依据电镜提示分离出的厌氧菌,根据其形态特点、生化分析、药敏结果及请教中国科学院微生物研究所的放线菌专家,初步确定为放线菌,并按药敏结果成功救活首例患者(另文).目前许多皮肤病学中仍将放线菌病归在真菌感染类内[2-4] ,但放线菌为细菌的一个目,已分出53个属、数千个种,至少有11个属可致放线菌病[5] .放线菌为兼性厌氧菌,本病中分离出的细菌为严格厌氧菌,分离极其困难,另外本病的临床特点及病理改变不同于目前已知的各种放线菌病[3,4,6] ,并能除外结节病[1,7,8] 、非典型分枝杆菌病[9-11] 等几种相似疾患,故认为系一种新的疾病[2] .细菌培养涂片见分离纯化的放线菌形态、大小不一,染色不均,多为杆菌形态.由于细菌存在于吞噬细胞内,多数已被溶酶体酶溶解消化,电镜下所见的形态表现更为多样性,除少数可分辨出细菌外,所见主要为大小、形状多样的次级溶酶体.电镜在该病的 诊断中发挥了关键作用,但电镜下所见的细菌形态不足以确定某种细菌,组织内的细菌也不能代表某种细菌的基本形态.由于细菌对厌氧条件的要求高,分离后于未能作进一步鉴定及留作电镜观察前即已死亡,纯化的细菌超微结构形态有待今后观察.
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