From 1997 to 2009, 1,862 dermatology, gynaecology, and paediatrics (DGP) associated clinical yeast isolates were analysed for species occurrence, specimen origin and type, (multi-) resistance pattern, and testing period. The top seven of the isolated DGP-associated species remained the same as compared to total medical wards, with
Superficial fungal infections are often chronic and recurring. It has been estimated that approximately 15% of the population has fungal infections of the skin (tinea pedis or athlete’s foot) or nails (onychomycosis) or of the feet. These infections are common in older children and adults [
It has been suggested by Clayton and Noble [
Species distribution within the not-
Aside of the changing epidemiology of classical and emerging human fungal infections [
Therefore, precise strain identification and knowledge of the epidemiology of
The aim of this reevaluation, after renaming the isolates according to their currently valid taxonomic denomination, was to evaluate the distribution and occurrence rate of the relevant yeast species, isolated from dermatology, gynaecology, and paediatric (DGP) patients. By using the “new nomenclature” this study should build a valid basis for the comparison of recent and future fungal epidemiological surveys. The actual susceptibility profile and its possible changes during the isolation period (1998–2008) of the 1,862 clinical DGP-yeast isolates, tested against frequently used azole antifungal agents in this area, are given in a corresponding paper [
The 1,862 clinical yeast isolates (Table
Yeast species distribution listed according to their isolation-frequency during the multicenter studies from 1998 to 2008 (% of individual species), together with their reported and current valid genus and species denominations (empty spaces = no isolates recovered), in comparison to a general German yeast species-distribution survey (2008b) and a survey on yeast distribution in a dermatologic clinic (2002–2011c).
Genus and species denominations | Year isolated/tested | Surveys from Germany | |||||||||||||||||||||
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Yeast name reported | Current valid namea | 1998–2008 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2008 | 2008b | 2003–2011c | |||||||||||
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840 | 45.1 | 57 | 25.7 | 2 | 1.7 | 222 | 85.6 | 45 | 16.3 | 251 | 46.9 | 104 | 60.5 | 41 | 54.0 | 118 | 57.8 | 8,718 | 55.8 | 2,223 | 65.3 |
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266 | 14.3 | 18 | 8.1 | 111 | 40.7 | 77 | 14.4 | 23 | 13.4 | 5 | 6.6 | 32 | 15.7 | 2,171 | 13.9 | 169 | 5.0 | ||||
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133 | 7.1 | 9 | 4.1 | 41 | 14.8 | 63 | 11.8 | 7 | 4.1 | 5 | 6.6 | 8 | 3.9 | 532 | 3.4 | 20 | 0.6 | ||||
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121 | 6.5 | 52 | 23.4 | 16 | 5.8 | 28 | 5.2 | 1 | 0.6 | 6 | 7.9 | 18 | 8.8 | 292 | 1.9 | 395 | 11.6 | ||||
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118 | 6.3 | 8 | 3.6 | 26 | 9.4 | 47 | 8.8 | 25 | 14.5 | 4 | 5.3 | 8 | 3.9 | 370 | 2.4 | 27 | 0.8 | ||||
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41 | 2.2 | 1 | 0.5 | 4 | 3.4 | 11 | 4.0 | 16 | 3.0 | 6 | 3.5 | 2 | 2.6 | 1 | 0.5 | 154 | 1.6 | 10 | 0.3 | ||
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33 | 1.8 | 22 | 9.9 | 2 | 0.7 | 5 | 0.9 | 1 | 1.3 | 3 | 1.5 | 25 | 0.2 | 123 | 3.6 | ||||||
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32 | 1.7 | 32 | 12.4 | ||||||||||||||||||
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28 | 1.5 | 6 | 2.7 | 5 | 1.8 | 10 | 1.9 | 1 | 1.3 | 6 | 2.9 | 103 | 0.7 | 9 | 0.3 | ||||||
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25 | 1.3 | 1 | 0.5 | 1 | 0.9 | 3 | 1.1 | 13 | 2.4 | 2 | 1.2 | 5 | 6.6 | 83 | 0.9 | 31 | 0.9 | ||||
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15 | 0.8 | 3 | 1.2 | 2 | 0.7 | 2 | 0.4 | 2 | 2.6 | 6 | 2.9 | 215 | 1.4 | ||||||||
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9 | 0.5 | 5 | 1.8 | 4 | 0.8 | 10 | 0.06 | 4 | 0.1 | ||||||||||||
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6 | 0.3 | 2 | 0.7 | 4 | 0.8 | 13 | 0.01 | ||||||||||||||
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5 | 0.3 | 1 | 0.5 | 3 | 0.6 | 1 | 1.3 | 6 | 0.04 | 4 | 0.2 | ||||||||||
