대한의진균학회제 21 차학술대회초록 일시 : 2014 년 5 월 31 일 ( 토 ) 장소 : 서울건국대병원대강당 주최 : 대한의진균학회대한피부과학회피부진균연구회
안녕하십니까? 1994 년에창립하여금년에창립 20 주년을맞이한대한의진균학회가 제 21 차학술대회를개최하게되었습니다. 이번학술대회에는해외연자특강으로 Malassezia 효모균연구의세계적대가인일본 Meijii 약학대학의 Takashi Sugita 교수가 Skin mycobiome and related diseases 를강의하고중국 Gilin 대학의 Fuqiu Li 교수가 The diversity of clinical manifestations of Sporotrichosis and experiences of treatment 를강의할예정입니다. 국내연자특강으로는서울의대박상원교수가 감염내과에서흔히보는진균감염 을중앙의대이미경교수가 Candida albicans 와숙주상피표면의상호작용 을강의할예정입니다. 교육강연으로는인제의대김효진교수가 칸디다에의한피부감염증, 부산의대김문범교수가 피부진균감염으로오진하기쉬운질환들 그리고건국의대이양원교수가 진균감염의분자생물학적진단방법 에대한강의가있을예정입니다. 이번제 21차학술대회는의진균학에대한지식의범위를넓히고함께공유하는귀한교류의장이될것으로기대합니다. 대한의진균학회는오는 6월 28일에는손발톱연구회와함께 Nail Forum 을준비하고있으며, 9월 24일에는제 3차동아시아피부과학술대회에 5분의한국 ( 최종수교수, 이양원교수 ), 중국 (Li 교수, Ran 교수 ), 일본 (Watanabe 교수 ) 의진균학자들을초청하여 Ancillary Meeting 을계획하고있습니다. 10월 25일에는워크샵도있을예정입니다. 대한의진균학회회원여러분의지속적인관심과많은참여를바랍니다. 감사합니다. 대한의진균학회 회장안규중
대한의진균학회제 21 차학술대회진행계획표 시 간 내 용 09 : 00 ~ 09 : 30 등 록 09 : 30 ~ 09 : 40 개회식 회장 : 안규중교수 ( 건국의대 ) 09 : 40 ~ 10 : 10 국내연자특강 1 ( 박상원교수 / 서울의대보라매병원감염내과 ) 10 : 10 ~ 10 : 40 국내연자특강 2 ( 이미경교수 / 중앙의대진단검사의학과 ) 10 : 40 ~ 11 : 00 Coffee break 11 : 00 ~ 11 : 50 해외초청연자특강 1 (Fuqiu Li / Department of Dermatology, Second Hospital of Jilin University, China) 11 : 50 ~ 13 : 30 기념촬영, 평의원회및중식 13 : 30 ~ 14 : 00 국내연자교육강연 1 ( 김효진교수 / 인제의대부산백병원피부과 ) 14 : 00 ~ 14 : 50 해외초청연자특강 2 (Takashi Sugita / Department of Microbiology, Meijii Pharmaceutical University, Japan) 14 : 50 ~ 15 : 10 Coffee break 15 : 10 ~ 15 : 40 국내연자교육강연 2 ( 김문범교수 / 부산의대피부과 ) 15 : 40 ~ 16 : 10 국내연자교육강연 3 ( 이양원교수 / 건국의대피부과 ) 16 : 10 ~ 17 : 10 일반연제 17 : 10 ~ 17 : 30 폐회식및총회 학술대회진행시유의사항 1. 연제발표자는미리 10분전에앞줄에대기하여주시기바랍니다. 2. 일반연제는원저인경우발표 7분, 임상증례는발표 5분입니다. 3. 연제를발표 1시간전에접수하여주십시오. 3
대한의진균학회제 21 차학술대회연제순서 국내연자특강 1 09 : 40-10 : 10 제목 : 감염내과에서흔히보는진균감염연자 : 박상원교수 ( 서울의대보라매병원감염내과 ) 좌장 : 우준희교수 ( 울산의대 ) 국내연자특강 2 10 : 10-10 : 40 제목 : Candida albicans와숙주상피표면의상호작용연자 : 이미경교수 ( 중앙대학교의과대학진단검사의학교실 ) 좌장 : 서무규교수 ( 동국의대 ) 10 : 40 ~ 11 : 00 Coffee break 해외초청연자특강 1 11 : 00-11 : 50 제목 : The Diversity of Clinical Manifestations of Sporotrichosis and Experiences on the Treatment 연자 : Fuqiu Li (Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, China) 좌장 : 노병인교수 ( 명지병원 ) 11 : 50 ~ 13 : 30 기념촬영, 평의원회및중식 국내연자교육강연 1 13 : 30-14 : 00 제목 : 칸디다에의한피부감염증연자 : 김효진교수 ( 인제대학교부산백병원피부과 ) 좌장 : 원영호교수 ( 전남의대 ) 해외초청연자특강 2 14 : 00-14 : 50 제목 : The Skin Fungal Microbiota and Related Skin Diseases 연자 : Takashi Sugita (Department of Microbiology, Meiji Pharmaceutical University, Tokyo, Japan) 좌장 : 안규중교수 ( 건국의대 ) 14 : 50 ~ 15 : 10 Coffee break 4
국내연자교육강연 2 15 : 10-15 : 40 제목 : 피부진균감염으로오진하기쉬운질환들연자 : 김문범교수 ( 부산대학교의과대학피부과 ) 좌장 : 유희준교수 ( 한양의대 ) 국내연자교육강연 3 15 : 40-16 : 10 제목 : 지루피부염의최신지견연자 : 이양원교수 ( 건국대학교의학전문대학원피부과학교실 ) 좌장 : 김미나교수 ( 울산의대 ) 일반연제 FC-1 ~ FC-9 16 : 10-17 : 10 좌장 : 최종수교수 ( 영남의대 ) FC-1. Localized Skin Infection Due to Scedosporium apiospermum... You Bum Song 1, Ji Young Yoo 1, Moo Kyu Suh 1, Gyoung Yim Ha 2, Jong Im Lee 3 / Departments of 1 Dermatology, Laboratory 2 Medicine & 3 Pathology, College of Medicine, Dongguk University, Gyeongju, Korea FC-2. A Case of Cutaneous Fungal Infection Caused by Verticillium Species... Dae-Woo Kim, Soo-Han Woo, Joo-Ik Kim, Chin-Ho Rhee, Jin Park, Seok-Kweon Yun, Han-Uk Kim / Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea FC-3. Exophiala lecanii-corni as a Cause of Chromoblastomycosis... Kyou Chae Lee, Sang Lim Kim, Jin Sub Lee, Weon Ju Lee, Seok-Jong Lee, Do Won Kim, Yong Hyun Jang / Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Republic of Korea FC-4. 부종을동반하여팔에발생한 Aspergillus niger 원발성피부감염... 김수현, 김성애, 이규석, 조재위 / 계명대학교의과대학피부과학교실 FC-5. A Case of Cutaneous Infection by Alternaria alternata... 김병수 / 영남대학교의과대학피부과학교실 FC-6. A Case of Disseminated Trichosporon asahii Infection in an Immunocompromised Patient... Sang Jin Kim 1, Joon Seong Park 2, Eun-So Lee 1 / 1 Department of Dermatology, Ajou University School of Medicine, Suwon, Korea, 2 Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea 5
FC-7. A Case of Rhodotorula Skin Infection Occurred in Immunocompromised Patient... Seung-Hwan Choi, Tae-Hoon Kim, Seung-Min Ha, Dong-Yeob Ko, Ki-Hoon Song, Ki-Ho Kim / Department of Dermatology, Dong-A University College of Medicine FC-8. Comparative Study of In Vitro Inhibitory Effects of UVC, Terbinafine Hydrochloride 1% and Paeonia Natural Extracts on Trichophyton rubrum... Ho Jung Jung, Yang Won Lee, Yong Beom Choe, Kyu Joong Ahn / Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea FC-9. Lack of Antifungal Effect of 1,064 nm Long Pulse Nd:YAG Laser on the Growth of Trichophyton rubrum... Yu Ri Kim, Yang Won Lee, Yong Beom Choe, Kyu Joong Ahn / Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea 17 : 10 ~ 17 : 30 폐회식및총회 6
해외초청연자특강 1 Fu-qiu Li 2 Takashi Sugita 해외초청연자특강 (Special Lecture) 7
대한의진균학회제 21 차학술대회 Fu-qiu Li 8
