臺灣博碩士論文加值系統

皮膚淺部真菌感染是常見感染在人類皮膚外層、毛髮和指甲，並造成全球病例不
斷增加，主要引起淺部真菌感染是癬菌，酵母菌和黴菌。從 91 位病人裡有 29
位病人有分離出真菌，總共分離出 13 種真菌，2 種皮膚癬菌、2 種黴菌和 9 種酵母菌其中有 1 種是新發現，在同一個樣品中酵母菌和有黴菌和癬菌長在同個培養皿上是最常見的，臨床上最常看到香港腳和灰指甲是最常感染的病灶，同時分離出酵母菌最常見的屬是Candida和Trichosporon ，皮膚癬菌最常分離出則是
Trichophyton rubrum 。 Exophiala oligosperma 為台灣第一次發現的紀錄。

Superficial fungal infections of the outer layer of skin, hair, and nail are common worldwide and their frequency is constantly increasing. The main groups of fungi causing superficial fungal infections are dermatophytes, yeasts and moulds. Fungi were isolated from 29 of 91 patients visiting the hospital. 13 species were identified, namely 2 dermatophytes, 2 moulds, 9 yeasts. Simultaneous isolation of a yeast and a hyphal fungus from the same sample was common. The most common yeasts belonged to Candida and Trichosporon. The most frequent clinical forms of infections were tinea pedis and onychomycosis, caused mainly by the dermatophyte Trichophyton rubrum. Exophiala oligosperma was recorded for Taiwan for the first time.

中文摘要 i
英文摘要 ii
目錄 iii
圖目錄 v
表目錄 vii
List of abbreviations viii
1 Introduction 1
1-1 Dermatophytes 1
1-2 Yeasts 2
1-3 Moulds 2
1-4 Aims 2
2 Materials and Methods 3
2-1 Sample collection 3
2-2 Sample collection and isolation of strains 3
2-3 Media 3
2-4 Keratin azure agar 3
2-5 DNA isolation 4
2-6 Tissue dissociation 4
2-7 Lysis 4
2-8 DNA binding 5
2-9 Wash 5
2-10 DNA elution 5
2-11 PCR 6
2-12 Agarose gel electrophoresis 7
2-13 Purification of PCR products 7
2-14 Processing PCR Amplifications 7
2-15 Binding DNA 7
2-16 Washing 8
2-17 Elution 8
2-18 DNA sequencing 8
2-19 Molecular identification 9
2-20 Morphological identification 9
3 Results 10
3-1 Result analysis 10
3-2 Description of species 11
3-2-1 Apiotrichum montevideense 11
3-2-2 Cutaneotrichosporon jirovecii 12
3-2-3 Cutaneotrichosporon debeurmannianum 13
3-2-4 Cutaneotrichosporon dermatis 14
3-2-5 Candida haemulonis 15
3-2-6 Candida parapsilosis 16
3-2-7 Debaryomyces hansenii 17
3-2-8 Exophiala oligosperma 18
3-2-9 Kodamaea ohmeri 20
3-2-10 Pyrenochaeta unguis-hominis 21
3-2-11 Trichophyton interdigitale 22
3-2-12 Trichophyton rubrum 23
3-2-13 Trichosporon faecale 24
4 Disscussion 25
4-1 Overall isolation frequency 25
4-2 Dermatophytes 25
4-3 Yeasts 25
4-4 Moulds 26
4-5 Mixed infections 26
4-6 Medical treatment 27
5 References 28
6 Appendixes 54
6-1 Appendix 1 54
6-2 Appendix 2 63
6-3 Appendix 3 64
6-4 Appendix 4 72

