BACKGOUND: CHROMagar Candida is a new differential culture medium that allows selective isolation and identification of clinically important Candida species. However, no study of CHROMagar Candida in superficial cutaneous candidiasis has been reported in Korea. OBJECTIVE: The purpose of this study was to evaluate the use of CHROMagar Candida to identify Candida species isolated from patients with cutaneous candidiasis. METHOD: A total of 95 strains isolated from 92 patients with candidiasis (70 Candida albicans, 9 Candida parapsilosis, 7 Candida guilliermondii, 1 Candida krusei, 1 Candida glabrata, 1 Candida tropicalis, 2 C. albicans plus C. parapsilosis, 1 C. albicans plus C. krusei) were subcultured to CHROMagar Candida (KOMED, Korea) and incubated for 48 hours. Colony appearance on CHROMagar Candida was assessed by two observers. RESULTS: Expected colony appearance on CHROMagar Candida was 100% for C. albicans, C. krusei, C. glabrata and C. tropicalis, respectively but 85.7% for C. guilliermondii and 77.8% for C. parapsilosis. Three mixed cultures of Candida species, not detected by conventional methods, were detected by CHROMagar Candida. CONCLUSION: CHROMagar Candida is a useful isolation medium capable of a rapid presumptive identification of Candida species and more reliable detection of mixed cultures in clinical specimens.
Candida albicans ; Candida glabrata ; Candida tropicalis ; Candida* ; Candidiasis ; Candidiasis, Cutaneous* ; Humans ; Korea

BACKGROUND: The rising incidence of fungal infections and the increasingly frequent use of antifungal agents have intensified the need for practical and reliable antifungal susceptibility test methods. In the present study, the minimal inhibitory concentration(MIC) distribution of Candida species was investigated and the agar dilution method was compared with the National Committee for Clinical Laboratory Standards(NCCLS) "reference" broth microdilution method for antifungal susceptibility testing. METHODS: A total of 116 clinical isolates of Candida species from patients at Hanyang University Kuri Hospital were studied from October 1997 to July 1999, and the MICs of Candida species were evaluated against amphotericin B and fluconazole by the NCCLS method and the agar dilution method. RESULTS: There were no differences in the MIC50 and MIC90 of Candida albicans and Candida tropicalis against amphotericin B between the two methods, but the MIC50 of C. albicans against fluconazole was higher in the agar dilution method than in the broth microdilution method. The resistant rate of C. albicans against fluconazole was 20.8% in the broth microdilution method and 33.8% in the agar dilution method. For C. tropicalis, 31.3% were resistant to fluconazole in the broth microdilution method and 25.0% in the agar dilution method. The agreement of C. albicans and C. tropicalis between the agar dulution method and the broth microdilution method within one doubling dilution of the microdilution reference were 88.8% for amphotericin B and 34.4% for fluconazole. CONCLUSIONS: The MICs of amphotericin B showed good agreement between the agar dilution and the broth microdilution method. Therefore, resistant strains could easily be detected by screening with agar of 2 g/mL concentrations. However, in the case of fluconazole, the agreement between the two methods was low and the trailing effect could not be ruled out in agar dilution method with some strains, indicating the need for further studies in this area.
Agar* ; Amphotericin B* ; Antifungal Agents ; Candida albicans ; Candida tropicalis ; Candida* ; Fluconazole* ; Humans ; Incidence ; Mass Screening

BACKGROUND: Many non-invasive, continuous-monitoring blood culture systems have introduced technology that reduces the time and labor. There is a report that terminal subculture is necessary to decrease false negative. The purpose of this study is to evaluate the terminal subcultures for blood cultures monitored by VITAL system and to determine the clinical significance of positive blood cultures not detected by VITAL system. METHODS: From June to August 1996, a total of 3,988 blood culture bottles were processed by VITAL system and terminal subcultures were performed on consecutive 5 day blood culture. Any culture that was instrument positive but negative upon terminal subculture was considered to be false positive. Any culture that was instrument negative but positive upon terminal subculture was considered to be false negative. And false negative were categorized into minor and major errors. RESULTS: Two-hundred and nineteen (5.5%) out of 3,988 blood culture bottles were signaled as positive by VITAL system. Twenty-four bottles out of 219 were VITAL positive but negative upon terminal subcultures (false positive rate, 0.8%). And seven of the 3,988 terminal subcultures were false negative (0.2%). Four out of seven were major error and three were minor error. The isolates of major error bottles were Staphylococcus spp. and minor error bottles were Escherichia coli and Candida tropicalis. These isolates were clinically significant pathogens, but there were no changes on antimicrobial chemotherapy after reporting the positive blood culture reports. CONCLUSIONS: These results suggest that using VITAL system, terminal subculture of 5 day instrument-negative blood culture bottles is not necessary and the VITAL system provides for the rapid and convenient tool for detecting bacteremia.
Bacteremia ; Candida tropicalis ; Drug Therapy ; Escherichia coli ; Staphylococcus

