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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=1739223725-vWbq93yM02wcglPvpQb2rtpPfFuqKVHQ-0-3f14842f5a390af01be91205fbf464e7)
图4-9-1 鹅口疮
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-2_12901.jpg?sign=1739223725-kKOt0e7UwNV4rlyDbD3o5EsPM84jFcRA-0-6335a5cd412d0e621bb69dbc90f2f5db)
图4-9-2 鹅口疮
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-3_12899.jpg?sign=1739223725-cNFAcmaQx3V1YqPMnvI2RVwEEEBGReY4-0-29ea987a751b2ddab26cd9e9719c4f94)
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=1739223725-URvQ5ZqSC1bMlh6LdEnsJIsCOqpnV1uN-0-fb99693793d15bd4f37484b5c06bac5e)
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=1739223725-4iztSjKeuNb15AEMn289pJ9ls5dViRHF-0-8f2c60b2d2c4479e05b9dd64e9ae50ed)
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=1739223725-AjHp2T23Jfztwd90HjDdW649x98085ET-0-1ca5bc0cfa5d105e4d5a44ee78aa39ef)
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=1739223725-sGUK0zlWN6XsKKhDjGy7hSZkz8xtDuvE-0-7a72e45994ed00da8fe2d0debc1f3617)
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=1739223725-1wBhs6N7QiGHGReKnhThuPV1cMjylr4h-0-b6dc8f29910abc25788fa33089b0cefc)
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=1739223725-DNEbJz8WzleooGofWvgcDUVgu0ZRVqpS-0-a9526f8abb02bbf9538143e421ec56cf)
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=1739223725-USfilRpxgtHGSAzeOL9thQyYJvuU0Sw0-0-4bdc84c721e805edc7e120d478200ad1)
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=1739223725-rHzle2BsKXzzcRYiMrmJuFYe2hUup5ma-0-9c0b965233897224d0e08d17eb743202)
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=1739223725-SnObQc7ysK3upl81HJew6CLT1EWiljIY-0-2e2c25c8a4670d6afc859c50c76023ce)
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=1739223725-FZIukyasbRXq6cu44mPtMl8h0blRjiCf-0-1d21f9a2c0812f1fc9d8d80998b364bc)
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=1739223725-DbhYoMDfvNagaR0GFErKaPBNE2NWPJUZ-0-84810f2ce1341016adae562dc9667736)
图4-9-14 慢性黏膜皮肤念珠菌病