臺灣博碩士論文加值系統

黴菌性角膜炎在眼科臨床上是很重要問題，特別在熱帶、亞熱帶從事農作物之工人容易發生，很多研究已證實環境中黴菌和角膜炎有相關。1997年3至4月間有五位洋蔥採收工人因黴菌感染而致角膜潰瘍至高雄醫學院附設中和紀念醫院治療，引起我們探討其危險因子的興趣。本研究培養基選用Sabouraud Dextrose Agar ( 加或不加40mg/l chloramphenicol)和Malt Extract Agar；自1997年12月至1998年4月間，選取南部地區洋蔥種植區之檢體共收集529件檢體，包括空氣277件、土壤52件、蔥葉100件、蔥皮100件，檢驗黴菌存活情形。此外，我們針對種植洋蔥之地區民眾，以分層抽樣法進行問卷訪視，600位受訪對象中，洋蔥工人（括兼職）共104人。本次研究依黴菌之孢子及菌絲形態共檢出17種菌屬，括Acremonium, Alternaria, Aspergillus, Candida, Cladosporium, Curvalaria, Fusarium, Monilia, Mycerium, Papularia, Penicillium, Pythrium, Rhizoctonia, Rhizopus, Stemphylium, Trichoderma, Yeast。在這些菌屬中空氣中檢體以Cladosporium最多、土壤及洋蔥皮則為Aspergillus、而蔥葉中以Alterania居多。黴菌平均濃度：空氣中幾何平均濃度為144~2,683 CFU/m3(對照組為50~758 CFU/ m3)、土壤中2,675~15,600 CFU/g、蔥葉500~1,188 CFU/g及蔥皮2,433~3,917 CFU/g。本次研究發現大部份空氣、土壤、蔥葉、蔥皮黴菌濃度在洋蔥採收中大於採收前，且非落山風區大於落山風區。問卷部份：用邏輯迴歸模式，我們發現從事洋蔥工作者（包括兼職）、住家與蔥田在一公里以內之民眾及年齡愈高者其眼部疾病危險性較高。由於眼部疾病在南臺灣洋蔥採收工人之盛行；因此，我們認為應教育他們注意眼睛保護、加強醫療照顧和避免眼部創傷是非常重要的。

Mycotic keratitis is an important ophthalmologic problem, especially for agricultural workers in the tropics and subtropics. A close relationship has been demonstrated between fungi in the environment and that causing mycotic keratitis. Between March and April 1997, 5 patients (onion harvesters) with corneal ulceration of mycotic infection were treated at Department of Ophthalmology of Kaohsiung Medical College Hospital. The further investigation of risk factors of these injuries. We studied the fungal flora of air-borne, soil, onion leaf, and skin from December 1997 to April 1998 in Southern Taiwan, the onion raised area. A total of 277 samples of air-borne, 55 samples of soil, 100 samples of onion leaf and 100 samples of onion skin from different localities were examined for the distribution of fungi. Samples were inoculated in Sabourand dextrose agar with and without 40mg/l chloramphenicol or Malt Extract Agar. 17 major fungal genera were found in onion area, these genera were Acremonium, Alternaria, Aspergillus, Candida, Cladosporium, Curvalaria, Fusarium, Monilia, Mycerium, Papularia, Penicillium, Pythrium, Rhizoctonia, Rhizopus, Stemphylium, Trichoderma, Yeast。Cladosporin were the most frequently isolated in the air-borne followed by Aspergillus. Aspergillus was the most commonly isolated fungi organism in the soil and onion skin, the next common fungi organism seen were Cladosporium and Fusarium. However, Alterania and Cladosporium were the most frequently isolated in the onion leaf, followed by Aspergillus, Myceria, and Fusarium. The geometric mean concentrations of onion area include air-borne 144~2,683 CFU/m3 ( control 50~758 CFU/ m3), soil 2,675~15,600 CFU/g, onion leaf 500~1,88 CFU/g, and onion skin 2,433~3,917 CFU/g. We found the most fungi's concentration is higher during harvest period than before, also found higher in non-Monsoon area than Monsoon area. In questionnaire, eye disease in the one kilometer down was significantly higher than two kilometer up. Onion harvesters, including part time onion harvesters, is the most commonly associated eyes disease. Due to the prevalence of eye diseases in the onion harvesters southern Taiwan, we consider that education them to notice eye protection, hygiene education, and improving medical care to reduce the occurrence of eye diseases and avoid ocular trauma are very important.

