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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=1739117559-14uFVccuA8oWelkyI9GDzxa02xvTNEPs-0-286a6768b76f52ec6852d9d07e3d20d0)
图4-9-1 鹅口疮
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-2_12901.jpg?sign=1739117559-VH1GcIRo80OXwc13UQppNsIQg9irBp2G-0-731a64296887711fba346c104f26a46c)
图4-9-2 鹅口疮
![](https://epubservercos.yuewen.com/2D47EB/21846772801639806/epubprivate/OEBPS/Images/P4-9-3_12899.jpg?sign=1739117559-qAMONtW3v3AD2GBhhPSoKJYWEzwZf1UD-0-a04921901fcfca5360e4fe7a5c3af8ed)
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=1739117559-Sl1Q8TwFTNy4jA7JZkZ1hGZzRzcASg8R-0-45593e538a0103eae48b79bc2ec8675f)
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=1739117559-fJQTfkZZOstzmXRhFg1pMha7eNUcu1wk-0-cc61ef93ceff476437c48551287e81bd)
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=1739117559-wdGNKwvPNWvtpx7cuVwCcoM0YMbmv3KM-0-1c6685597a6aee37544a0c251715a1d5)
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=1739117559-b5Q7ODhyiNBBwlheVyqiDXTEmm8nhGXb-0-01b4948a96f6db35a88379e70a99aba4)
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=1739117559-TTrjh9D2ENW1Gl80vDhfxb9SdtU4zhpm-0-3306b50e1965e2c9eb66188bb60c7e7a)
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=1739117559-OLJY5lcIAsDhsMBxt7IIZnYAgEGzsTmM-0-b4a9e04b2d177645328353bb7d443d70)
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=1739117559-4YTO8Dq4vv2LL0Svqvds1T8G2VYksFaX-0-b8bc876c9b83f407bf9d46d7486003f6)
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=1739117559-bd3bwxRj3jNs37mpqxICkuBKOxjxwHTO-0-c762fdb33d528fb24e215db1b45fbed5)
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=1739117559-17xcJYn3TRKy02gnWSTlqrpREH26KUFt-0-94eb6b1b3b4568ca67aea8aa7d3aa2aa)
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=1739117559-w5qVhCIiWQIXUNAP6nqyEdlXSJ4Nsxk4-0-5a912d2fac4f2f08b6392854e203ecf2)
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=1739117559-e745oACe2zjMhfYRKgBKIXK6CAELeC5F-0-dfb9f6001a8c37782604b33dc18a25a8)
图4-9-14 慢性黏膜皮肤念珠菌病