Potentially pathogenic fungi in the material collected by the Specialist Regional Hospital, Łódź

Potentially pathogenic fungi in the material collected by the Specialist (2): 197–205, 2010. The mycobiota responsible for the development of pathological changes of the skin and its adnexa in patients presenting at the Specialist Regional Hospital, Łódź, with suspected superficial mycosis between 01 May 2003 and 30 April 2005 is analyzed. In total of 2144 isolations 39.96% were dermatophytes, 39.39% were yeast-like fungi and 20.65% were moulds. Candida albicans was the most frequently diagnosed species in fallowed by Trichophyton rubrum .


INTRODUCTION
As potentially pathogenic fungi commonly occur in the biosphere, people are exposed to them throughout their development while susceptibility to fungal infection is universal and concerns people of all ages (Kurnatowska 1998).
Fewer than 200 of ca 100 000 fungal species described so far are causative agents of diseases in people (Richardson, Warnock 1995;Ławrynowicz 2002;Chodorowska 2008).The intensity of infections and toxic or allergic reactions varies while quantitative and qualitative changes are observed in the range of fungi pathogenic to humans depending mostly on the environment (Richardson, Warnock 1995).The following factors are considered to condition the changes: the level of urbanisation and industrialisation of an area, geographic location and climatic conditions.The fungal biota also changes over time (Boliński et al. 2003;Baran, Szepietowski 1994;Dynowska et al. 2004).That is why for many years around the world epidemiologic investigations are conducted (Baran et al. 1993;Venugopal, Venugopal 1993;Khosravi et al. 1994;Korstanje, Staats 1995;Merlin et al. 1999;O´Grady, Sahn 1999;Foster et al. 2004;Dynowska et al. 2008).ACTA MYCOLOGICA Vol. 45 (2): 197-205 2010 Dedicated to Professor Barbara Gumińska on the occasion of her eighty-fifth birthday The prevalence of mycoses, both superficial and systemic, has been growing rapidly in the last few years.About 40% of the world population are estimated to suffer from fungal infections (Kaszuba et al. 1997;Chodorowska 2008).
Superfical mycoses are an especially serious epidemiological, medical and social problem (Jabłońska, Chorzelski 1988;Gliński et al. 2002) and are commonly considered to be diseases associated with civilisation (Bojarski et al. 2001;Macura 2004).While they do not pose an immediate risk to human life and are often trivialized, fungal infections can be exceptionally bothersome by negatively influencing everyday life.Not only do they cause health problems but also the physical appearance adversely affected by the pathogen makes those suffering from mycoses selfconscious.Patients often feel they are limited both in professional and private lives.The discomfort and embarrassment related to the altered body image frequently undermines confidence, leads to diminished social contacts and everyday activities, and, in extreme cases, even to depression (Nowicki 1999).
Traditional methods of identification of this pathogens are based on phenotypic features, which, on the one hand, can be influenced by environmental factors, and, on the other hand, are very time -consuming and inefficient.Thus, molecular methods of identification, based on genotype are more and more frequently applied.They are fast and reliable and may supplement traditional methods in the future (Bojarski et al. 2001;Dobrowolska et al. 2008;Dobrowolska, Jaworski 2008;Nawrot 2008 ).

MATERIAL AND METHODS
Fungi identified in the clinical material (01 May 2003-30 April 2005) obtained from patients referred to the Laboratory of Mycology and Sexually Transmitted Diseases, Specialist Regional Hospital (Wojewódzki Szpital Specjalistyczny im.dr.Władysława Biegańskiego), Łódź, with suspected mycosis of the skin and/or its adnexa were analysed.
The taxonomic range of the mycobiota was analysed using descriptions of the clinical cases diagnosed.Each description contained the following data: the patient's sex, • the patient's age, • the site or sites on the body from which the material was collected for mycologi-• cal analysis, the result of the initial direct examination, • culture results (species or genus of the fungus).