Ashford, B. 1928.Certain conditions of the gastrointestinal tract in Puerto Rico and
their relation to tropical sprue. Am. J. Trop. Med. Hyg.8:507-538.
Budak A, Bogusz B, Tokarczyk M, Trojanowska D. 2013. Dermatophytes isolated
from superficial fungal infections in Krakow. Poland, between 1995 and
2010.Mycoses. 56, 422-428
Cendejas-Bueno E, Kolecka A, et al. 2012. Reclassification of the Candida
haemulonii complex as Candida haemulonii (C. haemulonii group I), C.
duobushaemulonii sp. nov. (C. haemulonii group II), and C. haemuloniivar. vulnera
var. nov.: three multiresistant human pathogenic yeasts. J Clin
Microbiol.50(11):3641-51
Chi C-C, Wang S-H, Chou M-C. 2005. The causative pathogens of onychomycosis
in southern Taiwan. Mycoses 48, 413-420
Colombo A-L, Chaves G-H. 2011. Current Knowledge of Trichosporon spp. And
Trichosporonosis.Clinicial Microbiology Reviews, 24(4):682-700
Dynowska M, Biedunkiewiczl A, et al. 2013. Fungi of the genus Trichosporon
isolated from the skin in hospitalized patients.ActaMycologica48 (2): 147–153
DeHoog GS, Guarro J, Gene J, Figueras MJ. 2000. Atlas of Clinical Fungi.
Utrecht/Reus: Centraalbureau voor Schimmelcultures ⁄ Universitat Rovira i Virgili
Gonzalez DZ, et al. 2013. Opportunistic yeast infections: candidiasis, cryptococcosis,
trichosporonosis and geotrichosis. Journal of the German Society of Dermatology.
11(5): 381-393
González-Avila M, Gómez-Gómez JV, Texis AP, et al. 2011. Uncommon Fungi
Isolated from Diabetic Patients Toenails With or Without Visible Onychomycoses.
Mycopathologia. 172(3):207-213
29 
 
Gardes, M. &Bruns, T.D. 1993.ITS primers with enhanced specifity for
Basidiomycetes: application to identification of mycorrhizae and rusts. Mol. Ecol., 2:
113–118
Glass NL &Donaldson GC. 1995.Development of primer sets designed for use with
the PCR to amplify conserved genes from filamentous ascomycetes.Appl Environ
Microbiol.61(4): 1323–1330
Hayette M-P, Rosalie S. 2015. Dermatophytosis, Trends in Epidemiology and
Diagnostic Approach. 9(3): 164-179
Hwang SM, Suh MK, Ha GY. 2012. Onychomycosis Due to Nondermatophytic
Molds. 24(2): 175–180
Hanhner D, Kirschner R, et al. 2008.First Isolation of the Anamorphic
Basidiomycetous Yeast Trichosporonfaecale in Germany, from the Skin of a Patient
with Tinea pedis. Mycopathologia.165(3):149-153
Huang CM, Wang Y, et al. 2014. Staphylococcus epidermidis in the human skin
microbiome mediates fermentation to inhibit the growth of Propionibacterium acnes:
implications of probiotics in acne vulgaris. Appl Microbiol Biotechnol. 98(1):411-24
Hou X, Xiao M, et al. 2016. Identification and Antifungal Susceptibility Profiles of
Candida haemulonii Species Complex Clinical Isolates from a Multicenter Study in
China. J Clin Microbiol. 54(11):2676-2680
Ilkit M, Durdu M. 2014. Tinea pedis: The etiology and global epidemiology of a
common fungal infection. Crit Rev Microbiol. 41(3): 314-388
Inácio CP, Rocha AP, et al. 2016. Experimental white piedra: a robust approach to
ultrastructural analysis, scanning electron microscopy and etiological discoveries.
ExpDermatol 25(1):79-81
30 
 
