| Objective:To investigate the clinical characteristics of patients with Autoimmune dermatosis combined with Deep fungal infection and provide evidence-based for the diagnosis and treatment to these patients.Methods:Patients with autoimmune dermatoses hospitalized in our department from October 2014 to October 2017 were enrolled in clinical data by Epidata software,of whom with deep fungal infection were screened out for inductive analysis,strain identification and drug sensitivity test in vitro..Results:1.general situation:there were 652 cases of Autoimmune dermatosis,435 women and 217 men,of which 75 cases were infected with deep fungal infection,52 were female,and 23 were male,and the proportion of men and women was about 1:2.Age was mainly concentrated at 30-60 years of age.There were 29 cases of SLE,15 cases of bullous diseases,9 cases of dermatomyositis and heavy drug rash,4 cases of psoriasis,3 cases of overlapping syndrome,2 cases of rheumatoid arthritis,2 cases of allergic purpura,1 cases of systemic scleroderma,and 1 cases of MCTD;2.source of specimen:75 patients,44 cases of oral secretions(58.67%),There were 15 cases of phlegm and stool(20%)and 1 cases(1.33%)of urine.The main infection sites were oral,clinical features and imaging features were not obvious;3.infected strains were Candida albicans(81.33%),5 Candida tropicalis(6.67%),3 Candida smooth Candida(4%),Candida glossy and Candida albicans in Dublin.2 cases(2.67%),Candida korou 1 cases(1.33%),Aspergillus in 1 cases(1.33%);4.75 patients with 49 cases(65.33%)with bacterial infection,16 cases of bacterial and fungal infection in the same site.10 cases of multi system fungal infection;5.cases:75 cases of patients with hormones used hormone.In 17 cases of methylprednisolone<40mg,45 cases were used between 40mg and 80mg,2 cases were 120mg,2 cases were 250mg,and 4 cases were 500mg.36 patients were treated with immunosuppressive agents and 29 patients used hydroxychloroquine sulphate;6.in vitro susceptibility test:the sensitivity of Candida albicans to AMB was 96.72%,and the susceptibility rates for 5-FC,FCA,ITR and VOR were 95.08%,90.16%,83.61%and 95.08%respectively,and the resistance rates were 1.64%,6.56%,8.20%,1.64%,respectively,and 5-FC,AMB,VOR of Candida tropicalis.The sensitivity rate was 100%,the sensitivity rate,the resistance rate of FCA,the resistance rate of ITR and the resistance rate were 40%,the sensitivity of Candida albicans to 5-FC,AMB,FCA and ITR was 100%,the sensitivity to VOR was 66.67%,the resistance rate was 33.33%,and the sensitivity of Candida smooth Candida and Candida krou to 5-FC,AMB,FCA and VOR was 100%,smooth and smooth.Candida albicans were resistant to ITRI cases and ITRI was mediated by Candida krou;Candida albicans in Dublin were sensitive to 5-FC,AMB,FCA,ITR and VOR 100%;7.treatment and prognosis:75 patients with Autoimmune dermatosis combined with deep fungal infection were treated with fluconazole,with an effective rate of 91.54%,of which 62 patients had complete remission and 3 cases.Divided remission;5 cases used voriconazole treatment,2 cases of complete remission;the use of amphotericin B in treatment of 1 cases of death.Conclusion:1.the incidence of Autoimmune dermatosis combined with deep fungal infection in our family was 11.5%,of which SLE patients were more,women was more than men and most of them were 30-60 years old;2.infected sites were mainly oral,followed by respiratory tract and digestive tract;3.pathogenic bacteria were mainly Candida albicans;most of the patients with 4.Autoimmune dermatosis with deep fungal infection were combined with bacteria infection,most of the single system infection;5.Autoimmune dermatosis combined with bacterial infection,the patients who used hormone and immunosuppressant treatment patients,the risk of deep fungal infection increased;6.our family is sensitive to AMB,5-FC,resistance to azoles is significantly lower than other reports;7.The patients with Autoimmune dermatosis combined with deep fungal infection have high efficiency after antifungal treatment.Fluconazole is still an effective antifungal drug.It can be the first choice for preemptive treatment and experience treatment. |
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