Ruo-yu Li 대한의진균학회제 20 차학술대회 해외초청연자특강 1 (Special Lecture) The Diversity of Clinical Manifestations of Sporotrichosis and Experiences on the Treatment Fu-qiu Li Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, China Abstract As we all know, sporotrichosis is a fungal infection of the skin with a generalized distribution. Sporotrichosis has several clinical features, usually including four types: fixed type, lymphangitic type, disseminated type, and extracutaneous sporotrichosis. However, in actual clinical work, the lesions tend to be polymorphous, which makes diagnosis difficult. In this study, we summarized the morphological features of sporotrichosis in general. Furthermore, we reported the special types: ulceration type, papules and small nodules type, scaly and plaque type, verrucous type, acneiform, granuloma, nasal type as well as sporotrichosis in children. The course of treatment is generally from 3 to 6 months for the cutaneous sporotrichosis, and patients with immune deficiency and extracuticular sporotrichosis need longer course of therapy. Current treatments include 10% potassium iodide, azole, allylamine, and polyene antifungal drugs, as well as thermotherapy. The local thermotherapy is suitable for pregnant women, infants whose parents do not want to take medicine and individuals who are not responsive to medication. Now it has been reported that the combination therapy of terbinafine and itraconazole to treat cutaneous sporotrichosis. Based on the above clinical characteristics, clinicians need to accumulate a lot of experiences and thus make a rapid and correct diagnosis. Then it is critical to develop the effective therapy strategies, includig drug selection, the dosage and duration of treatment. 9
대한의진균학회제 21 차학술대회 Fu-qiu Li CURRICULUM VITAE NAME Li Fuqiu Female, professor, chief physician, director of dermatological department in Second Affiliated Hospital of Jilin University Educational and Professional Research experience graduated from Jilin university, Doctor of Philosophy; graduated from Jilin university, Master's Degree; graduated from Bethuen medical university in 1986 (now Jilin University), Bachelor's Degree; department of dermatology, Second Affiliated Hospital of Jilin University, Graduate student tutor, Juntendo University, Tokyo, Japan, Visiting Scholar Research area investigation on cutaneous mycosis and the mutation of gene in bullous deramtoses, mainly involving as follows: the thermotolerance, the test of fungistasis, and epidemiology of Sporothrix schenckii; the correlation between geotyping of mitochondrial DNA and sporotrichsis; researches on genetic mutation in inherited bullous diseases, including familial benign chronic pemphigus (hailey-hailey disease), epidermolysis bullosa, and Congenital bullous ichthyosiform erythroderma. Honors Chinese Society of Dermatology (CSD), committee member and deputy leader in mycological group; Chinese Dermatologist Association (CDA), member of the standing committee and deputy leader in mycological group; Chinese Association of Integrative Medicine of Dermatology, committee member and deputy leader in mycological group; Chinese Dermatologist Association (CDA) in Jilin Province, chairman of committee; Chinese Society of Dermatology (CSD) in Jilin Province, vice-chairman of committee; Medical Association of Dermatology in Changchun, chairman of committee; Chinese Journal of Mycology, International Journal of Dermatology and Venereology, Chinese Journal of Dermatovenereology of Integrated Traditional and Western Medicine, Jilin Medical Journal, editorial board member; Dermatovenereology (China), editorial board member; Chinese Medical Doctor Association of Dermatology,: Awards for National thetopten of Outstanding Young Physicians 10
Ruo-yu Li 대한의진균학회제 20 차학술대회 해외초청연자특강 2 (Special Lecture) The Skin Fungal Microbiota and Related Skin Diseases Takashi Sugita Department of Microbiology, Meiji Pharmaceutical University, Tokyo, Japan Human skin is home to several hundred species of bacteria and fungi. Why does such a wide variety of microorganisms exist in the skin? Some microorganisms produce antibacterial peptides and form a biofilm on the skin that inhibits invasion by pathogens or promotes the integrity of cutaneous defenses by eliciting host immune responses. Other microorganisms absorb ultraviolet. Therefore, the skin microbiota plays a significant role in maintaining human health. However, when the balance of the skin microbiota is disrupted, skin diseases can develop. Although the skin fungal microbiota includes more than 100 fungal species colonizing human skin, Malassezia species predominate and account for 40~90% of all fungi at any body site. As these microorganisms require lipids for growth, they preferentially colonize sebum-rich areas, such as the head, face, and neck, as opposed to the limbs or trunk. Although Malassezia are normal components of the skin microbiota in health individuals, they are associated with the development or exacerbation of seborrheic dermatitis (SD), pityriasis versicolor (PV), and atopic dermatitis (AD). Interestingly, both M. globosa and M. restricta are detected in all cases, but the level of colonization of each species differs among skin diseases; i.e., M. restricta predominates over M. globosa in SD, while M. globosa predominates over M. restricta PV. Specific IgE antibody against Malassezia species is found in the serum of AD patients. Antifungal therapy improves the symptoms of AD by decreasing the level of Malassezia colonization, suggesting that these microorganisms also exacerbate AD. In SD, Malassezia species do not cause the disease directly, but metabolites of sebum irritate the skin. The microorganisms produce lipase, which hydrolyzes lipids into glycine and triglyceride. Triglyceride is further hydrolyzed into fatty acids, especially oleic acid, which causes skin irritation. Using whole genome analysis, we found many lipase genes in Malassezia cells, the expression of which was higher in patients with SD than in healthy controls. In this presentation, I would like to discuss the recent advances in research on the skin microbiota and related skin disease. 11
