대한의진균학회제 18 차학술대회초록 일시 : 2011 년 9 월 3 일 ( 토 ) 장소 : 서울건국대병원대강당 주최 : 대한의진균학회대한피부과학회피부진균연구회 - 0 -
대한의진균학회제 18 차학술대회초록 일시 : 2011 년 9 월 3 일 ( 토 ) 장소 : 서울건국대병원대강당 주최 : 대한의진균학회대한피부과학회피부진균연구회 - 1 -
대한의진균학회제 18 차학술대회진행계획표 시 간 내 용 9월 3일 08 : 30 ~ 09 : 00 등 록 09 : 00 ~ 09 : 10 개회식 09 : 10 ~ 09 : 30 수혜자보고 1 ( 조소연 ) 09 : 30 ~ 09 : 50 수혜자보고 2 ( 이미우 ) 09 : 50 ~ 10 : 30 해외초청연자특강 1 (Takashi Mochizuki) 10 : 30 ~ 10 : 50 Coffee break 10 : 50 ~ 11 : 30 해외초청연자특강 2 (Kusmarinah Bramono) 11 : 30 ~ 12 : 00 교육강연 1 (Jin Yu) 12 : 00 ~ 13 : 30 기념촬영, 평의원회및중식 13 : 30 ~ 14 : 10 해외초청연자특강 3 (Chunyang Li) 14 : 10 ~ 14 : 40 교육강연 2 ( 김광호 ) 14 : 40 ~ 15 : 00 Coffee break 15 : 00 ~ 15 : 30 교육강연 3 ( 이상오 ) 15 : 30 ~ 16 : 10 일반연제 16 : 10 ~ 16 : 30 폐회식및총회 학술대회진행시유의사항 1. 연제발표자는미리 10분전에앞줄에대기하여주시기바랍니다. 2. 일반연제는원저인경우발표 7분, 임상증례는발표 5분입니다. 3. 연제를발표 1시간전에접수하여주십시오. - 3 -
18th Annual Meeting of Korean Society for Medical Mycology Time Content 9 month 3 day 08 : 30 ~ 09 : 00 Registration 09 : 00 ~ 09 : 10 Opening announcement 09 : 10 ~ 09 : 30 Report 1 by recipients of grant (Soyun Cho, Korea) 09 : 30 ~ 09 : 50 Report 2 by recipients of grant (Mi-Woo Lee, Korea) 09 : 50 ~ 10 : 30 Special lecture 1 by invited speaker (Takashi Mochizuki, Japan) 10 : 30 ~ 10 : 50 Coffee break 10 : 50 ~ 11 : 30 Special lecture 2 by invited speaker (Kusmarinah Bramono, Indonesia) 11 : 30 ~ 12 : 00 Educational lecture 1 (Jin Yu, China) 12 : 00 ~ 13 : 30 Photo session, board meeting & lunch 13 : 30 ~ 14 : 10 Special lecture 3 by invited speaker (Chunyang Li, China) 14 : 10 ~ 14 : 40 Educational lecture 2 (Kwang Ho Kim, Korea) 14 : 40 ~ 15 : 00 Coffee break 15 : 00 ~ 15 : 30 Educational lecture 3 (Sang-Oh Lee, Korea) 15 : 30 ~ 16 : 10 Free communication 16 : 10 ~ 16 : 30 Closing - 4 -
대한의진균학회제 18 차학술대회연제순서 수혜자보고 1 : 09 : 10 09 : 30 제목 : Histopathologic Findings of Tinea Corporis 연자 : Soyun Cho (Seoul National University, Korea) 좌장 : 원영호교수 ( 전남의대 ) 수혜자보고 2 : 09 : 30 09 : 50 제목 : Clinical Analysis of Deep Cutaneous Mycoses: A 12-year Experience at a Single Institution in Korea 연자 : Mi-Woo Lee (Asan Medical Center, Korea) 좌장 : 우준희교수 ( 울산의대 ) 해외초청연자특강 1 : 09 : 50 10 : 30 제목 : Recent Molecular Approaches for the Epidemiology of Dermatomycoses 연자 : Takashi Mochizuki (Kanazawa Medical University, Japan) 좌장 : 김기홍교수 ( 영남의대 ) 10 : 30 ~ 10 : 50 Coffee Break 해외초청연자특강 2 : 10 : 50 11 : 30 제목 : Chronic Recurrent Dermatophytosis in the Tropics: Studies on Tinea Imbricata in Indonesia 연자 : Kusmarinah Bramono (University of Indonesia, Indonesia) 좌장 : 조백기교수 ( 가톨릭의대 ) 교육강연 1 : 11 : 30 12 : 00 제목 : Mucor irregularis, a Primary Human Pathogen 연자 : Jin Yu (Peking University, China) 좌장 : 유희준교수 ( 한양의대 ) 12 : 00 ~ 13 : 30 기념촬영, 평의원회및중식 해외초청연자특강 3 : 13 : 30 14 : 10 제목 : Chromoblastomycosis in China 연자 : Chunyang Li (Shandong University, China) 좌장 : 노병인교수 ( 관동의대 ) - 5 -
교육강연 2 : 14 : 10 14 : 40 제목 : Immunology of Dermatophytosis 연자 : Kwang Ho Kim (Hallym University) 좌장 : 안규중교수 ( 건국의대 ) 14 : 40 ~ 15 : 00 Coffee Break 교육강연 3 : 15 : 00 15 : 30 제목 : Unusual Skin and Soft Tissue Infections after Transplantation 연자 : Sang-Oh Lee (Asan Medical Center, Korea) 좌장 : 문기찬교수 ( 울산의대 ) 일반연제 FC-1 ~ FC-7 : 15 : 30 16 : 10 좌장 : 최종수교수 ( 영남의대 ) 서무규교수 ( 동국의대 ) FC-1. Comparison of Therapeutic Efficacy on Various Clinical Type of Distal Lateral Subungual Onychomycosis... 방철환, 이영복, 박현정, 조백기 / 가톨릭대학교의과대학성모병원피부과학교실 FC-2. Diagnosis of Onychomycosis: Is it Possible to Establish the Diagnosis of Onychomycosis with Clinical Characteristics?... 박지혜, 정미영, 이동윤 / 성균관대학교의과대학삼성서울병원 FC-3. 한가족내에서애완고양이로부터발생한것으로추정되는농창상 M. canis 감염증... 윤상돈, 류한원, 조재위, 이규석 / 계명대학교의과대학피부과학교실 FC-4. Paecilomyces lilacinus에의한국소피부감염증... 조용선, 황수란, 송기훈, 이종선, 박진, 윤석권, 김한욱 / 전북대학교의학전문대학원피부과학교실 FC-5. Chaetomium globosum에의한손발톱진균증... 서무규, 김동민, 이명훈, 하경임 1 / 1 동국대학교의과대학피부과학교실, 진단검사의학교실 - 6 -
FC-6. A Case of Mucocutaneous Candidiasis Mimicking Lichen Planus... Byong Han Song, Eun Joo Park, In Ho Kwon, Kwang Ho Kim, Kwang Joong Kim / Department of Dermatology, College of Medicine Hallym University Sacred Heart Hospital, Anyang, Korea FC-7. Cutaneous Blastomycosis... 박세원, 박혜영, 이동윤 / 성균관의대삼성서울병원피부과 16 : 10 ~ 16 : 30 폐회식및총회 - 7 -
특별강연 (Special Lecture) 특별강연 1 Takashi Mochizuki 특별강연 2 Kusmarinah Bramono 특별강연 3 Chunyang Li - 9 -
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특별강연 1 (Special Lecture 1) Recent Molecular Approaches for the Epidemiology of Dermatomycoses Takashi Mochizuki Department of Dermatology, Kanazawa Medical University 1-1 Daigaku, Uchinada, Ishikawa, Japan 920-0291 Methods of identifying fungal strains isolated from dermatomycoses have recently been evolving and molecular techniques are available for quicker species identification. For species identification, restriction fragment length polymorphisms of mitochondrial (mt) DNA, and nucleotide sequence data such as the D1/D2 regions or internal transcribed spacer regions of ribosomal RNA gene (rdna) are widely used for dermatophytes or dematiaceous fungi. During development of these molecular methods, some intraspecies variations have been detected, which facilitate intraspecies level typing and further strain identification useable in molecular epidemiologic studies. The discrimination power depends on the nucleotide sequence variation within the target molecules and the detection system used. Therefore appropriate molecular methods for subspecies typing and strain identification should be selected carefully according to the fungal species and the purpose of the study. For example, mtdna is suitable for intraspecies typing in Sporothrix schenckii but a more sensitive marker is required for dermatophyte species. In this lecture, I will give a short review of methods used in molecular epidemiology, then introduce some studies of dermatophyte species including Trichophyton mentagrophytes var. interdigitale and Trichophyton tonsurans using non-transcribed spacer regions of rdna. - 11 -