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5 | 0.3 | 1 | 0.4 | 4 | 0.8 | 10 | 0.06 | 3 | 0.1 | ||||||||||||
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4 | 0.2 | 2 | 0.4 | 2 | 1.0 | 16 | 0.2 | 33 | 1.0 | ||||||||||||
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4 | 0.2 | 1 | 0.5 | 1 | 0.4 | 1 | 0.2 | 1 | 0.5 | 8 | 0.1 | 9 | 0.3 | ||||||||
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2 | 0.1 | 2 | 1.2 | ||||||||||||||||||
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2 | 0.1 | 1 | 0.4 | 1 | 0.2 | 47 | 0.5 | 8 | 0.2 | ||||||||||||
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2 | 0.1 | 1 | 0.4 | 1 | 0.2 | ||||||||||||||||
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1 | 0.07 | 1 | 0.4 | 1 | 0.01 | ||||||||||||||||
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1 | 0.1 | 1 | 0.5 | 0 | 0 | ||||||||||||||||
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1 | 0.1 | 1 | 0.1 | 1 | 0.01 | ||||||||||||||||
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51 | 2.7 | 36 | 16.2 | 11 | 9.4 | 2 | 0.8 | 2 | 0.7 | 26 | 0.3 | ||||||||||
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76 | 4.1 | 7 | 3.2 | 69 | 58.9 | 115 | 3.4 | ||||||||||||||
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7 | 0.4 | 2 | 0.9 | 2 | 0.4 | 3 | 4.0 | 1 | 0.01 | 3 | 0.1 | ||||||||||
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3 | 0.2 | 1 | 0.4 | 2 | 1.2 | 5 | 0.03 | 26 | 0.8 | ||||||||||||
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1 | 01 | 1 | 0.5 | 2 | 0.01 | 101 | 3.0 | ||||||||||||||
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25 | 1.3 | 25 | 21.4 | ||||||||||||||||||
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5 | 0.3 | 5 | 4.3 |
Identification and differentiation of the isolates were performed using methods routinely employed at the microbiology/mycology laboratories of the participating test centres. Confirmatory identification was made for unusual or not-identified species by FTIR and/or PCR at the appropriate reference laboratory of the individual multicenter study. As the “one fungus one name” principle is effective since 2013 [
Susceptibility testing of these isolates was performed by microdilution against relevant azole antifungal agents, as described in the corresponding paper [
To ease the evaluation and setting of tables the patient-related factors such as clinical specialities (different wards), origin and type of specimen were merged and subsumed in large groups, for example,
The distribution according to their isolation frequency of clinical
Distribution of the most frequently isolated DGP-related
Despite the “new” taxonomy,
Isolation rates (number/%) of DGP-associated yeast species in relation to their origin (clinical speciality and specimen), which have been recovered during the multicenter studies from 1998 to 2008.
Isolate origin | Frequency (total = 1,862) | Dermatology, gynaecology, and paediatrics-associated clinical yeast species, isolated during the multicentre studies from 1998 to 2008 | |||||||||||||||||||
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Other |
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840 | 15 | 266 | 5 | 121 | 133 | 43* | 28 | 4 | 2 | 118 | 25 | 6 | 33 | 7 | 41 | 2 | 4 | 7 | 4 | |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( |
( | ||
Paediatrics | 767 ( |
358 ( |
10 ( |
108 ( |
1 ( |
46 ( |
91 ( |
39 ( |
15 ( |
1 ( |
0 | 58 ( |
13 ( |
4 ( |
6 ( |
5 ( |
3 ( |
0 | 1 ( |
4 ( |
4 ( |
Gynaecology | 578 ( |
321 ( |
0 | 99 ( |
4 ( |
12 ( |
18 ( |
32 ( |
7 (1) | 1 ( |
2 ( |
37 ( |
8 ( |
0 | 0 | 0 | 35 ( |
0 | 2 ( |
0 | 0 |
Dermatology | 372 ( |
83 ( |
5 ( |
33 ( |
0 | 58 ( |
7 ( |
3 ( |
2 ( |
0 | 12 ( |
3 ( |
2 ( |
26 ( |
2 ( |
1 ( |
2 ( |
1 ( |
3 ( |
0 | |
ICU Paediatrics | 127 ( |
70 ( |
|
21 ( |
0 | 4 ( |
15 ( |
1 ( |
1 ( |
0 | 0 | 11 ( |
1 ( |
0 | 1 ( |
0 | 2 ( |
0 | 0 | 0 | 0 |
ICU Gynaecology | 13 ( |
5 ( |
0 | 5 ( |
0 | 1 ( |
1 ( |
0 | 1 ( |
0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
ICU Dermatology | 5 ( |
3 ( |
0 | 0 | 0 | 0 | 1 ( |
0 | 1 ( |
0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Sterile fluid | 204 ( |
109 ( |
2 ( |
28 ( |
0 | 13 ( |
24 ( |
1 ( |
7 ( |