대한의진균학회제 21 차학술대회 Takashi Fu-qiu Sugita Li CURRICULUM VITAE Name : Takashi Sugita Nationality : Japan Current position : Full Professor, Department of Microbiology, Faculty of Pharmaceutical Science, Meiji Pharmaceutical University Address : 2-522-1 Noshio, Kiyose, Tokyo 204-8588 Japan, Meiji Pharmaceutical University E-mail : sugita@my-pharm.ac.jp Professional background and education 1996 Ph.D from Meiji Pharmaceutical University 1996 Special Researcher, Bio Resource Center, RIKEN 1998 Assistant Professor, Meiji Pharmaceutical University 2003 Lecture, Meiji Pharmaceutical University 2007 Associate Professor, Meiji Pharmaceutical University 2007 Visiting Scientist, RIKEN (~2009) 2012 Lecture, Faculty of Science and Technology, Chuo University (2012~) 2013 Full Professor, Meiji Pharmaceutical University Social activity The Japanese Society for Medical Mycology, Representative (2000~) Pharmaceutical Society of Japan, Expert Microbiologist (2007~) The Japanese Society for Bacteriology, Member The Mycological Society of Japan, Member The Japanese Society for Clinical Microbiology, Member The Japanese Society for Microbial Systematics, Member The Japanese Association for Infectious Diseases, Member The Japanese Society for Virology, Member Society of Genome Microbiology, Japan, Member Japanese Society of Pharmaceutical Health Care and Science, Member American Society for Microbiology (ASM), Member International Society for Human and Animal Mycology (ISHAM), Committee on Malassezia Society for General Microbiology (SGM), Member Editorial Board Japanese Journal of Medical Mycology, Editor (2003~2007) 12
Ruo-yu Takashi Li Sugita 대한의진균학회제20 21 차학술대회 Medical Mycology, Associate Editor (2009~) Mycopathologia, Editor (2009) Journal of Medical Science, Advisor (2009~) International Journal of Antibiotics, Editor (2013~) Award Encouraging Prize from Japanese Society of Medical Mycology (2002) Honorary member of Turkish Society for Medical Mycology (2014) Expertise Human microbiota, Taxonomy and identification, Microbial genomics, Evaluation of antimicrobial agents, Infection and allergy 13
대한의진균학회제 21 차학술대회 M E M O Fu-qiu Li 14
국내연자특강 1 박상원 2 이미경 국내연자특강 (Special Lecture) 15
대한의진균학회제 21 차학술대회 박상원 16
박상원 대한의진균학회제 21 차학술대회 국내연자특강 1 (Special Lecture) 감염내과에서흔히보는진균감염 박상원 보라매병원감염내과 여러분야에서면역억제치료에따른면역저하환자군의증가및중증환자치료의복잡성등으로인하여임상현장에서의침습적진균감염증은증가하고있고, 이러한감염증은상당한유병률과사망을초래한다. 침습적칸디다감염증은칸디다혈증이대표적이며, 가장빈도가많은진균감염으로중환자실에서치료중인환자및면역저하환자 ( 혈액암, 고형장기이식및조혈모세포이식환자 ) 가주요위험군이다. 원인균은환자자신의내재균인경우가많지만, 다른경로를통해병원내획득하는경우도있다. Non-albican Candida 감염의증가추세가있으며, C. glabrata, C. parapsilosis, C. tropicalis, C. krusei 등이이에속한다. 특히 C. krusei는 fluconazole에내성이며, C. glabrata는 fluconazole 내성인경우가많기때문에 1차치료제선택에어려움이있다. 중심정맥관감염은칸디다혈증의주요원인중의하나이며, 표준지침에따른적절한관리가필요하다. 침습적 mold 감염증중침습적 Aspergillus 감염증이가장문제가되고있으며, 혈관의침범및이로인한조직경색과괴사가병인이다. 호중구감소증의정도및기간, 고용량의스테로이드투여, 만성의세포매개면역장애질환등이감염발생과관련된대표적인위험인자이다. 주로폐를침범하며, 면역저하환자에서발생하기때문에국소증상이뚜렷하지않을수있어초기진단에주의가필요하다. 적극적인항원검사 (galactomannan assay), 영상학적검사 (CT) 등의사용이필요하고, 검체채취에접근이어려운경우가많긴하지만조직학적검사및배양검사가고려되어야한다. 예방적항진균요법은, 면역억제치료를받는고위험환자에서치명적인침습적진균감염발생을줄이고자시도되어왔다. 초기진단의어려움및이로인한치료의지연이환자생존에악영향을끼치기때문이다. Fluconazole이가장많이시도되어온약제이다. 그밖에도 itraconazole, posaconazole, micafungin 등이고위험군에서사용되고있다. 그러나예방적인요법은각진료기관에따라원인균의분포나내성의상황이다르고, 비용, 부작용도중요하므로복합적으로판단하여야할것이다. 국내에서최근큰변화는진료현장에서침습적진균감염치료제선택에절대적인영향을미치던심평원고시가 2014.2.1일부터변경됨에따라항진균제선택의폭이넓어졌다. 따라서전문가집단에서나온표준지침을적용할수있는여지가많아져서침습적진균감염증의치료양상이달라질것으로예상된다. 본강의에서는위에서언급한침습적진균감염증의최근이슈들에대해서살펴보고자한다. 17
대한의진균학회제 21 차학술대회 박상원 CURRICULUM VITAE NAME Sang-Won Park, M.D. DEMOGRAPHIC AND PERSONAL INFORMATION 1. Current Appointment 1) Associate Professor Department of Internal Medicine, Seoul National University College of Medicine 2) Attending Physician Division of Infectious Diseases, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center 2. Certification 1994 Medical license 1999 Board of Internal Medicine 2004 Subspecialty Board of Infectious Diseases 3. Personal Data Department of Internal Medicine, Boramae Medical Center, Shindaebang-dong, Dongjak-gu, Seoul, 156-707, Republic of Korea Phone : 82-2-870-2224 Fax : 82-2-870-3863 E-mail : hswon1@snu.ac.kr 4. Education and Training (in chronological order) 1988. 2 ~ 1994. 2 M.D. Seoul National University College of Medicine 1994. 3 ~ 1995. 2 Internship Seoul National University Hospital 1995. 3 ~ 1999. 2 Residency Internal Medicine, Seoul National University Hospital 2002. 5 ~ 2003. 2 Clinica Infectious Diseases, Seoul National University Hospital Fellowship 2002. 9 ~ 2004. 8 M.S. Internal Medicine, Seoul National University College of Medicine 2005. 3 ~ 2009. 2 Ph.D. Internal Medicine, Seoul National University College of Medicine 18