CURRICULUM VITAE Name Takashi Mochizuki Personal Date of Birth: 14 March, 1956 Education 1975 ~ 1981 Hirosaki University, Aomori, Japan, M.D. 1982 ~ 1986 Graduate School, Shiga University of Medical Science, Shiga, Japan, Ph.D. Professional experience 1991 ~ 1992 Visiting Researcher, Department of Botany, University of Texas at Austin, Texas, USA. 1992 ~ 1993 Visiting Professor (Associate), Department of Plant Pathology, University of California at Riverside, California, USA. 1986 ~ 1997 Instructor, Department of Dermatology, Shiga University of Medical Science, Shiga, Japan. 1997 ~ 2005 Associate Professor, Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan. 2005 ~ Present Professor, Division of Dermatomycology (Novartis Pharma), Research Institute of Medical Science, Kanazawa Medical University, Ishikawa, Japan. 2005 ~ Present Professor, Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan. - 12 -
특별강연 2 (Special Lecture 2) Chronic Recurrent Dermatophytosis in the Tropics: Studies on Tinea Imbricata in Indonesia Kusmarinah Bramono Department of Dermato-Venereology, Faculty of Medicine University of Indonesia, Jakarta Abstract Dermatophytosis is one of major public health problems in tropical countries, especially the chronic recurrent type. Tinea imbricata (TI), a dermatophytosis caused by Trichophyton concentricum (TC) is endemic in several remote and isolated areas in Indonesia. This dermatophytosis is unique due to its predominant genetic predisposition, which leads to chronic recurrent conditions among the affected. Moreover, hot and humid climate, low socioeconomic conditions, lack of hygiene, inadequate treatment due to difficult access to health care facilities, and persistence source for re-infections are among other factors that keep on maintaining the condition. Studies on TI in Indonesia had been done since 1960s. Several aspects on TI e.q. the epidemiology, clinical features, efficacy of antifungal treatment, can be obtained from those studies. Griseofulvin is still the mainstay treatment, but relapse rates were high. The last study conducted in West Papua combining griseofulvin treatment with health education for local health care providers and providing the patients with fungal disinfectant for clothing and bedding. Higher cure rates at the end of treatment and the four- month's later were obtained, in comparison to the previous studies. Parallel studies on the same patient populations showed that: 1. Clothing and bedding were fomites and potential sources of re-infections; 2. Sodium hypochlorite worked well as a fungal disinfectant, followed by anionic detergent and pine oil tar containing cleaner; 3. In vitro, terbinafine was the most effective antifungal agent for TC, followed by griseofulvin; itraconazole, and fluconazole were less effective. - 13 -
CURRICULUM VITAE Name : Kusmarinah Bramono Date of Birth : April 20, 1950 Education 1974 - Medical Doctor, University of Indonesia, Jakarta, Indonesia. 1987 - Specialist in Dermato-Venereology, University of Indonesia, Jakarta, Indonesia. 1988 - Certificate on Mycology Course, University of Indonesia, Jakarta, Indonesia. 1992 - Diploma on Dermato-Mycology Research, Juntendo University School of Medicine, Tokyo, Japan. 2006 - Doctoral degree, Department of Dermatology, Juntendo University School of Medicine, Tokyo Previous Academic Appointments 2002 ~ 2009 - Head of Sub-Department of Dermatomycology, Dept. of Dermato-Venereology, Faculty of Medicine, University of Indonesia Current Academic Appointments 2007 ~ - Member of the Ethical Committee for Medical and Health Sciences, Fac. of Medicine, Univ. of Indonesia / Cipto Mangunkusumo Hospital 2009 ~ - Chair of Postgraduate Training for Dermato-Vevereology, Fac. of Medicine, Univ. of Indonesia / Cipto Mangunkusumo Hospital Current Organization Appointments 1999 ~ - Executive Secretary of the Indonesian Study Group on Dermatomycoses 2004 ~ - President of the Indonesian Society for Human and Animal Mycology 2005 ~ - Board of Directors, the Asia Pacific Society for Medical Mycology 2008 ~ - Chair of the Indonesian College of Dermato-Venereology Some Publications 1. Bramono K, Pemayun TP, Darodjatun B, Djuanda A. Herpes zoster ophthalmicus (a retrospective study); Majalah Kedokteran Indonesia (Indonesian Medical Journal) 1984;34:159-163 2. Bramono K, Boediardja SA. Scabies. Media Dermatovenereologica Indonesiana 1985:33 3. Moertolo TF, Bramono K. Application of vitamins in dermatology. Media Dermatovenereologica Indonesiana 1990;17:47-54 4. Bramono K, Tsuboi R, Murai M, Miyakawa Y, Fukazawa Y, Ogawa H. Scanning electron microscope - 14 -
observation of adherence of Candida albicans to cultured keratinocytes. J Med Vet Mycol 1994;32: 473-476 5. Budimulja U, Kuswadji, Bramono K, Basuki S, Judanarso J, Untung LS, Widagdo S, Rohprabowo, Widyanto, Koesanto D, et al. A double-blind, randomized, stratified controlled study of the treatment of tinea imbricata with oral terbinafine or itraconazole. Br J Dermatol 1994; 130 supl. 43:29-31 6. Tsuboi R, Ogawa H, Bramono K, Richardson MD, Shankland GS, Crozier WJ, Sei J, Ninomiya J, Nakabayashi A, Takiuchi I, Payne CD, Ray TL. Pathogenesis of superficial mycoses. J Med Vet Mycol 1994; 32, suppl 1:91-104 7. Randhawa HS, Budimulja U, Bazas-Malik G, Bramono K, Hiruma M, Kullavanijaya P, Rojanavanich V. Recent developments in the diagnosis and treatment of subcutaneous mycoses. J Med Vet Mycol 1994; 32, suppl 1:299-307 8. Bramono K, Tsuboi R, Ogawa H. A carbohydrate-degrading enzyme from Candida albicans: correlation between α-glucosidase activity and fungal growth. Mycoses 1995;38:349-353 9. Dewi S, Bramono K, Wiryadi BE. The role of vaccination in morbus Hansen. Media Dermatovenereologica Indonesiana 1995;3:31-134 10. Bramono K, Kuswadji, Sainan E, Azis W, Budimulja U. Clinical comparative study of combination cream clotrimazole and betamethason dipropionate vs miconazole nitrate and hydrocortisone in cutaneous candidosis. Majalah Kedokteran Indonesia (Indonesian Medical Journal) 1996;46:149-153 11. Bramono K, Kuswadji, Budimulja U. Pulse dose treatment of itraconazole in onychomycosis (preliminary report). Indonesian Journal of Pharmacology and Therapy 1996;12:13-16 12. Tristianawati W, Bramono K. Antihistamines for skin diseases. Media Dermatovenereologica Indonesiana 1998;25:38-46 13. Bramono K. Onychomycoses in Indonesia: epidemiology and management. Media Dermatovenereologica Indonesiana 1999;4:158-163 14. Yudistirawaty, Bramono K. The role of zinc in dermatology. Media Dermatovenereologica Indonesiana 1999;26:43-48 15. Bramono K, Kuswadji