台大皮膚科 王修含 醫師
Part I: 十八銅人陣
一定要會認的黴菌，共十八隻黴菌，其它菌種請參閱Part II
DERMATOPHYTES
Trichophyton mentagrophytes: 葡萄藤(microconidia) + 雪茄(Macroconidia)
Trichophyton rubrum: 停在電線桿上的小麻雀(microconidia) + 球棒(Macroconidia)
Epidermophyton floccosum: 兔耳朵
Microsporum canis: 末端尖，似鳥嘴，尖刺壁，9-12格
Microsporum gypseum: 末端鈍，圓頭，無刺，壁較薄，3-6格
NON-DERMATOPHYTES
Mucor: 燈泡
Rhizopus: 有樹根的燈泡
Scopulariopsis: 串起來的糖葫蘆
Aspergillus spp.: 圓頭—戴放射狀皇冠
Penicillium spp.: 數根手指—戴放射狀皇冠 à 若gross colony為紅色，答案應寫Penicillium marneffei
Alternaria: 串聯的圓三角狀手榴彈
Curvularia: 並聯的(各自獨立的)橢圓手榴彈
(ps. Bipolaris: 並聯的圓形手榴彈)
Cladosporium: 樹枝狀麻花小辮子
Blastomyces dermatitidis: (引起blastomycosis)
25℃ mycelial form—solitary pyriform conidia
37℃ yeast form—fractile wall + broadly based budding
Pseudallescheria boydii: 大飯團+散落一地的小米粒 (此為sexual state)
(Scedosporium apiospermum: 末端結出一顆顆的水晶項鍊。此為asexual state)
Fusarium: 堆在一起的鐮刀
Cunninghamella: 圓形新娘捧花，胖胖的柄
Acremonium: 偏一邊的新娘捧花，細柄 (ps. Exophiala jeanselmei: 也是偏一邊的捧花，但柄稍胖)
Part II: 少林羅漢堂 (進階選修) (依字母順序排列)
Bipolaris: 並聯的圓形手榴彈 (D/D: Alternaria & Curvularia)
Chrysosporium: terminal conidia in short chain + branches set at 45∘ (cf. dermatophytes大多為90∘分枝)
Coccidioides immitis: alternate arthroconidia + spherule
Exophiala jeanselmei: 偏一邊的捧花，但柄稍胖 (D/D: Cunninghamella & Acremonium)
Exophiala werneckii: bicelluar yeasts with a rugose (多皺紋的) process at one end
Exophiala spinifera: spike-like annelids produced on conidiophores several cells long
Fonsecaea pedrosoi: conidia in successive ranks + conidial structure of the Rhinocladiella type
Fonsecaea compactum: conidia oval to round with broad attachment points
Geotrichum: 魚肝油小藥丸
Histoplasma capsulatum:
mycelial form (filamentous form): 許多有刺的氣球
yeast form: 就是yeasts (較無特色)
Madurella mycetomatis: toruloid (似串珠菌狀) hyphae and chlamydospores + black grain in tissue
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MICROSPORUM
Microsporum audouinii: “怪異末路黑道人”
形狀怪異且中間凹入的Macroconidia + terminal Chlamydia + anthropophilic (人類)
「黑道」者：即台語的audo…
D/D Microsporum canis: rice grain test (+) (米飯加壓會長M.canis，但不長M.audouinii)
Microsporum cookei: “廚房地面的厚壁扁豆”
cookei—“廚房”，geographic，外形似扁豆，厚壁
D/D M. gypseum— M. cookei格數比較多
M. canis— M. cookei的Macroconidia兩端不尖(較圓)，且壁上無刺 (not echinulate cell wall)
Microsporum ferrugineum: “鐵竹竿人”
Ferrugineum— “鐵色、鐵銹”之意，hyphae deformed or straight, with prominent “bamboo” septa
Slide culture下只看到一堆「竹竿」(hyphae)，很直，有厚度，且不產孢
(找不到microconidia & Macroconidia才是典型的M. Ferrugineum)
anthropophilic
Microsporum nanum: “山豬的娜娜扭蛋”
Macroconidia 似扭蛋，geophilic and zoophilic (通常與swine有關) à “山豬” (geo- & zoo-philic)
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Paecilomyces: 雞爪+鐵鍊 (phialides with thinly tapered apices and chains of oval conidia)
Paracoccidioides brasiliensis:
25℃ mycelial form—hyphae with some arthroconidia
37℃ yeast form—yeast with multiple buds (輪船的舵)
Phialophora verrucosa: 花瓶上開花
Rhinocladiella: ellipsoidal conidia arranged in a plume-like series at the apex of a conidiophore
Scytalidium: 長長的鐵鍊
Scytalidium dimidiatum: brown arthroconidia
Scytalidium hyalinum: hyaline arthroconidia
Sporothrix schenckii
25℃ mycelial form—hyaline conidia in rosettes, hyaline or brown thick-walled conidia fomed along the hyphae
37℃ yeast form—ovoid or elongated yeasts, producing one or several buds
Syncephalastrum: 放射狀的太陽 (無phalide or metula) 須與Aspergillus 鑑別診斷
(此菌尚無感染人類或動物的報告)
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TRICHOPHYTON
Trichophyton concentricum: sterile hyphae，無microconidia，也無Macroconidia
Trichophyton equinum: 已歸併至Trichophyton rubrum……太好了！又可以少背一隻菌了
Trichophyton megninii: 已歸併至Trichophyton rubrum
Trichophyton schoenleinii: “人類的學校有吊燈” (anthropophilic-schoen…(school)-chandelier)
hyphae in the form of “favic chandeliers (樹枝形吊燈)”，末端似樹蛙小指頭
Trichophyton soudanense:”蘇丹反身分枝人”
“蘇丹(soudan…)反身分枝(reflexive branching)人(anthropophilic)”
Hyphae with reflexive branching, that is, nearby branches pointing in opposing directions.
Trichophyton tonsurans: “數噸的氣球人”
“數噸(tonsuranS)” “人(anthropophilic)”
microconidia形狀較亂，不規則，有些地方拉長，出現「氣球」狀的東西
Macroconidia: sinuous (彎曲的、迂迴的) macroconidium
Trichophyton verrucosum: “牛疣算盤珠有鼠尾巴”
臨床上，此病為長在牛身上的疣狀物，再傳染至人體。(zoophilic)
有許多似算盤的珠子(chains of chlamydospores)
Macroconidia: rat-tail shaped macroconidia。microconidia: 與T. rubrum不易區別
Trichophyton violaceum: “紫色鐵絲人”
Gross colony: 正面似紅豆色，有紫色的hue
Slide culture: Deformed hyphae and chlamydospores，似硬梆梆的鐵絲，
而這種「鐵絲」，特徵為一邊平，一邊凸起。
不太產孢子 (除非加thiamine)，但偶有chlamydospores
anthropophilic
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Wangiella dermatitidis: 此genus僅此一種species，又名為Exophiala dermatitidis
Conidiophores and phialides poorly differentiated from vegetative hyphae
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