박상원 대한의진균학회제 21 차학술대회 2010. 12 ~ 2011. 11 Research Johns Hopkins TB Center (PI: Nuermberger, M.D.) Fellow 5. Professional Experience (in chronological order) 1999. 4 ~ 2002. 4 Overseas medical Korea-Bangladesh Friendship Hospital, Savar, volunteer Dhaka, Bangladesh (via KOICA) 2003. 3 ~ 2007. 8 Assistant Professor Dept. of Internal Medicine, Dankook University College of Medicine 2007. 9 ~ 2011. 8 Assistant Professor Dept. of Internal Medicine, Seoul National University College of Medicine 2011. 9 ~ present Associate Professor Dept. of Internal Medicine, Seoul National 2007. 9 ~ present Attending physician University College of Medicine Director Dept. of Internal Medicine, Boramae Medical Center Infection Control Office, Boramae Medical Center 19
대한의진균학회제 21 차학술대회 M E M O 박상원 20
박상원 대한의진균학회제 21 차학술대회 국내연자특강 2 (Special Lecture) Candida albicans 와숙주상피표면의상호작용 이미경 중앙대학교의과대학진단검사의학교실 지구상에존재하는진핵생물종의수는대략 870만정도로추정하고있으며, 이중진균은약 7% 인 611,000여종에이르는것으로알려져있다. 그리고진균의약 600종정도가사람에게병원체로작용하고있다. 이들진균은피부의경한감염에서부터중한피부감염및생명을위협하는전신감염을일으킬수있다. 특히 Candida spp. 는미국에서병원획득성전신감염의 4번째로흔한원인균으로조사되어, 그임상적중요성이지속적으로증가하고있다. Candida 속 (genus) 은매우이질적인유형들로이루어진약 200여종의효모양진균으로, 분류학적으로는불완전균류 (class Deuteromycetes) 에속한다. Candida spp. 는 budding yeast (blastoconidia) 의형태또는 filaments (true hyphae와 pseudohyphae) 형태중의하나로자랄수있는다형성의특징을가지고있다. Candida 속의이러한이질성 (heterogeneity) 은역사적으로 Candida 속에대한명칭이유성생식단계가없다는것에기초하고있기때문이다. 왜냐하면많은경우에서, Candida spp. 가유성생식함을보여주어도여전히분류학적으로 Candida로분류하고있기때문이다. 결과적으로 Candida spp. 는그들의생화학, 형태학, 유전적구성, 그리고인체감염을일으키는능력등의측면에서매우다르게나타나고있다. Candida에의한인체감염은전신감염과표재감염으로나눌수있으며, 전신감염이면역기능이심하게저하된환자에게발생하는치명적인감염인데비하여표재감염은습윤한점막표면, 즉구강과질등에호발하지만대부분치명적이지는않다. 사람에게감염을일으키는 Candida spp. 는 20여종이있으며, 이중 C. albicans가사람에게서가장많이분리되고있다. C. albicans 는기회감염병원체로서일반적으로인체에서습윤한점막표면인구강, 장관, 질등에정상상재균으로존재한다. 조사한집단에따라약간씩다르지만구강내 Candida 집락형성 (colonization) 은 40~60% 로보고되어있고, 질의경우당뇨환자에서 20~40% 로보고되고있다. 이러한이유로감염은흔히환자자신에게상재하던균에의한내인성감염에의하여발생한다. C. albicans는점막내정상상재균으로서질병을일으키는과정동안상피세포와상호작용을하게된다. 상피세포와 C. albicans의상호작용은부착 (adherence), 침범 (invasion), 그리고상피세포손상의유도 (induction of epithelial cell damage) 과정으로설명할수있다 (Fig. 1 & 2). C. albicans가사람의상피세포에부착하는과정은감염을일으키는데중요한첫단계로, 복잡하고다양한인자가관여한다. 부착은 C. albicans가점막표면에지속적으로존재하기위하여필수적이며, 이과정을통하여집락화와점막의감염을유도하게된다. 이과정은진균의세포표면에존재하면서숙주세포표면의특정리간드 (ligand) 에작용하게되는, 부착소 (adhesin) 로불리 21
대한의진균학회 제21차 학술대회 박 이상 미원 경 Fig. 1. Diagram of three interactions of C. albicans with epithelial cells (Zhu W and Filler SC. Cellular Microbiology 2010;12:273-282). Fig. 2. The progression of C. albicans infection of oral epithelial cells is characterised by three distinct stages (Naglik JR, et al. Microbes & Inf 2011;13:963-976). 22
박상원이미경 대한의진균학회제 21 차학술대회 는특정분자들에의해매개된다. C. albicans의세포표면에있는부착소들은혈청단백들, 세포외기질 (extracellular matrix, ECM) 성분, cadherin이나 integrin과같은고정된리간드등과상호작용할수있다 (Table 1). 일단 C. albicans가점막표면에부착하게되면, 숙주에지속적으로존재하기위하여 C. albicans의집락화와성장이필요하게된다. 집락화의정도는 C. albicans가박멸되거나상재균으로존재하거나또는감염으로발전되는지를결정하는중요한요인이되고, C. albicans가점막을포함한숙주표면에균막 (biofilm) 을형성하는능력또한지속적으로숙주에존재하는데중요하게기여하게된다. Table 1. Examples of C. albicans adhesins and associated host cell ligands (Williams DW, et al. J Oral Microbiol 2013;5:22434) Candida adhesin Integrin analog (INT) Fibronectin adhesin (FN) Fucoside-binding adhesin GlcNAc-binding protein Fimbrial adhesin Hyphal wall protein 1 (HWP1) Agglutinin-like sequence (ALS) family Enhanced adherence to polystyrene (EAP1) Host cell receptor ic3b, Arginine-glycine-aspartic acid (RGD) Fibronectin and vitronectin receptors Glycoside (glycoprotein or glycolipid) receptor N-Acetylglucosamine βgalnac (1-4β-Gal) A substrate of epithelial cell-associated transglutaminases facilitating cross-linking with epithelial cells Multiple receptors including E-cadherin, N-cadherin and host cell ferritin Host cell targets not yet identified 상피세포침범은점막칸디다증의발병기전에중요하며, 이는상피세포를침범하는능력이감소된 C. albicans의돌연변이형에서독력 (virulence) 이감소됨이점막칸디다증동물모델에서확인되었다. C. albicans가상피세포를침범하는기전은상피세포의세포내섭취 (endocytosis) 유도와상피세포안이나사이로균사 (hypha) 가능동적으로투과하는 (active penetration) 2가지기전으로추정하고있다 (Fig. 1 & 2). 점막칸디다증에서의특징적소견은진균침범에의한상피세포표면의파괴와소실이다. 진균의세포내섭취가상피세포의손상에직접적으로작용하지는않는것으로보고되고있으나, 아직까지정확한기전은알려져있지않다. 그러나괴사 (necrosis) 와세포자멸사 (apoptosis) 의두가지기전으로발생할것으로이해되고있다. 23
대한의진균학회제 21 차학술대회 박상원이미경 CURRICULUM VITAE 성명 : 이미경 (Lee Mi-Kyung) 소속 : 중앙대학교의과대학진단검사의학교실 경력사항 1997년 ~ 2003년 중앙대학교부속필동병원진료조교수 2002년 ~ 2003년 미국질병관리예방센터 (CDC) 초청연구원 ( 한국과학재단지원 ) 2003년 ~ 2006년 중앙대학교의과대학조교수 2006년 ~ 2011년 중앙대학교의과대학부교수 2008년 1-2월 ~ 미국 Western IRB International fellow 연수 ( 임상시험관련전문가육성프로그램, 보건복지부지원 ) 2011년 ~ 현재 중앙대학교의과대학교수 2013년 ~ 2014년 3월 미국 Wake Forest University 연수 학력사항 1990년 중앙대학교의과대학의학과졸업 1995년 중앙대학교대학원석사 ( 진단검사의학 ) 1999년 중앙대학교대학원박사 ( 진단검사의학 ) 연구경력및학회활동 한국과학재단해외박사후연수지원 (2002년) 한국학술진흥재단신진교수연구지원 (2004년) 한국학술진흥재단우수여성과학자연구지원 (2007년, 2008년 ) 한국학술진흥재단기초연구과제지원-공동 (2008년) 한국과학재단기본연구 (2009년) 한국연구재단기초연구사업연구지원 (2011년) 대한진단검사의학회임상미생물분과위원및간사 (2010년 ~ 현재 ) 대한임상미생물학회학술부장 (2007년), 재무이사 (2008~2011년), 회원관리이사 (2012년) 대한의진균학회기획이사 (2010~2012년) 한국보건의료연구원연구윤리심의위원 (2010~2012년) 중앙대학교병원 IRB 위원 (2003년 ~ 현재 ), IRB 전문간사 (2006년 ~ 현재 ) 국가생명윤리정책연구원공용기관생명윤리위원회위원 (2012년 ~ 현재 ) 24
국내연자교육강연 1 김효진 2 김문범 3 이양원 국내연자교육강연 (Special Lecture) 25
대한의진균학회제 21 차학술대회 김효진 26