U, Budimulja U. The efficacy and safety of butenafine cream 1% vs bifonazole cream 1% in the treatment of tinea cruris and/or corporis: a double blind randomized controlled study in two hospitals. Majalah Kedokteran Indonesia (Indonesian Medical Journal) 2000;50:219-223 16. Budimulja U, Bramono K, Urip KS, Basuki S, Widodo G, Rapatz G, Paul C. Once daily treatment with terbinafine cream (Lamisil ) for 1 week is effective in the treatment of tinea corporis and cruris. Mycoses 2001;44:1-7 17. Dameria L, Bramono K. Pathogenesis of vulvovaginal candidosis. Indonesian Journal of Medical Mycology 2001;2:149-154 18. Poerwanto I, Bramono K, Budiardja SA. Isolation and species of Candida from the mouth, rectum and vagina of patients with Candidal and non-candidal fluor albus. Indonesian Journal of Medical Mycology 2002;3:14-19 19. Indrarini, Bramono K, Urip KS, Daili SF. Prevalence of Malassezia folliculitis among patients with - 15 -
acne vulgaris and acneiformis eruption at Cipto Mnagunkusumo Hospital Jakarta. Media Dermatovenereologica Indonesiana 2004;31:41-47 20. Febrianti T, Bramono K. Adjuvant therapy for pemphigus. Media Dermatovenereologica Indonesiana 2004;2:94-103 21. Legiawaty L, Sudarmi E, Bramono K. Sjaiful FD. The role of Malassezia, sp. in atopic dermatitis. Media Dermatovenereologica Indonesiana 2004;1:41-47 22. Pratiwi D, Bramono K, Wasitaatmadja SM. The role of chronic sun exposure: pathogenesis of photoaging and photocarcinogenesis. Media Dermatovenereologica Indonesiana 2005;32:31-37 23. Bramono K, Budimulja U. Epidemiology of onychomycoses in Indonesia: data obtained from three individual studies. Jpn J Med Mycol 2005;46:171-176 24. Bramono K, Yamazaki M, Tsuboi R, Ogawa H. Comparison of proteinase, lipase and alpha-glucosidase activities from the clinical isolates of Candida species. Jpn J Infect Dis 2006;59:73-76 25. Septrida QD, Widaty S, Bramono K, Pratomo US. Unusual manifestation of dermatophytosis on systemic lupus erithematous patient. Indonesian Journal of Medical Mycology 2007;7:9-11 26. Bramono K, Menaldi SL, Widaty S, Hernani Ch. The prevalence of skin diseases, risk factors for dermatomycoses and dermatophyte species isolated form cases with dermatophytoses: a survey in a rural low land area in West Java. Media Dermatovenereologica Indonesiana 2008;35:2-7 27. Krisanty RI, Bramono K, Made Wisnu I. Identification of Malassezia species from pityriasis versicolor in Indonesia and its relationship with clinical characteristics. Mycoses 2009;52:257-62 - 16 -
특별강연 3 (Special Lecture 3) Chromoblastomycosis in China Chunyang Li, M.D. Qilu Hospital Shandong University Jinan, 250012, China The first case of Chromoblastomycosis in china was reported in 1951. Almost 400 patients had been found by the end of 1999, more than 300 of them coming from Shandong province and others scattering in 14 provinces. Another 73 cases were reported from 2000 to 2011. About 86% of all patients live on agriculture. Most of them are men (the male-to-female ratio is 4:1) and at the age of 20~60 years with the youngest at 11 months and the oldest at 85 years. The causative agent mainly involved is Cladophialophora carrionii in northern china, especially in Shandong province. An investigation showed C. carrionii was isolated from wild toads in endemic area of Shandong province, while none from non-endemic area. The results suggested that wild toads might be associated with endemicity of Chromoblastomycosis. In southern china, Fonsecaea pedrosoi is once common, while in 2008, a study demonstrated that in 24 identified isolates of F. pedrosoi from symptomatic patients, 20 strains were Fonsecaea monophora by re-evaluation. So it seems that F. monophora is the predominant etiologic agent in south area. Only six cases are caused by Phialophora verrcosa in china. Most patients have a long course about 5 to 20 years with the shortest one being 1 month and the longest one lasting 50 years. Hands and arms are the most frequently infected sites (about 67.4%). Next sites involved are feet and legs (27.1%). Faces, shoulders, trunks and buttocks are involved in few cases. Squamous cell carcinoma occurs in the infected lesions of four cases with long course. Treatment includes: (1) Operation. Fifty-six cases are cured by cutting off the lesions. (2) Topical drug treatment. Fifty-nine are cured with local application of 30% glacial acetic acid. Other drugs used include 0.2 mg/ml amphotericin B, 10% potassium iodide ointment and infusion of medicinal herb. (3) Physiotherapy includes electrocautery, laser, X-rays and liquid nitrogen frozen. (4) Systemic antifungal drugs. The most common drugs are itraconazole (200~400 mg/d) and terbinafine (250~500 mg/d). Amphotericin B, 5-FC, clotrimazole, fluconazole and ketaconazole are also used in some patients.. - 17 -
CURRICULUM VITAE Dr. Chunyang Li graduated from Shandong Medical College in 1974, and she got the master's degree in 1981. From 1988 to 1991, she studied in Peking Union Medical College on medical mycology and obtained her doctor's degree in 1991. From 1974 to 1978, she worked as a resident in dermatological dept. of the affiliated hospital of Shandong Med. Univ.. In 1986, she promoted to attending physician and in 1996, obtained the professional title of chief physician and professor. In 1996, she was selected as a master tutor, and in 2002, as a doctor tutor. From 1992 to 2000, she was the director of the Dept. of Dermatology, Qilu Hospital of Shandong Univ. From 2003 to 2011 she was the chairman of Society for Dermatology, Medical Association of Shandong Province. Now, she is: - Honorary chairman of Society for Dermatology, Medical Association of Shandong Province - Committee member of Society for Dermatology and Venereology, Medical Association of China - Committee member of National Association for Microbiology, Mycological Branch - Member of International Society for Human and Animal Mycology and committee member of ISHAM branch in China - Member of EADV - Editor, Chinese J. of Dermatology, Chinese J of Mycology - 18 -
교육강연 (Educational Lecture) 교육강연 1 Jin Yu 교육강연 2 Kwang Ho Kim 교육강연 3 Sang-Oh Lee - 19 -
