| Background:Sporotrichosis has been considered as a neglected fungal disease with an increasing incidence,and identified as a public health problem in Brazil.As one of the high incidence areas in the world,it is of great significance to study the clinical and epidemiology of sporotrichosis in Jilin province.The common methods of diagnosis in sporotrichosis include histopathologic examination and fungal culture.The method of histopathology examination lacks specificity,and the culture is time-consuming.The method of molecular diagnosis is highly sensitive and may only takes few hours,but it requires higher laboratory conditions.Sporotrichosis often occur in the rural where medical and health conditions are relatively poor,therefore it has a higher chance of misdiagnosis.So it is of great significance to explore diagnostic methods that are simple and sensitive in clinical practice.Methods:1、The cases diagnosed as sporotrichosis in our department from 2010 to 2019were collected and compared with the epidemiology of sporotrichosis from 1990 to2009,so as to understand the clinical and epidemiological characteristics of sporotrichosis.In addition,literature reports of sporotrichosis in China were searched through“CNKI”,“WANFANG”,"VIP"and"Pubmed",in order to improve the epidemiological data of sporotrichosis in China as far as possible.2、We collected Formalin-Fixed and Paraffin-Embedded clearly diagnosed as sporotrichosis,to explore the diagnostic value of calcium fluorescent white(CFW)staining for sporotrichosis,and compared with the Grocott’s sliver stain(GSS)and periodic acid Schiff(PAS)staining in terms of detection rate,operating procedures and the degree of difficulty of interpreting the results.3、To explore the method of establishing the model of sporotrichosis in guinea pigs,and to compare the effects of different concentrations of spore suspension and different methods on the model,so as to provide a preliminary basis for the intradermal test of sporotrichosis.Results:1、Among the 2133 patients collected in our department in Jilin Province,758were male(35.54%)and 1375 were female(64.46%).There were 1750 farmers accounting for the largest proportion(82.04%).Spring and winter were more common with a proportion of 65.02%.In the affected areas,the central part of Jilin Province(Changchun,Siping,Jilin,Liaoyuan)had the highest proportion,accounting for64.41%.The average disease duration was 5.27±2.52 months.In clinical manifestations,there were 1,629 cases(76.37%)of fixed type,832 cases on the face,accounting for the largest proportion(51.07%);501 cases(23.49%)of the lymphatic type,and 359 limbs,accounting for the largest proportion(71.66%).Among the lesions,nodules accounted for the largest proportion(43.55%).Histopathologic examination showed that there were 1802 cases with atypical performance,accounting for 84.48%.2、The epidemiological characteristics of sporotrichosis showed no significant changes in the population,season,location and clinical manifestations in the past 10years compared with 1990-2009.The average age was 52±1 years old,and the highest age group was over 60 years old in this survey.In the period from 1990 to 2009,the average age was 45±1 years old,and the highest age group was 51-60 years old.The average course of disease was 5.27±2.52 months in this survey,and was not clearly calculated from 1990 to 2009,but most of the courses were 2-6 months(79.55%).3、Through searching the literatures of sporotrichosis published through the“CNKI”,“WANFANG”,"VIP"in China,3273 cases were collected,1194 cases were collected through"Pubmed",together with a total number of 4467.There were 3986patients with definite gender,1857 males and 2129 females.There were 2243 cases with definite clinical type,1450 cases with fixed type,771 cases with lymphatic type and 22 cases with cutaneous disseminated type.241 strains were identified by molecular biological method,of which 217 identified as S.globosa,including 41strains in Changchun,37 in Chongqing,21 in Liaoning,19 in Sichuan,15 in Jiangxi,14in Beijing,9 in Shanghai,9 in Shandong,4 in Hubei,6 in Jiangsu,3 in Hubei,2 in Guangzhou,2 in Anhui,1 in Neimenggu,1 in Hebei.The 24 strains were identified as S.schenckii s.str,23 in jiangxi and 1 in hubei.4、PAS,GSS,and CFW staining were performed on 100 Formalin-Fixed and Paraffin-Embedded tissues respectively.The results showed that 31 cases(31%)with PAS,40 cases(40%)with GSS and 74 cases(74%)with CFW were detected.The detection rate of CFW was statistically significant compared with that of PAS and GSS(P<0.05).The detection rate of PAS was not statistically significant compared with GSS(P>0.05).Among the 100 cases,only 3 cases were positive with PAS,1case was positive with GSS,and the result of CFW was negative.The detection rates of PAS+GSS+CFW was 77%,and the detection rate of single CFW was not statistically significant compared with that of the three methods(P>0.05).The operation steps of CFW were simple and the results were easy to read.5、When the concentration of suspension was 1×10~8 spores/ml,four methods of subcutaneous injection were given,including injection of 0.1ml suspension(method 1for short);0.3ml suspension(method 2 for short);the subcutaneous injection of dexamethasone for 3 consecutive days and 0.1ml suspension(method 3 for short);0.1ml suspension was given for 3 consecutive days(method 4 for short).Both methods 3 and 4 could produce subcutaneous nodules in guinea pigs.When the concentration of suspension was 1×10~9 spores/ml,subcutaneous nodules were produced in guinea pigs by methods 2,3 and 4.And the subcutaneous nodules were the largest in diameter when the injection of 0.3ml suspension was given to guinea pigs,but the duration of subcutaneous nodules was not extended.Conclusion:1、The high incidence of sporotrichosis in Jilin province was closely related to the improper treatment of corn stalks.The proportion of sporotrichosis in men and women was 1:1.4.The common population was middle-aged and elderly women,the occupation was farmers and the seasons were spring and winter.The clinical manifestations of sporotrichosis were mostly of fixed type.There was a correlation between different pathogenic sites and clinical types.The epidemiological characteristics of sporotrichosis in Jilin province showed no significant changes in the population,season,location and clinical manifestations in the past 10 years compared with1990-2009.The age had the increasing trend and the average course of disease had the extension trend.2、The proportion of sporotrichosis in men and women was 1:1.15 in China.The clinical manifestations of sporotrichosis were mostly of fixed type.The species of sporotrichosis in China currently include S.globosa and S.schenckii s.str,the strains of S.schenckii s.str had been found in Jiangxi and Hubei.3、CFW is of great value in the diagnosis of sporotrichosis,the detection rate of CFW fluorescence staining in Formalin-Fixed and Paraffin-Embedded tissue was74%,significantly higher than that of PAS and GSS.The detection rates of using three staining methods at the same time were not better than that of CFW alone.And CFW was obviously better than GSS and PAS in operation steps and reading degree of results.4、The skin lesions were subcutaneous nodules when the spore suspension of sporotrichosis was given with subcutaneous injection to guinea pigs.When the concentration of suspension was 10~9 spores/ml and 0.3ml was injected,the diameter of subcutaneous nodules in guinea pigs was the largest.The subcutaneous nodules lasted for about 10 days and subsided spontaneously.The increased suspension concentration did not extend the duration of nodules,suggesting that if we want to establish a guinea pig model of chronic skin infection of sporotrichosis,immunosuppression after skin lesions or repeated subcutaneous injection of spore suspension may be attempted. |
PDF Full Text Request