감염내과에서흔히보는진균감염 대한의진균학회제 21 차학술대회 국내연자교육강연 1 (Special Lecture) 칸디다에의한피부감염증 김효진 인제대학교부산백병원피부과 칸디다증은효모균 Candida albicans, 때로는 Candida 속의다른균종이피부, 조갑, 점막및내부장기에감염을일으키는질환이다. 칸디다증은피부점막칸디다증, 만성점막피부칸디다증, 전신성칸디다증등세가지로분류할수있다. 피부와점막에생기는표재성질환이더흔하고, 내부장기를침범하는전신성감염은위중한질환이다. 칸디다속으로분류되는 200종이상의효모균중에서불과 10개미만이정상세균총의구성원으로서잠재적병원균이며, C. albicans는가장흔한원인으로전체효모균감염증의 70~80% 를차지한다. 칸디다균종은피부및점막에정상균총으로존재하나표재성칸디다감염은주로숙주의면역기능이저하되는경우에주로발생한다. 이러한유발요인에는생리적요인 ( 유아 / 고령, 임신, 생리 ), 내분비계요인 ( 당뇨, 쿠싱증후군 ), 면역계요인 (AIDS, 악성종양 ), 물리적요인 ( 외상 ( 감염, 화상 ), 침연, 비만 ), 의인성요인 ( 광범위항생제투여, 면역억제제 ) 등이있다. 피부점막에발생하는칸디다증에는구강칸디다증 ( 아구창 ), 피부및성기점막칸디다증 ( 칸디다간찰진, 기저귀칸디다증, 효모균성지란미란증, 항문주위 / 음낭칸디다증, 칸디다외음질염, 칸디다조갑주위염, 칸디다조갑곰팡이증 ) 등이있다. 27
대한의진균학회제 21 차학술대회 김효진 CURRICULUM VITAE 경 력 2003년 ~ 2007년 경북대학교병원피부과전공의 2010년 ~ 2012년 분당서울대학교병원피부과전임의 2012년 ~ 현재 인제대학교부산백병원피부과조교수 2013년 10월 ~ 현재 인제대학교부산백병원피부과과장 / 주책임교수 학회활동 대한의진균학회재무실무이사대한모발학회정회원 /2014 세계모발학회실행위원대한아토피피부염학회, 대한피부미용외과학회정회원 학 력 1996년 ~ 2002년 경북대학교의과대학 2003년 ~ 2005년 경북대학교의과대학대학원석사 2013년 ~ 현재 경북대학교의과대학대학원박사과정재학 28
감염내과에서흔히보는진균감염 대한의진균학회제 21 차학술대회 국내연자교육강연 2 (Special Lecture) 피부진균감염으로오진하기쉬운질환들 김문범 부산대학교의과대학피부과 Among various skin diseases, most skin diseases are not curable but only controllable. Dermatologists should be concerned about curable skin diseases like fungal infections. In cutaneous fungal infections, superficial fungal infections such as tinea pedis and tinea corporis are most common. Though most of superficial fungal infections usually have their clinical characteristics, a variety of skin diseases can also mimic them. And so, to confirm fungal infections under clinical suspicion, we should perform several diagnostic procedures including potassium hydroxide (KOH) exam, Wood's light exam, culture, histopathologic exam or molecular study. Of these diagnostic tests, KOH exam is very useful especially for superficial fungal infections because it is quick and inexpensive. However, some dermatologists seem to regard KOH troublesome and tend not to do KOH. As a result, they can lose the chance for the cure of superficial fungal infections. To prevent this circumstance, dermatologists need to be familiar with superficial fungal infectionmimicking skin conditions, and to be eager to do a KOH exam. In this talk, I am going to present diverse skin diseases mimicking superficial fungal infections and my data about tinea incognito in Korea and various nail disorders misdiagnosed and treated as onychomycosis. 29
대한의진균학회제 21 차학술대회 김효진김문범 CURRICULUM VITAE 김문범 ( 金紋範 ) 생년월일 : 1967년 8월 1일현직위 : 부산대학교의과대학피부과학교실교수 학력및경력 1983년 ~ 1986년 브니엘고등학교졸업 1986년 ~ 1992년 부산대학교의과대학졸업 1992년 ~ 1993년 부산대학교병원인턴수료 1993년 ~ 1996년 육군 11사단 9연대군의관 1997년 ~ 2001년 부산대학교병원피부과레지던트수료 2006년 부산대학교의학대학원졸업 2001년 ~ 2003년 부산대학교의과대학피부과학교실전임의 2003년 ~ 2008년 부산대학교의과대학피부과학교실조교수 2008년 ~ 2013년 부산대학교의과대학피부과학교실부교수 2013년 ~ 부산대학교의과대학피부과학교실교수 2014년 ~ 부산대학교병원진료지원실장 학회활동 대한의사협회 (1992~) 대한피부과학회 (1997~) 대한의진균학회이사 (2012~) 피부병리연구회이사 (2005~) 대한아토피피부염학회교육이사 (2010~2012) 및이사 (2013~) 대한모발학회교육이사 (2010~) 대한피부연구학회무임소이사 (2012~2013) 대한피부과학회기획정책이사 (2014~) 임상진료연구관심분야 탈모증, 백반증, 아토피피부염, 조갑이상증, Dermoscopy 연락처 Telephone ; 051-240-7338 (hospital), 010-3844-0229 (mobile) FAX ; 051-245-9467 e-mail ; drkmp@hanmail.net 30
감염내과에서흔히보는진균감염 대한의진균학회제 21 차학술대회 국내연자교육강연 3 (Special Lecture) 지루피부염의최신지견 이양원 건국대학교의학전문대학원피부과학교실 지루성피부염 (seborrheic dermatitis) 은피지선의활동이증가된부위에발생하는아급성또는만성표재성습진성피부염으로, 주로두피, 안면, 귀, 흉골부위, 액와부등에호발하며, 건성또는지성의인설을나타내는홍반성판을특징으로한다. 지루성피부염의원인은아직확실히밝혀져있지않으나피지선이발달된부위에주로발생하는피부염이므로피지의과다분비가주된발병인자로거론되고있으며, 피부의정상균총중지질친화성균종인 Malassezia 효모균의관련성, 신경전달물질의이상및표피증식의이상등이가설로제시된바있다. 최근지루성피부염을 azole계항진균제로치료시효모균의소실과함께임상증상이호전을보인보고도있으며, 동물실험에서 Malassezia 효모균을피부에도포시지루성피부염과유사한병변이나타나는현상이규명되어 Malassezia 효모균의병인적연관성이중요하게대두되고있다. 지루성피부염은모발건강에도영향을주게되는데염증반응의부산물로발생하는비듬은 Malassezia 효모균의좋은배지로작용할수있으며모발성장의방해요인으로작용할수있다. 또한지루성피부염시동반되는가려움증으로두피와모발을긁게되어모발외피에손상을주게되고이것이모발을부러지기쉽게만드는요인으로작용하게된다. 또한안면부에발생하는경우가려움증뿐만아니라홍반과각질을동반함으로서미용적으로많은문제를초래하게되어사회적인활동에까지영향을주고있다. 이렇게그임상적중요성이대두되고있는지루피부염과 Malassezia 효모균과의관련성에대해고찰하고, 지루피부염의병인에대한최근연구들을살펴보고자한다. 31
대한의진균학회제 21 차학술대회 김효진이양원 CURRICULUM VITAE Name : Yang-Won Lee Sex : Male Date of Birth : Jan 26 th, 1971 Office address : Department of Dermatology Konkuk University Hospital 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea Telephone : 82-2-2030-7573 Fax : 82-2-2030-5179 E-mail : 20050078@kuh.ac.kr Education Feb. 1996 Feb. 2000 Feb. 2006 B. S in genetic engineering, College of biomedical science, Kyunghee University. Doctor of Medicine (MD), School of Medicine, Konkuk University. Ph. D. Konkuk University School of Medicine Graduate School. Academic Appointments 2000 ~ 2001 Residency training (internship), Konkuk University Hospital. 2001 ~ 2005 Residency training in Dermatology, Konkuk University Hospital. 2005 ~ 2006 Fellowship training in Dermatology, Konkuk University Hospital. 2006 ~ 2007 Clinical assistant professor in Dermatology, Konkuk University Hospital. 2007 ~ 2011 Assistant professor in Dermatology, Konkuk University Hospital. 2010 ~ 2011 Visiting professor in Dep. of Biomechanical Engineering, Michigan State University 2011 ~ present Associate professor in Dermatology, Konkuk University Hospital. Academic Award 2002 Best Paper Award, The 9 th Korean Society for Medical Mycology. 2003 Best Poster Award, The 55 th Spring Meeting, Korean Dermatological Association. 2003 Top graduate (Presidential citation), The Graduate School of Konkuk University. 2006 Best Paper Award, The 13 th Korean Society for Medical Mycology. 2006 Scholarship, The 65 th annual meeting of 32