•
Only those infections in which a positive result was obtained in culture were analysed.
The material identification was based on the works by De Hoog and Guarro (1995) as well as Baran (1998).
The article presents species or genus of the fungus depending on the patient's sex.Other factors will be presented and analyzed in the next articles.
In the group of 2 144 (100%) men, positive mycological results were obtained in 805 (37.55%) cases and negative results in 1 339 (62.45%) cases.In the group with positive results, monofocal isolations were conducted for 597 (74.16%) male patients while the material was collected from more than one pathological site in 208 (25.84%) men.The total number of pathological foci with positive results was 938.

DISCUSSION
Fungal isolations confirmed in culture were recorded in 38.14% of the total group in the study period.Although considerably more women (61.12%) than men (38.88%) were examined, positive results in both groups were recorded in fewer than 50% patients.This corresponds to both world and Polish trends for superficial mycoses.A higher percentage of positive results (55.54%) was recorded in studies by Kaszuba et al. (1997) comprising all mycological diagnostic data from the Łódź region between 1982 and 1986.However, women always constituted a more numerous group (53.33%).Positive results were recorded in only 32% of the total study group in studies by Erkiert-Polguj et al. (2008) and women were diagnosed more often than men.
Dermatophytes which constituted 39.96% of all mycological isolations were observed in only a small majority of infections, almost immediately followed by yeastlike fungi (39.39%).Moulds constituted 20.65% isolations.Similar results were observed by Kaszuba et al. (1997), Sikora et al. (2000) and Boliński et al. (2003).Nowicki et al. (2006) report that non-dermatophytic fungi were major pathogens causing superficial mycoses in studies conducted in the Gdańsk region between 2003and 2005. Erkiert-Polguj et al. (2008) demonstrate the dominance of infections caused by yeast-like fungi which constituted 54% of infections diagnosed while dermatophytic infections accounted for 40.5%.
C. albicans (34.2%) was the most frequently isolated species in the present study, while the keratinophilous and keratinolytic T. rubrum constituted 23.7% of isolations.Similar results: Candida sp.(39.08% of all isolations) and T. mentagrophytes (27.90%), were obtained in studies conducted in the Wrocław region between 1995 and 1999 (Sikora et al. 2000).
In their analysis of the geographic distribution of dermatophytes in Poland between 1988 and 1992, Baran and Szepietowski (1994) also demonstrated that T. rubrum, a definite dominant throughout almost entire Poland, was the most frequently recorded species, followed by T. mentagrophytes.Sikora et al. 2000 report that T. mentagrophytes (62.7%) was the most frequently isolated dermatophytic fungus in the Wrocław region between 1995 and 1999.T. rubrum (27.8%) was the second and Epidermophyton floccosum (Harz) Langer.et Milochevitch (6.2%) was the third most frequently identified species.These results closely correspond with the results obtained by Erkiert-Polguj et al. (2008) in the material collected by the Clinical Hospital of Dermatology, Medical University, Łódź, between 2004 and2006.The sequence of the three aetiological factors was the same: T. mentagrophytes, T. rubrum, E. floccosum.
C. albicans (86.87%) was the most frequently diagnosed species of strains of yeast-like fungi in the study period (01 May 2003-30 April 2005).Sikora et al. (2000) also report Candida sp. as the genus dominant in this group of pathogens.
S. brevicaulis (13.31%) was the most frequently diagnosed mould in the study period, followed by A. niger (9.00%) and A. fumigatus (7.44%).In 68.69% cases, pathogens were identified as moulds and further identification was not conducted.Sikora et al. (2000) also show that S. brevicaulis was the most frequently identified species in this group of fungi.

CONCLUSIONS
Fungal isolations confirmed in culture were recorded in 38.14% of the total group in the study period and women were diagnosed more often than men.Dermatophytes were observed in only a small majority of infections, almost immediately followed by yeast-like fungi.
C. albicans was the most frequently diagnosed species in the present study, followed by T. rubrum.C. albicans was also the most frequently isolated species of strains of yeast-like fungi.T. rubrum was the most frequently isolated dermatophytic fungus and S. brevicaulis was the most frequently diagnosed mould.

Table 1
Patients presenting with suspected mycosis between 01 May 2003 and 30 April 2005

Table 2
Aetiological factor depending on the patient's sex