫色鐵絲人”

     Gross colony: 正面似紅豆色，有紫色的hue

Slide culture: Deformed hyphae and chlamydospores，似硬梆梆的鐵絲，

而這種「鐵絲」，特徵為一邊平，一邊凸起。

                不太產孢子 (除非加thiamine)，但偶有chlamydospores

      anthropophilic

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Wangiella dermatitidis: 此genus僅此一種species，又名為Exophiala dermatitidis

     Conidiophores and phialides poorly differentiated from vegetative hyphae