감염내과에서이양원 흔히보는진균감염 대한의진균학회제 21 제차 21차학술대회 American Academy of Dermatology. 2007 Research Award, Korean Dermatological Association. 2008 Research Grant for young investigators, Korea Research Foundation 2008 Travel grants, The 5 th Georg Rajka International Symposium on Atopic Dermatitis 2009 Travel grants, The 17 th Congress of The International Society for Human and Animal Mycology 2010 Amorepacific scholarship, Korean Dermatological Association. 2012 Amorepacific award for young investigator, Korean Dermatological Association. 2013 'Ohun' scholarship award, The 65 th Autumn Meeting, Korean Dermatological Association. Social Activities 2013 ~ The present Treasurer, Korean Society for Medical Mycology 2006 ~ The present Member of International society for human and animal mycology (ISHAM) Malassezia working group 2013 ~ The present Planning director, Korean Society for Aesthetic and Dermatologic Surgery 2010 ~ The present Member of board of directors, The Korean Hair Research Society 2012 ~ The present Director of ethics legislation, Korean Society for cosmetic dermatology 33
대한의진균학회제 21 차학술대회 M E M O 김효진 34
구연연제초록 (Free Communication) [FC-1 ~ FC-9] 35
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FC-1 Localized Skin Infection Due to Scedosporium apiospermum You Bum Song 1, Ji Young Yoo 1, Moo Kyu Suh 1, Gyoung Yim Ha 2 and Jong Im Lee 3 Departments of 1 Dermatology, Laboratory 2 Medicine & 3 Pathology, College of Medicine, Dongguk University, Gyeongju, Korea Scedosporium(S.) apiospermum is an asexual state of Pseudallescheria boydii which has been isolated from soil, sewage, and decaying vegetation. It can cause cutaneous infections by traumatic implantation of the contaminant due to penetrating injury. This ubiquitous fungus cause not only mycetoma, but also infections of variety of body sites including the skin. The localized skin infection due to this organism is much rare than mycetoma. We report a case of cutaneous S. apiospermum infection occurred in 80-year-old male. The skin lesion was manifested by a 8.0 4.0 cm-sized erythematous plaque with pustules and crusts on the dorsum of right hand. The fungal culture from the biopsy specimen on Sabouraud's dextrose agar showed white to gray colored cottony colonies of S. apiospermum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of S. apiospermum strain IHEM 23829. After the patient was treated with oral itraconazole for 4 weeks, he showed elevated liver enzyme. So we treated him with oral fluconazole for 3 months. There has been no recurrence observed for 3 months of follow up. Key Words: Localized skin infection, Scedosporium apiospermum 37
FC-2 A Case of Cutaneous Fungal Infection Caused by Verticillium Species Dae-Woo Kim, Soo-Han Woo, Joo-Ik Kim, Chin-Ho Rhee, Jin Park, Seok-Kweon Yun and Han-Uk Kim Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea Verticillium, which is one of the deuteromycetes, is commonly known as a plant parasite and contaminant. It can rarely cause infections in humans, such as keratitis, soft tissue infections, or peritonitis. Here, we report a rare case of cutaneous infection caused by Verticillium species. A 76-year-old woman presented with an 8-month history of pruritic and painful scaly plaque on her left forearm. She was treated with systemic and topical antibiotics for several months, but the lesion was not improved. There was no past history of systemic illness or medication including immunosuppressive agents. Physical examination showed an erythematous scaly and crusted plaque on the left forearm. There were no other associated systemic symptoms. Routine laboratory examinations were within normal limits. Histopathological findings revealed chronic granulomatous inflammation and periodic acid-schiff was positive for fungal hyphae. Tissue culture on Sabouraud dextrose agar showed white and powdery colony. Lactophenol cotton blue mount of the culture preparation showed septated hyphae, simple or branched conidiophores, elongated phialides and oval, single-celled conidia consistent with Verticillium species. She was treated with fluconazole (200 mg/day) for the first 2 weeks and itraconazole (200 mg/day) for the next 2 weeks, but produced a poor clinical response. After that, the lesion was significantly improved with voriconazole (200 mg, twice daily) for 4 weeks. Key Words: Cutaneous fungal infection, Verticillium species 38
FC-3 Exophiala lecanii-corni as a Cause of Chromoblastomycosis Kyou Chae Lee, Sang Lim Kim, Jin Sub Lee, Weon Ju Lee, Seok-Jong Lee, Do Won Kim and Yong Hyun Jang Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Republic of Korea Chromoblastomycosis is a chronic fungal infection of the skin and the subcutaneous tissue caused by traumatic inoculation of a specific group of dematiaceous fungi (usually Fonsecaea pedrosoi, Phialophora verrucosa, Cladosporium carrionii, or Fonsecaea compacta) through the skin. Rare cases of chromoblastomycosis caused by Exophiala species have also been reported, allowing the inclusion of this species among those that cause the disease. In Korea, chromoblastomycosis caused by Exophiala lecaniicorni was not reported until now. A 76-year-old man presented ill-defined discrete and confluent flat topped firm erythematous papules arranged in reticular pattern on right forearm for 18 months. The lesion gradually increased in size and itching