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교육강연 1 (Educational Lecture Mucor irregularis, a Primary Human Pathogen Jin Yu, Sibu Wang and Ruoyu Li Department of Dermatology and Venereology, Research Center for Medical Mycology Peking University First Hospital Mucor irregularis (former Rhizomucor variabilis) has been identified as an emerging human pathogen mostly isolated in Asia areas, occasionally outside of Asia recently. It can infect humans to cause primary cutaneous zygomycosis. In China, M. irregularis is the most common etiologic agent in primary cutaneous zygomycosis, which usually presents as a subacute or chronic infectious process. The patients usually have no severe underlying diseases/disorders. M. irregularis has a characteristic morphological appearance. It shows underdeveloped rhizoids which make it misclassified as a Rhizomucor species. New molecular taxonomic studies proved M. irregularis belongs to a Mucor species. Like M. irregularis, Rhizomucor regularior and R. chlamydosporus, the mesophilic species in Rhizomucor, have been reclassified to M. circinelloides and M. indicus, respectively. All the above species have been found to be related to subacute or chronic cutaneous zygomycosis in China. We have studied eleven clinical isolates of Mucor spp. from cases of chronic cutaneous zygomycosis. They were identified both by morphological and molecular methods which hase a high degree of correlation. The in vitro susceptibility of the isolates to seven antifungal agents (amphotericin B, itraconazole, terbinafine, voriconazole, fluconazole, flucytosine, micafungin) was tested; amphotericin B was the most active agent against all the species in this study. We also reviewed clinical cases of primary cutaneous zygomycosis in China and several interesting cases will be shown. - 21 -
CURRICULUM VITAE Chinese Name : Yu Jin E-mail : yujin676@gmail.com, jinyu@medmail.com.cn EDUCATION 1993 ~ 1998 Peking University, B.Sc. degree 1998 ~ 2000 Peking University, M.S. degree 2000 ~ 2003 Peking University, M.D., PhD. PROFESSIONAL EXPERIENCE 1998 ~ 2003 Resident, Department of Dermatology, Peking University First Hospital 2003 ~ 2007 Attending physician, Department of Dermatology, Peking University First Hospital, Peking University Research Center for Medical Mycology 2007 ~ now Associate Professor, Department of Dermatology, Peking University First Hospital, Peking University Research Center for Medical Mycology MAJOR INTEREST Medical Mycology, Epidemiology, Therapy and Diagnosis, Clinical Dermatology PUBLICATIONS Wang Si bu, Li Ruo yu, Yu Jin. Identification and susceptibility of Rhizomucor spp. isolated from patients with cutaneous zygomycosis in China. Med Mycol (English) 2011 Ru-Zhen Chou, Ruo-yu Li, Jin Yu. Candida albicans anti-oxidant genes expression in vivo vaginal candidasis. Chin J Derm Venereol 2010;24(11):995-998 Jin Yu, Ruoyu Li, Lujuan Gao, et al. Utility of Galactomannan Enzyme Immunoassay and (1,3)β-D-glucan assay in Invasive Fungal Infection. Natl Med J China 2010;90(6):371-374 Jin Yu, Ruoyu Li, Min Zhang, Li Liu, Zhe Wan. In vitro interaction of terbinafine with itraconazole and amphotericin B against fungi causing chromoblastomycosis in China. Medical Mycology 2008;46(7): 745-747 (English) Jin Yu, Ruoyu Li, Xiaohong Wang, Zhe Wan, Duanli Wang. Morphological Studies on Scropularioposis spp. Isolated from Patient Nails. Clin J Dermatol 2008;37(9):564-567 Jin Yu, Aiping Wang, Jianzhong Zhang, Ruoyu Li. The Efficacy and Safety of Fusidic Acid Cream in the Treatment of Bacterial Skin Infections. Clin J Dermatol 2008;37(9):615-616 Jin Yu, Min Zhang, Jianlei Wang, et al. Candida species distribution in the patients with high risk of deep fungal infections and relevant risk factors: a prospective cohort study. Natl Med J China 2007;87(42) - 22 -
Jin Yu, Min Zhang, Ruoyu Li, Weilin Xu, Hanyun Ren, Yixin Song. Fluconazole prophylactic treatment affect the drug susceptibility in vitro of Candida spp strains isolated from the patients with high risk of deep fungal infections. Chin J Lab Med 2007:30(1) Jin Yu, Shuxia Yang, Yi Zhao, Ruoyu Li. A Case of Subcutaneous Phaeohyphomycosis Caused by Chaetomium globosum and the sequences analysis of C. globosum. Medical Mycology 2006:44 (English) Jin Yu, Ruo yu Li. Primary Renal Zygomycosis Due to Rhizopus Oryzae: Report of A Case. Medical Mycology 2006:44 (English) Jin Yu, Ruoyu Li, Glenn Bulmer. Current Topics of Tinea Capitis in China. Japaneses Journal of Medical Mycology 2005:46(2) (English) Yu J, Li RY, et al. The Morphological and Molecular Biological Study of the Rare Pathogenic Chaetomium spp. Clin J Dermatol 2005:34(8) Yu J, Li RY. Fungal infection in Urinary System. Natl Med J China 2004;84:24 Yu J, Chen W, Wan Z, Li RY. Adult Tinea Capitis Due to Trichophyton violaceum in China. Mycopathologia 2004;157:49-52 (English) Yu J, Wan Z, Chen W, Li RY. Molecular typing study of the Microsporum canis strains isolated from an outbreak of tinea capitis in a school. Mycopathologia 2004;157:37-41 (English) Yu J, Li RY. The Study on Early Diagnosis of Invasive Aspergillosis by ELISA Assay and Nest PCR Method. Chinese J Lab Med 2003;26(9):543-546 Yu J, Wan Z, Li RY. Report of an Outbreak of Tinea Capitis caused by Microsporum canis. Chinese J Dermatol 2003;36(8):427-429 Yu J, Ji Z H, Li RY. Identificantion of Common Pathogenic Candida Species by PCR-RFLP Analysis. Chinese J Dermatol 2002;35(2):131-133 Yu J, Li R Y, Wang D, et al. Analysis on Species Distribution and Risk Factors of Nosocomial Invasive Candida Infection. China J Leprosy Skin Dis 2000;16(4):211-215 Yu J, Li RY, et al. Disseminated Cryptococcosis with Mollusum Contagiosum-like Lesions. China J Leprosy Skin Dis 1999;10(2):115-116 Foundations: National Natrual Science Foundation of China (No: 30600027): oxidative stress related signal factors in pathogensis of Candida albicans infection. 2007. 1~2009. 12. - 23 -