目 錄
摘 要
英文摘要
壹、前 言 ----------------------------------------------- ---( 1 )
貳、文獻探討 -----------------------------------------------( 3 )
一、洋蔥 ------------------------------------------------( 3 )
二、地理位置及氣候 ----------------------------------------( 3 )
三、黴菌的一般特性 ----------------------------------------( 4 )
四、黴菌性角膜炎 --------------------------------------( 5 )
參、材料方法與結果 -------------------------------------( 8 )
第一部份 作業環境測定 -------------------------------( 8 )
一、研究對象 -------------------------------------------( 8 )
二、採樣時間 ------------------------------------------( 8 )
三、採樣儀器 ------------------------------------------( 8 )
四、培養基泡製 -----------------------------------------( 8 )
五、採樣策略 ----------------------------------------( 9 )
六、實驗步驟 ----------------------------------------( 9 )
七、結 果 ----------------------------------------------(10)
(一)、空氣檢體---------------------------------------------(11)
(二)、土壤檢體---------------------------------------------(16)
(三)、蔥葉檢體---------------------------------------------(18)
(四)、蔥皮檢體---------------------------------------------(19)
(五)、黴菌濃度與氣象資料------------------------------(20)
(六)、環境測定之氣象資料------------------------------(20)
第二部份 問卷調查--------------------------------------(21)
一、研究對象 --------------------------------------------(21)
二、抽樣原理 -------------------------------------------(21)
三、研究族群選取--------------------------------------(22)
四、問卷設計 -------------------------------------------(23)
五、資料收集方法 ------------------------------------(24)
六、資料處理與分析-----------------------------------(24)
七、結果 ----------------------------------------------(24)
(一)、樣本之基本資料 -----------------------------------(24)
(二)、85~87年罹病資料 -----------------------------------(25)
(三)、受訪者住家距離遠近與眼部疾病分析--------------(25)
(四)、從事農業及洋蔥作業人員與眼部疾病分析--------(25)
(五)、從事非農業工作及洋蔥作業人員與眼部疾病分析--------(26)
(六)、受訪者在農忙期從事不同程度洋蔥相關工作在之每日
平均工作時數---------------------------------------------------------(26)
(七)、從事洋蔥相關工作不同職業別人在農忙期之每日平
均工作時數------------------------------------------------------------(26)
(八)、眼睛疾病依年齡分層情形--------------------------------------(27)
(九)、造成眼部疾病之相關因子的邏輯迴歸模式------------------(27)
(十)、角膜炎個案之基本資料 ----------------------------------------(27)
(十一)、從事洋蔥相關工作者在農作時出現眼睛發癢或不舒
與其他變項之相關情形---------------------------------------------(28)
(十二)、從事洋蔥相關工作於洋蔥作業時對眼部行為-----------(28)
(十三)、從事洋蔥相關工作者眼睛防護認知及使用情形-------(28)
(十四)、收到防護眼鏡使用情形--------------------------------------(28)
肆、討論 ---------------------------------------------------(30)
(一)、黴菌菌落型態-------------------------------------------(30)
(二)、黴菌生長條件-------------------------------------------(30)
(三)、黴菌存在環境情形-------------------------------------(30)
(四)、黴菌在空氣、土壤、蔥皮、蔥葉分布情形-------(31)
(五)、微生物性角膜炎在流行病學設計、評估----------(32)
(六)、眼部疾病情形-------------------------------------------(32)
(七)、眼部疾病與性別之間關係----------------------------(33)
(八)、蔥田距離與眼部疾病----------------------------------(33)
(九)、從事洋蔥相關工作與眼部疾病關係----------------(34)
(十)、眼部疾病與眼藥水-------------------------------------(34)
(十一)、眼部疾病與白內障----------------------------------(35)
(十二)、角膜炎個案情形-------------------------------------(35)
(十三)、洋蔥地區衛生教育宣導方面----------------------(35)
伍、結論與建議 --------------------------------------------(37)
陸、研究限制 ------------------------------------------------(39)
柒、參考文獻 ------------------------------------------------(40)
捌、表及圖 --------------------------------------------------(44)
附錄

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