Irinyi L, Serena C, et.al. 2015.
International Society of Human and Animal Mycology (ISHAM)-ITS reference DNA
barcodingdatabase--the quality controlled standard tool for routine identification of hu
man and animalpathogenic fungi. Med Mycol. 53(4):313-37
Kurtzman, C.P. & Robnett, C.J. 1997. Identification of clinically important
ascomycetous yeasts based on nucleotide divergencein the 5'end of the large-subunit
(26S) ribosomal DNA gene. J. of Clin.Microbiol.,35(5): 1216–1223
Kim MN, Shin JH, et al. 2009. Candida haemulonii and closely related species at 5
university hospitals in Korea: identification, antifungal susceptibility, and clinical
features. Clin Infect Dis. 48(6):e57-61
Mariné M, Brown NA, Riaño-Pachón DM, Goldman GH. 2015. On and Under the
Skin: Emerging Basidiomycetous Yeast Infections Caused by Trichosporon Species.
PLoS Pathog. 11(7): e1004982
Mahreen A. 2010. Epidemiology of superficial fungal infections. Clinics in
Dermatology. 28, 197-201
Ruan S-Y, Chien J-Y, Hsueh P-R. 2009. Invasive Trichosporonosis Caused by
Trichosporonasahiiand Other Unusual Trichosporon Species at a Medical Center in
Taiwan. Clinicial Infectious Disease. 49(1): e11-e17
Scott.JA, Untereiner.WA. 2004. Determination of keratin degradation by fungi
using keratin azure. Med Mycol. 42:239−46
Souza AC, Ferreira RC, et al. 2012.Accurate identification of Candida parapsilosis
(sensulato) by use of mitochondrial DNA and real-time PCR.J Clin
Microbiol. 50(7):2310-4.
Suh SO, Houseknecht JL, et al. 2015.Characterization of the medically important
yeast Trichosporon mucoides and its close sister Trichosporon dermatis by traditional
31 
 
and advanced technologies.J Med Microbiol.64(10):1135-43
Tasi M-S, Yang Y-L, Wang A-H, Wang L-S, et al.2012.Susceptibilities to
Amphotericin B, Fluconazole and Voriconazole of Trichosporon Clinical Isolates.
Mycopathologia. 174(2):121-30
TostiA, Piraccini BM, Lorenzi S. 2000. Onychomycosis caused by
nondermatophytic molds: Clinical features and response to treatment of 59 cases.J Am
Acad Dermatol. 42(2 Pt 1):217-24
Welsh O, Welsh E, Ocampo-Candiani J, Gomez M, Vera-Cabrera V. 2006.
Dermatophytoeses in Monterrey, Mexico.Mycoses. 49, 119-123
Wang S-H, Chi C-C. 2005. Onychomycosis in Taiwan.Int J ClinPract. 59(8):
906-911.
Weiß, M., Yang, Z.L.& Oberwinkler, F. 1998. Molecular phylogenetic studies in the
genus Amanita. Can. J. Bot. 76: 1170–1179
White, T.J., Bruns, T.D., Lee, S. & Taylor, J. 1990.Amplification and direct
sequencing of fungal ribosomal RNA genes for phylogenetics. In: Innis, M. A.,
Gelfand, D. H., Sninsky, J. J. & White, T. J. eds. PCR protocols, a guide to methods
and applications. San Diego, California: Academic Press. 315–322
Weitzman I, Summerbell RC. 1995. The Dermatophytes. Clinicial Microbiology
Reviews 240-259
Wong B, Kiehn TE, et al. 1982. Bone infection caused by Debaryomyces hansenii in
a normal host: a case report. J Clin Microbiol. 16(3):545-8
Wen YM, Rajendran RK, et al. 2016. Onychomycosis Associated with Exophiala
oligosperma in Taiwan. Mycopathologia. 181(1-2):83-8
Yehia MA, El-Ammawi TS, et al. 2010.The Spectrum of Fungal Infections with a
Special Reference to Dermatophytose in the Capital Ares of Kuwait During
2000-2005: A Retrospective Analysis. Mycopathologia. 169: 241-246
32 
 
Zaias N, Escovar S.X., Rebell G. 2014. Opportunistic toenail onychomycosis. The
fungal colonization of an available nail unit space by non-dermatophyttes is produced
by the trauma of the closed shoe by an asymmetric gait or other trauma. A plausible
theory. JEADV 28(8): 1002-1006