교육강연 2 (Educational Lecture Immunology of Dermatophytosis Kwang Ho Kim Department of Dermatology, College of Medicine, Hallym University Introduction Dermatophytes are hyphomycetes that can degrade keratin, so they can cause infections of the keratin-containing superficial skin, which is called 'Tinea'. The pathogenesis and course of tinea is decisively determined by pathogen-related factors and by the defense mechanisms of the host. An infection starts with an adherence of fungal propagules, followed by the formation of hyphae that can spread within the tissue. And then, keratinocytes are activated, the epidermal barrier is destroyed, epidermal proliferation is enhanced and defensins are expressed within the epidermis. In addition, innate and specific immune responses are initiated, involving neutrophilic granulocytes, macrophages, antibodies and T cells. The cellular mechanisms are thought to be crucial for healing. Dermatophytes that penetrate into the dermis can cause granulomatous inflammatory reactions and systemic immune reactions are supposed to be a trigger of so-called id reactions. Understanding the nature and function of the immune response to dermatophytes is an exciting challenge that might lead to novel approaches in the treatment and immunological prophylaxis of dermatophytosis. ** Mannoproteins and β-glucan, components of fungal wall structure, mainly cause immune response of host. - 24 -
Immunology of Dermatophytosis Immunology of Dermatophytosis should be emphasized since there is high incidence of opportunistic fungal infection in patients with defective immunity such as AIDS and transplantation patients. The currently accepted view is that a cell-mediated immune response is responsible for the control of dermatophytosis. Also, susceptibility to chronic dermatophytosis is associated with atopy and with immediate type hypersensitivity Innate Immune response Professional phagocytes, consisting of neutrophils, macrophages, and dendritic cells, have an essential role in the initiation of the specific immune response. Natural killer cells, gamma delta T cells, and nonhematopoietic cells, such as epithelial and endothelial cells, are also important for onsetting the immune response. Innate immunity is instrumental for the development of adaptive cell-mediated immune responses controlling mycotic infections or for disease progression. 1. Keratinocyte Keratinocytes participate directly in dermatophyte defense and, in addition, activate further cells via released cytokines. Keratinocytes release multiple cytokines in tinea. In addition to interferon-γ especially TNF-α, IL-1β, IL-8 and IL-16 appear to be important for the inflammatory tissue reaction. Lesional keratinocytes in tinea express defensins as antimicrobial peptides. By this peptides, the transepidermal water loss is markedly enhanced and expression of Human β Defensin-2 increased in lesional tinea as compared to normal skin. 2. Neutrophils and macrophages Phagocytosis by neutrophils is the primary mechanism that prevents the establishment of fungal infections, and is usually the most effective. However, cytotoxic activity of neutrophils was transient. To recognize and respond to a fungal pathogen, neutrophils use a number of pathogen recognition receptors, including TLRs and C-type lectin. The cytotoxic effect was mediated by oxidative intermediates derived from the respiratory burst of the phagocytic cells. 3. Complement Fungi products can activate the alternative pathway of complement without interaction with antibodies (but also, classic pathway). 4. Toll like receptors (TLRs) Toll-like receptors are a family of pattern recognition receptors that evolved to detect microbial infection. Activation of resident macrophages through TLRs also leads to production of various cytokines (IL-1, IL-6, TNF, etc.) and chemokines (KC-1, MCP-1, etc.), which collectively orchestrate the acute inflammatory response to infection. - 25 -
Adaptive immunity - Humoral Immunity Several studies have shown that humoral immunity to dermatophytes is not protective. However, antibodies are detected in infected patients and animals. The production of antibodies occasionally occurs in complications of dermatophytosis such as vasculitis and urticaria. The possibility that dermatophyte antigens serve as a non-specific adjuvant for the production of IgE antibodies, resulting in allergic disease, in predisposed individuals has been evaluated. Kaaman et al. showed a higher concentration of IgG antibodies against dermatophyte antigens, measured by ELISA, in infected individuals compared with that found in uninfected controls. High levels of specific IgE and IgG4 were detected in patients with chronic dermatophytosis. On the other hand, Ig levels are low in patients that present a positive delayed type hypersensitivity (DTH) skin test. Adaptive immunity - Cellular Immunity If the pathogen can breach early innate immunity, an adaptive immune response will ensue, with the generation of T cells and B cells. In experimental animal models, athymic (nude) rats that lack T-cell-mediated immunity, could not clear Trichophyton mentagrophytes infections compared with genetically matched euthymic control rats. In addition, using sublethally irradiated mice which were particularly susceptible to Trichophyton infection, found that regional lymph node cells from syngeneic acutely infected donors conferred protection to irradiated recipients. 1. Dentritic cells (DCs) DCs plays a key role in the induction of cell-mediated immunity to intracellular pathogens by triggering the production of IFN-γ in NK and T cells. Furthermore, DCs are uniquely adept at decoding the fungus-associated information and translating it into qualitatively different adaptive immune responses of T-cells such as Th1, Th2, Th17 and Treg cells. 2. Th17 cell Th17 cells are now thought to be a separate lineage of effector Th cells contributing to immune pathogenesis previously attributed to the Th1 lineage. CD4+ T cells cultured with TGF-β and IL-6 express the transcription factor RORγt (retinoid-related orphan receptor gamma t) and become Th17 cells that are stabilized by DC-derived IL-23. Th17 cells promote neutrophil-mediated inflammation. Also, Th17 cells regulate fungal infection by means of IDO inhibition, Th1 inhibition and Treg antagonism. 3. CD4+CD25+ Treg cells CD4+CD25+ Treg cells are crucial for controlling the magnitude and duration of immune response to microbes. Expansion of the number or the function of Treg can reduce pathological tissue destruction due to inflammation at the infection site but at the cost of increasing the load of infection and prolonging the pathogen persistence by suppressing protective immune responses. For instance, increased numbers of CD4+CD25+ Treg cells may play - 26 -