emerged spontaneously. He had a history of swimming in the sea of Egyptian pharaohs island. Before the travel, he had a history of trauma at the site of the lesion a week ago. An incisional biopsy was taken from the lesion. On histopathological examination, pigmented bodies resembling "copper pennies" were identified. Tissue culture showed dark brown to olivaceous black colored velvety colony and mycological findings showed pigmented spine-like conidiophores and clusters of single celled conidia. The DNA sequence of internal transcribed spacer (ITS) region of clinical sample was 100% match to that of Exophiala lecaniicorni CBS 123.33 strain (GenBank accession number AY857528.1). Skin lesions improved after three months of oral itraconazole and topical amorolfine treatment. Key Words: Chromoblastomycosis, Exophiala lecanii-corni 39
FC-4 부종을동반하여팔에발생한 Aspergillus niger 원발성피부감염 김수현 김성애 이규석 조재위 계명대학교의과대학피부과학교실 아스페르길루스 (Aspergillus) 종은공기, 토양등생활주변에존재하는심재성진균으로서, 숙주의방어기전이약화되면기회감염을일으킬수있다. 피부아스페르길루스증은원발성과속발성으로나눌수있으며, 직접균이피부에침입하여발생하는원발성피부아스페르길루스증의경우면역약화환자의정맥도관부위또는외상에의한접종부위와같은피부가손상된부위에발생하게된다. 900여종의아스페르길루스종중에서사람에게감염을일으키는균종은 8종이알려져있으며, 이중 A. fumigatus는전신감염을, A. flavus는피부병변을잘일으키나, A. niger에의한감염은매우드물다. 본증례는 71세남자환자로외상등의특별한유발요인없이홍반성부종성반과궤양이좌측손등에발생하여내원하였다. 환자의과거력상당뇨, 위궤양외의병력없었으며면역억제를의심할만한임상소견및면역억제제의투여경력은없었다. 처음에는세균감염에의한봉와직염을의심하였으나, 일반적인항생제치료에호전보이지않았고좌측손등의부종성병변에서시행한조직검사상 GMS 염색양성소견보여진균학적검사를통해 Aspergillus niger 에의한피부감염을진단하였다. 아스페르길루스증은 90% 가폐에서발생되며원발성으로피부병변이발생하는경우는매우드물다. 또한피부아스페르길루스증의초기병변은반, 구진, 결절, 판등의형태로나타나게된다. 본증례에서는부종을동반한비전형적인임상양상을보인 Aspergillus niger 원발성피부감염으로교육적인증례라생각하여보고하는바이다. 40
FC-5 A Case of Cutaneous Infection by Alternaria alternata 김병수 영남대학교의과대학피부과학교실 Alternaria species are common saprophyte found in the environment such as soil, atmosphere, and other objects. They are not usually pathogenic in humans but recently, infections by this fungi have occasionally been reported, occurring mostly in immunocompromised patients. They can cause hypersensitivity pneumonitis, bronchial asthma, or allergic rhinitis and rarely skin infection. A 76-year-old man presented with rice grain to pea sized well demarcated violaceous plaque with some pustules on the both forearm for 6 months. He had been treated for Parkinson's disease and dementia for 3 years but did not take any immunosuppressants. Direct smear with KOH was negative. Skin biopsy performed on the right forearm showed neutrophilic abscess and suppurative granulomatous inflammation containing neutrophils, histiocytes, and giant cells in the dermis with round spores. Periodic acid-schiff and Gomori- Methenamine Silver stains revealed ring to oval shaped spores. White to gray colored colony with black to brown reverse cultured on potato dextrose agar at 7 days of culture. The slide culture stained with lactophenolcotton blue showed hyphae and club-shaped conidia with transversal, longitudinal or oblique septa. Alternaria alternata was identified by sequencing of fungal ribosomal ITS using PCR assays. He was treated with topical ketoconazole cream application for a month, and healed leaving hyperpigmentation with scales. 41
FC-6 A Case of Disseminated Trichosporon asahii Infection in an Immunocompromised Patient Sang Jin Kim 1, Joon Seong Park 2 and Eun-So Lee 1 1 Department of Dermatology, Ajou University School of Medicine, Suwon, Korea 2 Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea Abstract Trichosporon spp is a normal flora of mucous membranes in the gastrointestinal and respiratory epithelium, as well as the skin. But it can cause both superficial and invasive infections in humans. Trichosporon asahii is associated with invasive infection and it occurs almost exclusively in immunocompromised patients. The majority of cases have been seen in patients with hematologic malignancy with neutropenia. One-third of patients with disseminated Trichosporon disease show cutaneous findings. Herein, we report a case of Trichosporon asahii infection in an immunocompromised patient. A 62-year-old male patient with multiple myeloma was in hospital to manage neutropenic fever. He developed multiple erythematous papules and plaques on lower abdomen and both legs. Skin biopsy revealed diffuse dermal infiltration of fungal organism and intravascular invasion without obvious inflammatory reaction. At that time, the blood culture identified Trichosporon asahii on two consecutive examinations. He was diagnosed disseminated trichospironosis and has been treated with intravenous voriconazole in combination with liposomal amphotericin B. After three weeks of treatment the blood culture result was changed to negative, so the diagnosis was confirmed. To our knowledge, there is no domestic report about cutaneous manifestation of disseminated Trichosporon asahii infection in an immunocompromised patient. Thus, we report a rare and interesting case caused by Trichosporon asahii. 42
