Clinical And Drug Sensitivity Analysis Of Refractory Sporotrichosis

Objective:To find and analyze the incidence and condition of drug-resistant strains we used fungal culture on skin tissue blocks collected from 8 patients with refractory sporotrichosis,and testing for drug susceptibility by M38-ED3 method.The curative effect of combined therapy on refractory sporotrichosis was observed and the causes of refractory and drug resistance were analyzed.Methods: The fungi strain of 8 patients with refractory sporotrichosis from the dermatological clinic of the Second Hospital of Jilin University were activated and mycelium phase suspension was obtained.In vitro sensitivity of fungicidal mycelium to drugs was measured by microfluid-based dilution of mycotic broth(M38-ED3),based on committee for clinical laboratory standardization(CLSI),the medicine include itraconazole,terbinafine,fluconazole,voriconazole and amphotericin B.Combined treatment with itraconazole and terbinafine were used to treat refractory cases,and the effect was observed.Results:Ⅰ.The minimum inhibitory concentration(MIC)of the five antifungal agents against the 8 resistant strains of sporotrichosis was as follows:1.Itraconazole: the MIC value of Case 5 was 16 μg/mL,the MIC value of Case 3 and6 was 0.5μg/mL,and the MIC values of other patients were all 1 μg/mL.2.Terbinafine: MIC values of Case 5 and 6 were 0.0625 μg/mL in patients,MIC values of 2 and 4 were 0.125 μg/mL in patients,and MIC values of 0.25μg/mL in other patients.3.Fluconazole: the MIC value of Case 5 was 16 μg/mL,while the MIC values of other patients were all more than 64 μg/mL.4.Voriconazole: MIC value of Case 5 was 4 μg/mL,MIC value of Case 6 was 0.5 μg/mL,and MIC value of other patients were all more than 16 μg/mL.5.Amphotericin B: the MIC value of Case 8 was 2 μg/mL,and 1μg/mL for other patients.6.No multiple drug resistance was found.Ⅱ.8 strains were identified as Sporothrix globosa by gene sequencing.Ⅲ.8 cases of refractory sporotrichosis were treated with itraconazole and terbinafine,and all of them improved the therapeutic effect.Conclusion:1.Fungal gene sequencing of 8 patients was Sporothrix globosa.2.One in eight patients was resistant to itraconazole.3.All of the 8 patients were sensitive to terbinafine.4.Fluconazole showed low antifungal activity in vitro in eight patients and could only be used as a second-line therapy in the treatment of sporotrichosis.5.Voriconazole is not sensitive except for a few strains.6.Among the 8 patients,1 case was insensitive to amphotericin B,while the other patients were in a more sensitive state.The findings of this study were consistent with those of previous literature.7.Itraconazole combined with terbinafine is a more effective therapy.