a role in failure of clearance of dermatophytes from skin by preventing the protective inflammation which is leading to development of onychomycosis. As seen in this instance, Treg seems to play a role in the maintenance of chronic infections and persistence of pathogens, consequently enabling the disease reactivation. Luigina R. Medical Mycology 2008;46:515-529 archives.focus.hms.harvard.edu Effect of systemic antifungal treatment on the immune status According to a research, Effective antimycotic treatment, in particular with terbinafine, was shown to enhance and restore cell-mediated immunity which potentially improves the therapeutic outcome even for a group of patients. Conclusion The definition of the immune mechanisms which govern distinct immune responses against dermatophytes may be pivotal in the understanding of the host determinants of protective immunity. Also, identification of major T-cell epitopes specific to fungal infection will provide an avenue for the design of new treatments. Reference 1. Kwon KS, Park HJ, Bong-Seok Jang BS, Kim MB, Oh CK, Jang HS. Immunohistochemical Study of Human β Defensin-2 Expression in Superficial Mycosis. Korean J Dermatol 2006;44:538-544 2. Almeida SR. Immunology of Dermatophytosis. Mycopathologia 2008; 166:277-283 3. Kim SS, Lee HG, Lee CJ. Cutaneous Immune Reactions to Trichophytin in Dermatophytosis. Kor J Med Mycol 2001;6:150-159 4. Kaya TI, Eskandari G, Guvenc U, Gunes G, Tursen U, et al. CD4+CD25+ Treg cells in patients with toenail onychomycosis. Arch Dermatol Res 2009;301:725-729 - 27 -
5. Schmid-Wendtner MH, Korting HC. Effective treatment for dermatophytoses of the foot: effect on restoration of depressed cell-mediated immunity. J Eur Acad Dermatol Venereol 2007;21:1013-1018 6. Swan JW, Dahl MV, Coppo PA, Hammerschmidt DE. Complement activation by Trichophyton rubrum. J Invest Dermatol 1983;80:156-158 7. Dahl MV, Carpenter R. Polymorphonuclear leukocytes, complement, and Trichophyton rubrum. J Invest Dermatol 1986;86:138-141 8. Kaaman T, von Stedingk LV, von Stedingk M, Wasserman J. ELISA-determined serological reactivity against purified trichophytin in dermatophytosis. Acta Derm Venereol 1981;61:313-317 9. Green F, Lee KW, Balish E. Chronic T. mentagrophytes dermatophytosis of guinea pig skin grafts on nude mice. J Invest Dermatol 1982;79:125-129. - 28 -
CURRICULUM VITAE NAME : Kwang-Ho Kim, M.D., Ph.D. ADDRESS : Department of Dermatology, College of Medicine, Hallym University, Hallym Univ. Sacred-Heart Hosp. 896 Pyungchon-dong, Anyang-si, Gyeonggi-do, Korea, #431-070 Phone: 82-31-380-3763 Fax : 82-31-386-3761 E-mail: dermakkh@yahoo.co.kr ACADEMIC EDUCATION 1991 ~ B.S.; College of Medicine, Hallym University, 1 Okchon-dong, Chuncheon, Gangwon-do 200-702, Korea 2001 M.S.; Department of Dermatology, College of Medicine, Hallym University, Korea 2002 Ph.D.; Department of Physiology, College of Medicine, Korea University, Korea APPOINTMENTS AND PROFESSIONAL ACTIVITIES 1991 ~ 1996 Internship & Dermatology Residency; Hangang Sacred-Heart Hosp., Department of Dermatology, College of Medicine, Hallym University, Korea 1996 ~ 1999 Obligatory Military Service, Department of Dermatology, National Defense Club, Korea 1999 ~ 2010 Clinical Instructor, Assistant Professor and Associate Professor; Hallym Univ. Sacred-Heart Hosp. Department of Dermatology, College of Medicine, Hallym University, Korea 2006 ~ 2007 Visiting Research; Irving Cancer Research center, Department of Dermatology, Columbia University Medical Center, New York 2007 ~ present Member, Korean Atopic Dermatitis Association 2009 ~ present Director, Korean Society for Medical Mycology Scientific Secretariat of the Korean Dermatopathology Association 2011 ~ present Professor; Hallym Univ. Sacred-Heart Hosp. Department of Dermatology, College of Medicine, Hallym University, Korea - 29 -
SELECTED PUBLICATION Choi WJ, Kim BC, Park EJ, Cho HJ, Kim KH, Kim KJ. Nodular colloid degeneration. Am J Dermatopathol 2011;33:388-391 Park EJ, Youn SH, Cho EB, Lee GS, Hann SK, Kim KH, Kim KJ. Xanthelasma palpebrarum treatment with a 1,450-nm-diode laser. Dermatol Surg 2011;37:791-796 Choi WJ, Youn SH, Back JH, Park S, Park EJ, Kim KJ, Park HR, Kim AL, Kim KH. The role of KLF4 in UVB-induced murine skin tumor development and its correlation with cyclin D1, p53, and p21 (Waf1/Cip1) in epithelial tumors of the human skin. Arch Dermatol Res 2011;303:191-200 Youn SH, Kwon IH, Park EJ, Kim KH, Kim KJ. A Two-week Interval Is Better Than a Three-week Interval for Reducing the Recurrence Rate of Hand-foot Viral Warts after Cryotherapy: A Retrospective Review of 560 Hand-foot Viral Warts Patients. Ann Dermatol 2011;23:53-60 Kim KH, Back JH, Zhu Y, Arbesman J, Athar M, Kopelovich L, Kim AL, Bickers DR. Resveratrol targets transforming growth factor-β2 signaling to block UV-induced tumor progression. J Invest Dermatol 2011;131:195-202 Park SBM, Lee YW, Park EJ, Kwon IH, Kim KH, Kim KJ. A Case of Tinea Faciei Caused by Trichophyton mentagrophytes with Atypical Presentation. Kor J Med Mycol 2010;15:170-174 Park JH, Yoo CS, Kil MS, Kim CW, Kim SS, Kim KH. A Case of Chronic Mucocutaneous Candidiasis Occurring in a Patient with Scrofuloderma-like BCGitis. Kor J Med Mycol 2010;15:175-181 Youn SH, Lee YW, Seung NR, Park EJ, Cho HJ, Kim KH, Kim KJ. Rapidly progressing malignant melanoma influenced by pregnancy. Int J Dermatol 2010;49:1318-1320 - 30 -
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연자소개 성 명 : 이상오 1994년 2월 한양대학교의과대학졸업 1995년 2월 서울아산병원인턴수료 1999년 2월 서울아산병원내과전공의수료 2002년 5월 ~ 2003년 2월 서울아산병원감염내과임상강사 2003년 3월 ~ 2004년 8월 가천의과대학교길병원감염내과조교수 2004년 9월 ~ 2007년 2월 경희대학교의과대학감염내과조교수 2007년 3월 ~ 현재 울산대학교의과대학감염내과부교수 2010년 3월 ~ 2011년 6월 Mayo Clinic, Visiting Scientist - 53 -
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수혜자보고 (Beneficiary Report) 수혜자보고 1 Soyun Cho 수혜자보고 2 Mi-Woo Lee - 55 -
