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念珠菌病 Candidiasis
是由念珠菌属的真菌(白念珠菌为主)引起的皮肤、黏膜及内脏器官的急性或慢性感染。
诊断要点:
临床表现多样。
口腔念珠菌病又称鹅口疮,为口腔黏膜上出现白色假膜,基底有红色糜烂、渗出。念珠菌性阴道炎好发于糖尿病及妊娠妇女,阴道黏膜红肿、表面有白色薄膜附着,有凝乳状分泌物,自觉剧烈瘙痒。
念珠菌性龟头包皮炎在龟头及冠状沟和包皮内侧有针头大的丘疱疹,表面附着较多白色乳酪状伪膜。
念珠菌性间擦疹发生于间擦部位,包括指趾间浸渍、红斑、糜烂性损害。
丘疹性皮肤念珠菌病好发于夏季,多见于颈、肩、躯干、四肢和会阴等处,皮损为2~3mm大小的扁平丘疹及丘疱疹,暗红色,表面有圈状脱屑。
念珠菌性甲沟炎的甲沟红肿,挤之有少许分泌物,但很少化脓。
慢性黏膜皮肤念珠菌病(CMCC)是因天然免疫缺陷而引起的一种顽固的皮肤黏膜感染,黏膜表现同口腔念珠菌病,皮肤表现为疣状或结节状损害,表面结痂,病程为慢性经过。
治疗要点:
局部治疗主要针对局限于皮肤、黏膜部位的念珠菌病。如口含克霉唑、制霉菌素片治疗口腔念珠菌病,阴道念珠菌病患者每晚用3%碳酸氢钠溶液清洗外阴后在阴道内放入制霉菌素、克霉唑和咪康唑栓剂等。系统治疗主要适用于系统性感染,但对于顽固的、反复发作的局部感染也可应用,常选用氟康唑、伊曲康唑等,长期应用应注意监测耐药发生。
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-1_12900.jpg?sign=1739220576-4kx9HMg0lXVlh6xMHk4pWxJHfcApoQTP-0-3d1c9c30157a94dee23163474d6368b6)
图4-9-1 鹅口疮
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-2_12901.jpg?sign=1739220576-EpGVxy0a1NOmgUwt1KTiI2sV0kfWZ0fU-0-49d393cb69ddc46071d3ae519da945fb)
图4-9-2 鹅口疮
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-3_12899.jpg?sign=1739220576-PrnOrTZovJAFPeBzv8VHJGBqQ4XGkHTM-0-33aafc7999300c1b09bd01afe9cc10f0)
图4-9-3 念珠菌性龟头炎及尿道炎
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-4_12902.jpg?sign=1739220576-2qokDEyk7S8mPsiN7rISh9w1bCIZEUcG-0-f58957d1fef8ea79a02a469e5c0d33e6)
图4-9-4 念珠菌性龟头炎
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-5_12904.jpg?sign=1739220576-B8A2RXb0P2uQv8DnydRWGKarnF919QGD-0-113bca137ea9e8e2000ac9df024c92fb)
图4-9-5 念珠菌性间擦疹
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-6_12905.jpg?sign=1739220576-pvdKkBREumOsOLBhn5hPbZAsd3AnTwSb-0-b854c9fba8680111f8f0672a22f0f3a9)
图4-9-6 念珠菌性间擦疹
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-7_12907.jpg?sign=1739220576-nsNbAp371LSbnbtbxLXRABygFzrXMoQ4-0-58eb0e0f728cb18bd21a83144ed91160)
图4-9-7 念珠菌性间擦疹
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-8_12908.jpg?sign=1739220576-bzSd5RROfVIprLR8kRrqaid4L7aunJcw-0-7fc9673acbbcf7973b9380c42a015d62)
图4-9-8 念珠菌性甲沟炎
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-9_12909.jpg?sign=1739220576-5hRpoPELo7zQceq4frb93fLpPKgFYz0s-0-ee6aaeca10cdc5964791e4a1a41b460d)
图4-9-9 慢性黏膜皮肤念珠菌病
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-10_12912.jpg?sign=1739220576-EekNVJZ2uMzhyqt3BC8Uq6RQi8tm2wLu-0-b7f4d1b9336c7ee0a6ab224f29d43450)
图4-9-10 慢性黏膜皮肤念珠菌病
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-11_12913.jpg?sign=1739220576-CprGQnLCBPFaToZU8vVp10u5AW08TXeY-0-10fc40221a40e4fb4326a05d7ac40f5f)
图4-9-11 慢性黏膜皮肤念珠菌病
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-12_12914.jpg?sign=1739220576-rvZdcz2jnVJzrdTGsmYMs6HsGSPyz23n-0-1bb247d971a10755030338ff93523f5b)
图4-9-12 慢性黏膜皮肤念珠菌病
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-13_12915.jpg?sign=1739220576-Hn3XbmyKqxXto5eCkp0MkFwuvO9IgmBN-0-cfd1c9a9f7a3c45ebd8e327dc7882b07)
图4-9-13 慢性黏膜皮肤念珠菌病
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-14_12917.jpg?sign=1739220576-Q0w9EGyYETiUiiXgyqpMbEtKUWbYi6gf-0-1e32eedac024a570557aeefd52f195ce)
图4-9-14 慢性黏膜皮肤念珠菌病