FC-7 A Case of Rhodotorula Skin Infection Occurred in Immunocompromised Patient Seung-Hwan Choi, Tae-Hoon Kim, Seung-Min Ha, Dong-Yeob Ko, Ki-Hoon Song and Ki-Ho Kim Department of Dermatology, Dong-A University College of Medicine A 52-year-old man presented with solitary erythematous patch on the left lower leg for 1month. The patient had a history of chronic actinic dermatitis and he was taking oral cyclosporine. There was no history of animal contact to the skin lesion. Direct microscopic examination of skin scrapings using 20% potassium hydroxide (KOH) solution demonstrated oval budding yeast cells. Culture of lesion on standard Sabouraud dextrose agar (SDA) revealed reddish yeast colonies. Rhodotorula is a unicellular pigmented yeast, part of the Basidiomycota phylum, quite easily identifiable by distinctive orange/red colonies when grown on SDA. Before 1985, Rhodotorula was not considered yet as a pathogen, but today it is known to cause significant infections in immunocompromised patients, usually with a malignancy or immunosuppression. Rhodotorula is most commonly found in patients who are immunosuppressed and/or are using foreign-body technology such as central venous catheters. Rhodotorula is commonly treated by removing the catheter and the use of antibiotics. And Rhodotorula skin infections are extremely rare. Amphotericin B is considered as the gold standard therapy for this infection. Herein, we report a rare case of Rhodotorula skin infection occurred in immunocompromised patient. 43
FC-8 Comparative Study of In Vitro Inhibitory Effects of UVC, Terbinafine Hydrochloride 1% and Paeonia Natural Extracts on Trichophyton rubrum Ho Jung Jung, Yang Won Lee, Yong Beom Choe and Kyu Joong Ahn Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea Background Trichophyton(T.) rubrum is most common fungal pathogen that causes tinea pedis and onychomycosis. It recurrently infects human and usually persists for very long time, provoking public health concern. Due to the limitation in current treatment options, alternative therapies are desirable. We investigated the inhibitory effect of UVC, terbinafine hydrochloride 1% and paeonia natural extracts on T. rubrum in vitro. Objective and Method Total 25 T. rubrum strains were cultured for 10 days on Mycosel agar plate; 5 strains of T. rubrum and 5 copies for each strain. They were divided into 5 groups: control, UVC irradiation, terbinafine spray, paeonia natural extracts spray, UVC and paeonia natural extracts sprays. The cultured media were irradiated for 1 hour daily for 3 weeks in the germicidal lamp emitting 253.7 nm (UVC), power of 2.875 mw/cm 2 at 10 cm distance. Terbinafine and paeonia extracts were sprayed twice on the surface to fully cover the colony area. The median diameter of each colony were measured every other day for 3 weeks. The change of colony diameter and the growth rate were analyzed. Results The UVC had barely no effect on restraining the growth of T. rubrum, similar with the growth of the control group. However, both the terbinafine spray and paeonia extracts slowed down the growth rate remarkably and showed a similar effect. Conclusion We could only figure out the fungistatic effect, and not the fungicidal effect of paeonia extract and terbinafine hydrochloride in vitro. UVC irradiation setting in this study was totally ineffective. More studies are needed on more variable wavelength and the fluence of UVC irradiation. In addition, further verification on the mechanism and the effect of anti-fungal activity by paeonia extracts are needed. Key Words: T. rubrum, Paeonia, Natural extract, UVC, Antifungal 44
FC-9 Lack of Antifungal Effect of 1,064 nm Long Pulse Nd:YAG Laser on the Growth of Trichophyton rubrum Yu Ri Kim, Yang Won Lee, Yong Beom Choe and Kyu Joong Ahn Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea Introduction There has been a report suggesting clinical effectiveness of phototherapy using a long-pulsed Nd:YAG laser as the alternative treatment of onychomycosis, but objective evaluation of the therapeutic effect and in-depth study of the mechanism of treatment are still insufficient. Objectives This study investigated the antifungal effect of 1,064 nm long-pulsed Nd:YAG laser irradiation on Trichophyton rubrum, a pathogen which has been attributed in more than 80% of onychomycosis. Materials & Methods T. rubrum collected from the nails of 5 onychomycosis patients were irradiated with the laser by 200 shots each time at intervals of 3 to 5 days for 29 days. The colony diameter was compared with that of the control group to observe the difference in growth rate. Results The growth rate was not different between the irradiated colony and the control colony. Conclusions In this study, the laser did not seem to have a direct effect on T. rubrum. It can be speculated that the therapeutic effect of 1,064 nm long-pulsed Nd:YAG laser on onychomycosis may be attributable to tissue changes of the lesion, rather than to damaging of the fungus itself.s 45
대한의진균학회제 21 차학술대회초록집 2014년 5월 27일인쇄 2014년 5월 31일발행발행인 : 안규증편집인 : 조소연발행처 : 대한의진균학회 7 0 0-7 1 1 대구광역시중구동덕로 130 경북대학교병원피부과전화 : (053) 420-5838 팩스 : (053) 426-0770 e-mail : weonju@knu.ac.kr 인쇄처 : 서흥출판사 Tel : 702-0143, Fax : 714-7062 e-mail : shbio2001@hanmail.net Printing : May 27, 2014 Publishing : May 31, 2014 Publisher : Kyu Joong Ahn, M.D. Editor : Soyun Cho, M.D. Published by: Korean Society for Medical Mycology Department of Dermatology Kyungpook National University School of Medicine 130, Dongduk-ro, Jung-gu, Daegu Republic of Korea, Tel : 82-53-420-5838 Fax : 82-53-426-0770 e-mail : weonju@knu.ac.kr 학회홈페이지 : www.ksmm.org