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수혜자보고 1 (Beneficiary Report Histopathologic Findings of Tinea Corporis Soyun Cho, MD, PhD Department of Dermatology, Seoul National University College of Medicine Dermatophytosis is not always easy to diagnose because KOH and culture results are not always positive and clinical lesions may mimic various other dermatoses. Histopathologic findings of 16 cases of dermatophytosis other than tinea pedis or onychomycosis, whose diagnosis was confirmed through PAS stain, were analyzed retrospectively for histologic 'clues' to the diagnosis. Patients' ages ranged from 7 to 63 years (mean, 37.9), and male-to-female ratio was 1:1.7 (6 males and 10 females). Most common initial clinical impression was contact dermatitis, followed by atopic dermatitis, seborrheic dermatitis, herpes simplex infection, subcorneal pustular dermatosis, psoriasis, granuloma annulare, folliculitis and Hailey-Hailey disease. In 3 cases (19%) skin lesions appeared after trauma, and in 2 cases (13%) contact with animals was noted before lesion development. Among 7 cases where fungal culture was concurrently ordered, Trichophyton rubrum was cultured in 3 cases. Among the skin samples, the most frequent histopathologic finding was variable host inflammatory response, occurring in 100% of the samples, followed by basket weave keratin layer or parakeratosis (69% each), neutrophils in stratum malpighii (56%), spongiotic changes (44%), papillary dermal edema (38%), neutrophils in stratum corneum, compact orthokeratosis, sandwich sign, and hemorrhage (25% each), interface and/or lichenoid changes, subcorneal pustules, folliculitis and/or folliculocentric inflammation, dermal fibrosis (19% each), and psoriasiform changes (13%). Folliculocentric inflammation was seen exclusively in facial lesions. In many cases, fungal hyphae were only scarcely present. In 2 facial lesions, PAS-(+) hyphae were seen only in hair follicles. This case series study demonstrates that dermatophytosis should be strongly considered in the differential diagnosis of lesions with nonspecific upper dermal inflammation, neutrophils in the epidermis, and papillary dermal edema. - 57 -
CURRICULUM VITAE PERSONAL INFORMATION Name : Soyun Cho Birthday : Aug. 28, 1968 Nationality : South Korea Current position : Associate Professor Organization : Seoul National University College of Medicine Address : Department of Dermatology, 41 Boramae-gil, Dongjak-gu, Seoul, 156-707 Korea Education 1987 ~ 1993 Ewha Womans University College of Medicine, Seoul, Korea (M.D.) 1995 ~ 1997 Ewha Womans University College of Medicine, Seoul, Korea (M.S.) 1997 ~ 2000 Ewha Womans University College of Medicine, Seoul, Korea (Ph.D.) Post-graduate training 1993 ~ 1994 Rotating internship, Ewha Womans University Medical Center, Seoul, Korea 1994 ~ 1998 Dermatology residency, Ewha Womans University Medical Center, Seoul, Korea Teaching appointment & Experiences 1998 ~ 2000 Fellow, Dermatology, Ewha Womans University Dongdaemun Hospital, Seoul, Korea 2000 ~ 2001 Fellow, Dermatology, Asan Medical Center, University of Ulsan, Seoul, Korea 2001 ~ 2002 Clinical research fellow, Dept. of Dermatology, University of Michigan, MI, USA 2002 ~ 2003 Lecturer, Dept. of Dermatology, University of Michigan, MI, USA 2003 ~2005 Assistant Professor, Department of Dermatology, Inje University Seoul Paik Hospital 2005 ~ 2009 Assistant Professor, Department of Dermatology, Seoul National University College of Medicine, Head of Dermatology, Boramae Hospital 2009 ~ present Associate Professor, Department of Dermatology, Seoul National University College of Medicine, Head of Dermatology, Boramae Hospital Major Interest Skin aging & photoaging, matrix biology, retinoids, mycology, acne, dermatopathology - 58 -
수혜자보고 2 (Beneficiary Report Clinical Analysis of Deep Cutaneous Mycoses: A 12-year Experience at a Single Institution in Korea Mi-Woo Lee and Myoung-Shin Kim Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea Deep cutaneous mycoses may cause significant morbidity and mortality, especially in immunocompromised host. There were only a small number of studies focusing on deep cutaneous mycoses and no data exist from Asian countries. This study aimed to investigate clinical characteristics, underlying predisposing factors, etiologic organisms and outcomes of our patients with deep cutaneous mycoses. A retrospective medical record review was conducted of the patients with deep cutaneous mycoses treated at our institution from 1998 to 2010. Fungal organisms were confirmed both culture and histopathology of skin specimen. 41 cases of deep cutaneous mycoses were identified. Most of patients (32/41) had underlying immunosuppressive medical conditions, and seven of the other nine patients had obvious physical trauma history. Nodular skin lesions were most frequently found (19/41) and the morphology of the lesion was varied. Candida (16/41) was the most common organism, followed by Aspergillus, Alternaria, Fusarium (4/41, respectively) and others. Dermatologists should be familiar with the clinical appearance of skin lesions of deep cutaneous mycoses, which may be lethal with delayed treatment. Because of lack of specific diagnostic tool and highly polymorphous appearance, suspicion and early skin biopsy are the most important steps for prompt diagnosis and treatment. - 59 -
CURRICULUM VITAE Mi Woo Lee, MD Associate Professor, Department of Dermatology Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea EDUCATION 1989 Seoul National University, School of Medicine, Seoul, Korea (M.D.) 1994. 2 Seoul National University, School of Medicine, Seoul, Korea (M.S.) 2000. 2 College of Medicine University of Ulsan, Seoul, Korea (PhD.) EXPERIENCE 1990 ~ 1994 Resident in Dermatology, Asan Medical Center, Seoul 1994 ~ 1998 Private Clinic 1998 ~ 2000 Fellow in Dermatology, Asan Medical Center, Seoul 2000 ~ 2001 Post-doctor scholarship in Dermatopathology, University of California, San Francisco 2001 ~ 2002 Fellow in Dermatology, Asan Medical Center, Seoul 2004 ~ 2005 Researcher in Dermatology, University of California, Los Angeles 2002 ~ 2006 Assistant Professor, Department of Dermatology, Asan Medical Center, College of Medicine University of Ulsan, Seoul 2006 ~ Associate Professor, Department of Dermatology, Asan Medical Center, College of Medicine University of Ulsan, Seoul - 60 -
