目的 报道1例由万博节皮菌(趾间毛癣菌有性期)所致面部难辨认癣,取皮损鳞屑直接提取真菌DNA做菌种鉴定,并与真菌培养鉴定结果比较,对培养的菌落直接用抗真菌乳膏做药敏实验指导治疗.方法 病变部鳞屑经KOH涂片真菌镜检阳性后,取鳞屑直接提取DNA,以真菌通用引物ITS1/4做PCR扩增后测序；同时从培养生长的菌提取DNA做分子生物学鉴定；并将抗真菌乳膏加入含菌平板孔中观察抑菌圈大小.结果 鳞屑直接提取的DNA与培养获得菌落提取的DNA经PCR-测序均鉴定为万博节皮菌,诊断万博节皮菌感染所致面部难辨认癣.镜检阳性后即给予特比萘芬口服(250mg/d)及1％萘替芬-0.25％酮康唑乳膏外用,每周复诊并取鳞屑镜检和培养,基于药物抑菌实验结果指导治疗5周,至临床治愈和真菌培养转阴.结论 鳞屑直接提取DNA做PCR-测序能及早明确菌种,待培养菌落长出后做PCR-测序验证,直接用成品抗真菌乳膏做体外药敏实验指导临床选药,动态培养鳞屑以确定疗程.此个体化诊治方案为从临床到实验室、从实验室到临床转化医学真菌学的成功实例.%Objective To report a case of facial tinea incognito due to Arthroderma vanbreuseghemii ,identified by direct DNA extraction from the scales,and compared with that from the isolated colony. The isolated colony was tested in vitro for drug susceptibility. Methods The scales scraped from the affected area were prepared for PCR and fungal culture. DNA was extracted directly from the scale and amplified using the universal fungal primers ITS 1/4,the sequences of amplification products were blasted in GenBank. After the pathogen was isolated,the drug susceptibility test was performed using the commercialized anti-fungal creams. Results The case was finally diagnosed as facial tinea incognito due to A. vanbreuseghemii ,the teleomorph of Trichophyton interdigitale . The patient was cured after 5 weeks oral terbinafine (250 mg/d) and topical application of antifungal cream containing 1% naftifine-0.25% ketoconazole after 5 weeks. Conclusions PCR-based molecular biological validation of DNA from scales with the ability of rapid identification for pathogenic fungus and using anti-fungal cream directly for in vitro susceptibility test could be a good guidance for direct treatment and monitor during the therapy. This individual diagnosis and treatment program is a successful model of transla-tional medical mycology from bedside to bench and from bench to bedside.
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