0 | 0 | 9 ( |
3 ( |
1 ( |
0 | 0 | 2 ( |
0 | 0 | 5 ( |
0 |
Blood culture | 138 ( |
66 ( |
1 ( |
29 ( |
0 | 13 ( |
13 ( |
0 | 1 ( |
1 ( |
0 | 10 ( |
0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Catheter | 31 ( |
22 ( |
0 | 2 ( |
0 | 5 ( |
1 ( |
0 | 0 | 0 | 0 | 1 ( |
0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Aspirate | 19 ( |
9 ( |
0 | 1 ( |
0 | 0 | 3 ( |
3 ( |
0 | 0 | 0 | 0 | 2 ( |
0 | 0 | 0 | 1 ( |
0 | 0 | 5 ( |
0 |
Device | 4 ( |
2 ( |
0 | 1 ( |
0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 ( |
0 | 0 | 0 | 0 | 0 | 0 | 0 |
Material, dermatologic | 228 ( |
30 ( |
0 | 0 | 0 | 35 ( |
0 | 0 | 0 | 2 ( |
0 | 0 | 0 | 0 | 15 ( |
0 | 0 | 0 | 0 | 0 | 0 |
Material, gynaecologic | 146 ( |
88 ( |
0 | 37 ( |
1 ( |
5 ( |
6 ( |
0 | 0 | 0 | 0 | 3 ( |
0 | 0 | 0 | 0 | 4 ( |
0 | 1 ( |
0 | 0 |
Material, solid | 111 ( |
45 ( |
0 | 9 ( |
0 | 9 ( |
6 ( |
1 ( |
0 | 0 | 0 | 3 ( |
0 | 0 | 3 ( |
1 ( |
3 ( |
0 | 0 | 1 ( |
0 |
Urine | 21 ( |
9 ( |
0 | 3 ( |
0 | 1 ( |
0 | 0 | 1 ( |
0 | 0 | 3 ( |
4 ( |
0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Stool | 20 ( |
13 ( |
0 | 6 ( |
0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 ( |
0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Swabs, paediatric | 460 ( |
214 ( |
7 ( |
66 ( |
0 | 11 ( |
68 ( |
5 ( |
7 ( |
0 | 0 | 55 ( |
6 ( |
3 (1) | 4 ( |
5 ( |
3 ( |
0 | 1 ( |
0 | 4 ( |
Swabs, gynaecologic | 364 ( |
189 ( |
0 | 55 ( |
3 ( |
7 ( |
6 ( |
1 ( |
8 ( |
0 | 2 ( |
26 ( |
7 ( |
0 | 0 | 0 | 27 ( |
0 | 1 ( |
0 | 0 |
Swabs, dermatologic | 116 ( |
44 ( |
5 ( |
21 ( |
0 | 22 ( |
6 ( |
2 ( |
4 ( |
0 | 0 | 7 ( |
0 | 2 ( |
1 ( |
1 ( |
1 ( |
0 | 1 ( |
0 | 0 |
Other
Aspirate: bursa, limbic, pericardial, transtracheal, pus, and pleura.
Catheter: indwelling, urine, vascular, venereal, ports, and anaesthetic tube.
Sterile fluid: sterile body fluids, liquor, bile, dialysates, drainage, BAL, tracheal secrets, pleura, lachrymal, synovial, and serum, except blood and urine.
Solid (sterile) material: tissues/lung tissue, bone-marrow, throat discharge/sputum, abscess, spleen, bone, liver, stomach, and ear.
Device: contact lenses, heart valves, stents, pacemakers, and artificial joints.
Dermatological material: skin, nails, hairs, dandruff, and scales.
Gynaecological material: scrapings, genital-, prostate secrets, and ejaculate.
Urine: mid-stream, punctuate, and catheter.
Despite the uneven distribution and low testing rates of some clinical isolates throughout the study periods, the isolation rate demonstrated a slight, statistically not significant increase of the NCY species (Figure
It has been reported that
Aside from
Occurrence differences, respectively, of profiles of the most frequent isolated yeast species (number/percentage (% of species)) in the DGP wards and DGP ICUs.
Ward/ICU |
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Dermatology | 372 | 83/22.3 ( |
33/8.9 ( |
58/15.6 ( |
7/1.9 ( |
26/7.0 ( |
Gynaecology | 578 | 321/55.5 ( |
99/17.1 ( |
12/2.1 ( |
18/3.1 ( |
|
Paediatrics | 767 | 358/46.7 ( |
108/14.1 ( |
46/6.0 ( |
91/11.9 ( |
6/0.8 ( |
D-ICU | 5 | 3/60.0 ( |
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1/20.0 ( |
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G-ICU | 13 | 5/38.5 ( |
5/38.5 ( |
1/7.7 ( |
1/7.7 ( |
|
P-ICU | 127 | 70/55.1 ( |
21/16.5 ( |
4/3.2 ( |
15/11.8 ( |
1/0.8 ( |
Romeo and Criseo [
Protothecosis is a sporotrichosis-like infection in humans, in both immunocompromised and immunocompetent patients, and in animals. It is caused by achlorophyllic algae of the genus
Of the twelve different species of
The opportunistic yeast pathogen
The DGP-species distribution of urine samples was somewhat different to those isolated in a survey from 2003 to 2004 from urine specimens of 100 hospitalized patients in a Turkish hospital who had nosocomial candiduria [
With 80% to 95%,
The distribution of specimens according to its origin is given in Table
As shown in Table
About 20–25% of the world’s population is affected by skin mycoses, thus being one of the most frequent forms of infection [
The authors declare that they have no conflict of interests.
To perform and report this study no financial support from pharmaceutical or other companies or from a national or international funding source was received.