구연연제초록 (Free Communication) [FC-1 ~ FC-7] - 61 -
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FC-1 Comparison of Therapeutic Efficacy on Various Clinical Type of Distal Lateral Subungual Onychomycosis 가톨릭대학교의과대학성모병원피부과학교실 방철환 이영복 박현정 조백기 Background Onychomycosis is a common fungal infection accounting for 50% of all nail disorders. Above all the clinical type of onychomycosis, distal lateral subungual onychomycosis (DLSO) is the most common clinical type seen up to 70~90% in onychomycosis patients. In our clinical experience, the cure rate and recurrence rate of DLSO are different according to the clinical type of DLSO. Objectives It is hypothesized that lateral DLSO is more difficult to cure than other type of DLSO. Methods To investigate the difference of the cure rate, we reviewed 81 DLSO cases who visited our clinic from 2006. 6. 1 to 2010. 6. 31, and classified them into 4 groups; edge type, distal type, lateral type and linear type. We treated the patients with PO antifungal agent for 4 months, and followed them up in 2 months. Scoring clinical index for onychomycosis (SCIO) was checked and photography was taken before treatment and after treatment. Results 1. There are no significant differences in average age and male to female ratio between lateral DLSO and non-lateral DLSO. 2. The history of recurrence Lateral DLSO is higher than that of non-lateral DLSO. However, there are no significant static differences. 3. The comparison of SCIO score distribution before treatment between lateral DLSO and non-lateral DLSO, there was no significant statistic difference. However, there was significant change in SCIO score distribution after the treatment. 4. SCIO change in lateral DLSO was 6.99, while non-lateral DLSO was 11.1. (p=0.018) 5. There was 2cases of worsen case in lateral DLSO, while there was no worsen case in non-lateral DLSO. (p=0.019) Conclusion Lateral DLSO is more difficult treat than non-lateral DLSO. SCIO score is reliable index to use in clinical study of onychomycosis. - 63 -
FC-2 Diagnosis of Onychomycosis : Is it Possible to Establish the Diagnosis of Onychomycosis with Clinical Characteristics? 성균관대학교의과대학삼성서울병원 박지혜 정미영 이동윤 Onychomycosis is the most general nail disease and one of the most prevalent problems for visiting dermatologic outpatient clinic. It is caused by dermatophytes, yeasts and nondermatophytic molds, and among these fungi, Trichophyton rubrum is known as the most common pathogen of onychomycosis. As the increasing elderly population, the prevalence of onychomycosis has increased. Also, if onychomycosis is left untreated for a long time, it can be a source of other infections such as cellulitis. Thus, it is very important to make an accurate diagnosis as soon as possible for starting proper treatments. For diagnosis of onychomycosis, laboratory tests are used such as direct smear examination, fungus culture and histopathology by PAS (Periodic acid-schiff) staining. But, there is no gold standard. The most commonly used standard is a combination of laboratory tests. However, the laboratory tests are time-consuming and pricey. Accordingly it can takes time for diagnosis and make delay for treatment. The purpose of this study is to identify the value of clinical diagnosis for onychomycosis. In order to clarify the possible role of clinical diagnosis, we reviewed 114 patients with toenail abnormalities retrospectively. We confirmed the presence of fungi on culture or a positive PAS staining of nail plate. All patients were investigated for clinical characteristics such as an area of involved nail plate, the presence of tinea pedis, the involvement of finger nails, color of involved nail plate, the pattern of nail dystrophy, number of affected nails and histopathological pattern of PAS staining. - 64 -
FC-3 한가족내에서애완고양이로부터발생한것으로추정되는농창상 M. canis 감염증 계명대학교의과대학피부과학교실 윤상돈 류한원 조재위 이규석 Microsporum canis는두부백선의가장흔한원인균으로, 드물게안면백선, 체부백선을일으키기도하며. 주된감염원은애완용고양이로알려져있다. 일반적으로 M. canis에의한두부백선은회색의인설반또는염증성의융합성모낭염병변으로나타나는반면체부백선은경계가명확하고홍반성의인설성구진의형태로나타나며, 그크기가비교적일정하며다발성으로발생하는특징이있어서로구분된다. 본증례는가피로덮인홍반성구진과반이안면및체간에발생하여내원한환자로처음에는농가진과같은세균감염을의심하였으나, 체간의인설성병변에서시행한 KOH 검사에서균사를확인하였고, 진균배양을시행하여 M. canis에의한체부백선을진단하였다. 또한함께거주하는딸에서이와유사한경계가명확한홍반성인설성구진이발생하여진균학적검사를통해 M. canis에의한체부백선을진단하였다. 본증례는한가족내에서발생한애완용으로키우던고양이로부터감염된것으로추정되는농창상 M. canis 감염증으로그임상양상에있어교육적인증례라생각하여보고하는바이다. - 65 -
FC-4 Paecilomyces lilacinus 에의한국소피부감염증 전북대학교의학전문대학원피부과학교실 조용선 황수란 송기훈 이종선 박 진 윤석권 김한욱 Paecilomyces lilacinus는토양에존재하는부패균 (saprophyte) 으로인체감염은드물지만면역능력이감소할경우감염을일으킬수있으며, 또한특별한유발요인없이정상인에서도감염을일으킬수있다. 본균에의한피부감염증은국내피부과문헌및대한의진균학회지검색상현재까지 3예만이보고되어있다. 81세남자환자가내원 3개월전부터발생한왼쪽손등의인설이있는붉은판과농포를주소로내원하였다. 과거력상환자는면역능력의감소를일으킬만한위험인자는없었다. 피부병변에서시행한 KOH 검사상균을발견할수는없었으나, 병리조직학적검사에서는 H&E 염색에서만성육아종소견이관찰되었고, PAS 염색에서균요소가관찰되었다. 병변의생검조직일부를 Sabouraud 배지에접종하여배양을시행하였는데배양 15일째에는흰색의가장자리를가지며중심부가연분홍색인균집락이관찰되었으며, 계대배양시비슷한소견을보였다. 본집락에서시행한슬라이드배양표본의 Lactophenol-cotton blue 염색에서는 Paecilomyces 속 (genus) 에합당하는소견을보였으며, DNA 염기서열결정 (sequencing) 검사결과 Paecilomyces lilacinus로동정되었다. 경구 itraconazole을 1일 200 mg 2주간투여하여피부병변은일부호전되었으나, 이후환자가내원하지않아추적관찰은중단되었다. 저자들은 81세남자환자에서발생한 Paecilomyces lilacinus에의한국소피부감염증을겸험하고이를보고한다. - 66 -
FC-5 Chaetomium globosum 에의한손발톱진균증 동국대학교의과대학피부과학교실, 진단검사의학교실 1 서무규 김동민 이명훈 하경임 1 Chaetomium(C.) 균종은토양과나무부스러기에존재하는부패성자낭균류 (ascomycetes) 인흑색진균으로, 인체감염은 C. globosum, C. atrobrunneum, C. strumarium, C. perlucidum, C. funicolum 과연관되어있다. 이균종은주로면역결핍환자에서피하흑색진균증 (phaeohyphomycosis) 및전신감염을일으키는것으로보고되었으며, 건강인에서는손발톱진균증을일으킨다. 현재까지 C. globosum에의한손발톱진균증의보고는 5예정도로드물다. 환자는 35세남자로약 2년전부터우측첫번째, 다섯번째, 및좌측첫번째, 네번째발톱끝이황갈색으로변색되었고, 발톱밑과각화증이동반되었다. 과거력및가족력상특이사항은없었고, 이학적소견은발톱소견이외전신상태는비교적양호하였다. 검사실소견은모두정상범위내지음성소견을보였으며, 병변부발톱 KOH 검사에서소수의분절된균사를보였고, 2개의사부로사면배지에접종하여 25 에서 1주간배양한결과빠르게성장하며, 처음에는흰색융모를띄다가회갈색으로변하고, 배지의뒷면은오렌지갈색의착색을보이는다수의동일한균집락이관찰되었다. 평판배지에계대배양하였을때도동일한소견을보이고, 반복배양시에도모두동일한결과를보였다. Lactophenol cotton blue로염색하여시행한현미경관찰상갈색의분절된균사, 피자기 (perithecia) 및자낭포자 (ascospores) 가보였고, 피자기는크고, 흑갈색의플라스크형태를보이며, 표면에는머리카락같이분지되지않은실들이붙어있었다. 또한피자기는열려있는구멍 (ostioles) 을지니고, 내부에는자낭 (asci) 과자낭포자를지니고있었으며, 자낭포자는갈색의레몬모양의단세포형태를보였다. 균집락으로부터 DNA를분리하여진균핵내의 ITS 부위의염기서열을얻은후 C. globosum strain ATCC 6205의 ITS 부위의염기서열과비교한결과 100% 일치하였다. 이상의 KOH 소견, 진균배양, 광학현미경소견, 그리고 ITS 부위의염기서열분석으로 C. globosum으로동정하였다. 치료로는 3개월간 terbinafine 1일 250 mg 경구투여와 amorolfine 5% nail lacquer를도포하였다. - 67 -