Abstract：
BACKGROUND: Hyperthermia is a common monotherapy for sporotrichosis, but only in patients with special conditions, such as pregnancy and nursing. However, hyperthermia has not been used more widely for sporotrichosis in clinical practice.
METHODS: An HIV-positive adult male with lymphocutaneous sporotrichosis caused by Sporothrix globosa that did not respond to conventional itraconazole therapy lasting >2 months received adjunctive therapy with local hyperthermia. To simulate the effects of heat exposure on the growth and morphology of Sporothrix spp. in vitro, S. globosa, S. schenckii and S. brasiliensis were exposed to intermittent heat (42°C) for 1 h a day for 7 or 28 days and observed under transmission electron microscopy.
RESULTS: Itraconazole combined with local hyperthermia significantly improved the lesions, and the patient was successfully cured of sporotrichosis, with no recurrence after 2 years of follow-up. Cultures of Sporothrix spp. treated with 7 days of daily heat exposure in vitro showed obvious decreases in colony diameters, but not numbers, compared with untreated cultures (p < .001). After 28 days of heat exposure in vitro, Sporothrix spp. were unable to thrive (p < .001), and ultrastructural alterations, including loose cell wall structure, incomplete cell membrane, disrupted vacuoles and fragmented nuclei, were noticeable.
CONCLUSIONS: Our case findings and in vitro experiments on Sporothrix spp., together with a literature review of previous sporotrichosis cases, suggest that hyperthermia has a clinical role as a treatment adjunct. Large-scale clinical trials are required to examine the utility of hyperthermia in various forms of cutaneous sporotrichosis.
METHODS: An HIV-positive adult male with lymphocutaneous sporotrichosis caused by Sporothrix globosa that did not respond to conventional itraconazole therapy lasting >2 months received adjunctive therapy with local hyperthermia. To simulate the effects of heat exposure on the growth and morphology of Sporothrix spp. in vitro, S. globosa, S. schenckii and S. brasiliensis were exposed to intermittent heat (42°C) for 1 h a day for 7 or 28 days and observed under transmission electron microscopy.
RESULTS: Itraconazole combined with local hyperthermia significantly improved the lesions, and the patient was successfully cured of sporotrichosis, with no recurrence after 2 years of follow-up. Cultures of Sporothrix spp. treated with 7 days of daily heat exposure in vitro showed obvious decreases in colony diameters, but not numbers, compared with untreated cultures (p < .001). After 28 days of heat exposure in vitro, Sporothrix spp. were unable to thrive (p < .001), and ultrastructural alterations, including loose cell wall structure, incomplete cell membrane, disrupted vacuoles and fragmented nuclei, were noticeable.
CONCLUSIONS: Our case findings and in vitro experiments on Sporothrix spp., together with a literature review of previous sporotrichosis cases, suggest that hyperthermia has a clinical role as a treatment adjunct. Large-scale clinical trials are required to examine the utility of hyperthermia in various forms of cutaneous sporotrichosis.
摘要：
背景：热疗是孢子丝菌病的常见单一疗法，但只有在有特殊情况的患者中，如怀孕和哺乳。然而,在临床实践中，热疗尚未被更广泛地用于孢子丝菌病。
方法：一名HIV阳性成年男性，由球形孢子丝菌引起的淋巴皮肤孢子丝菌病，对持续超过2个月的常规伊曲康唑治疗无反应，接受了局部热疗的辅助治疗。模拟热暴露对孢子丝菌生长和形态的影响。在体外，S、globosa，S.申克,将S.brasiliensis暴露于间歇性热（42°C），每天1小时，持续7或28天，并在透射电子显微镜下观察。
结果：伊曲康唑联合局部热疗可明显改善病灶，患者成功治愈了孢子丝菌病，随访2年后无复发。孢子丝菌的培养物。每日热暴露7天的体外处理显示菌落直径明显减小，但不是数字，与未经处理的培养物相比（p<0.001）。在体外热暴露28天后，孢子丝菌属。无法茁壮成长(p<0.001)，和超微结构改变，包括松散的细胞壁结构，不完整的细胞膜，被破坏的液泡,和破碎的原子核，很明显。
结论：我们的病例发现和对孢子丝菌的体外实验。,以及以前孢子丝菌病病例的文献综述，表明热疗作为辅助治疗具有临床作用。需要进行大规模的临床试验来检查热疗在各种形式的皮肤孢子丝菌病中的应用。
方法：一名HIV阳性成年男性，由球形孢子丝菌引起的淋巴皮肤孢子丝菌病，对持续超过2个月的常规伊曲康唑治疗无反应，接受了局部热疗的辅助治疗。模拟热暴露对孢子丝菌生长和形态的影响。在体外，S、globosa，S.申克,将S.brasiliensis暴露于间歇性热（42°C），每天1小时，持续7或28天，并在透射电子显微镜下观察。
结果：伊曲康唑联合局部热疗可明显改善病灶，患者成功治愈了孢子丝菌病，随访2年后无复发。孢子丝菌的培养物。每日热暴露7天的体外处理显示菌落直径明显减小，但不是数字，与未经处理的培养物相比（p<0.001）。在体外热暴露28天后，孢子丝菌属。无法茁壮成长(p<0.001)，和超微结构改变，包括松散的细胞壁结构，不完整的细胞膜，被破坏的液泡,和破碎的原子核，很明显。
结论：我们的病例发现和对孢子丝菌的体外实验。,以及以前孢子丝菌病病例的文献综述，表明热疗作为辅助治疗具有临床作用。需要进行大规模的临床试验来检查热疗在各种形式的皮肤孢子丝菌病中的应用。