BACKGROUND: Candida species are the fourth leading cause of nosocomial bloodstream infections and have one of the highest mortality rates among nosocomial pathogens. C. tropicalis has been reported to be one of the leading Candida species other than C. albicans to cause Candida infection in patients who have malignancy, diabetes mellitus, and burn. This study was designed to determine whether burn might influence the species distribution and susceptibilities of azoles against clinical isolates of Candida species including C. tropicalis. METHODS: A total 372 Candida isolates from various samples in a tertiary burn center were studied, and the MICs of Candida isolates to fluconazole, itraconazole, and voriconazole were tested by broth microdilution method of the Clinical and Laboratory Standards Institute (CLSI) M27-A2. A comparison was made between Candida isolates from burn patients and non-burn patients. RESULTS: The percentages of C. albicans, C. tropicalis, C. parapsilosis and C. glabrata isolates from burn patients and non-burn patients were 42.3% and 64.2% (P=0.000), 35.7% and 21.6% (P=0.002), 11.9% and 7.8%, and 10.1% and 6.4%, respectively. Decreased susceptibilities to fluconazole, itraconazole, and voriconazole were observed more frequently in burn patients (4.76%, 19.05%, and 0.60%, respectively) than non-burn patients (2.45%, 14.22%, and 0%, respectively). CONCLUSION: The results of this study suggest that burn may lead to influence the species distribution and susceptibilities to azoles of Candida species.
Azoles ; Burn Units ; Burns ; Candida ; Candida tropicalis ; Danazol ; Diabetes Mellitus ; Fluconazole ; Humans ; Itraconazole ; Pyrimidines ; Triazoles

BACKGROUND: Pediatric onychomycosis has been previously investigated; however, the specific causative agents of onychomycosis in Korean children have not been reported. OBJECTIVE: This study aimed to determine the most common causative agents of onychomycosis in Korean children. METHODS: We reviewed the medical records of 149 pediatric patients (<18 years of age) referred for fungal cultures because of a clinical suspicion of onychomycosis between 2005 and 2014 at our clinic. Patient specimens were cultured on Sabouraud's dextrose agar with and without cycloheximide. RESULTS: Onychomycosis was clinically suspected in 149 children. Of the 44 patients with onychomycosis, confirmed by culture, 72.7% had toenail onychomycosis, 22.7% had fingernail onychomycosis, and 4.5% had toenail and fingernail onychomycosis. The male-to-female patient ratio was 1.93:1. Fourteen (31.8%) children had concomitant tinea pedis, and 12 (27.2%) had family members with tinea pedis or onychomycosis. Distal and lateral subungual onychomycosis were the most common (68%) clinical types. Trichophyton rubrum was the most frequently isolated pathogen (66.7%), followed by Candida albicans (14.8%), Microsporum canis (11.1%), Candida parapsilosis (3.7%), and Candida tropicalis (3.7%). Candida albicans was the most commonly isolated pathogen (50.0%) in fingernail onychomycosis. CONCLUSION: Pediatric onychomycosis is more common than most people think. Thus, we suggest the need for a careful mycological examination of children with suspected onychomycosis.
Agar ; Candida ; Candida albicans ; Candida tropicalis ; Child* ; Clinical Study* ; Cycloheximide ; Glucose ; Humans ; Medical Records ; Microsporum ; Nails ; Onychomycosis* ; Tinea Pedis ; Trichophyton

BACKGROUND: Animal skin provides an ideal medium for the propagation of microorganisms and it is used like raw material in the tannery and footware industry. The aim of this study was to evaluate and identify the microbial load in oropharyngeal mucosa of tannery employees. METHODS: The health risk was estimated based on the identification of microorganisms found in the oropharyngeal mucosa samples. The study was conducted in a tanners group and a control group. Samples were taken from oropharyngeal mucosa and inoculated on plates with selective medium. In the samples, bacteria were identified by 16S ribosomal DNA analysis and the yeasts through a presumptive method. In addition, the sensitivity of these microorganisms to antibiotics/antifungals was evaluated. RESULTS: The identified bacteria belonged to the families Enterobacteriaceae, Pseudomonadaceae, Neisseriaceae, Alcaligenaceae, Moraxellaceae, and Xanthomonadaceae, of which some species are considered as pathogenic or opportunistic microorganisms; these bacteria were not present in the control group. Forty-two percent of bacteria identified in the tanners group are correlated with respiratory diseases. Yeasts were also identified, including the following species: Candida glabrata, Candida tropicalis, Candida albicans, and Candida krusei. Regarding the sensitivity test of bacteria identified in the tanners group, 90% showed sensitivity to piperacillin/tazobactam, 87% showed sensitivity to ticarcillin/clavulanic acid, 74% showed sensitivity to ampicillin/sulbactam, and 58% showed sensitivity to amoxicillin/clavulanic acid. CONCLUSION: Several of the bacteria and yeast identified in the oropharyngeal mucosa of tanners have been correlated with infections in humans and have already been reported as airborne microorganisms in this working environment, representing a health risk for workers.
Alcaligenaceae ; Animals ; Bacteria ; Candida ; Candida albicans ; Candida glabrata ; Candida tropicalis ; DNA, Ribosomal ; Enterobacteriaceae ; Humans ; Moraxellaceae ; Mucous Membrane* ; Neisseriaceae ; Pseudomonadaceae ; Skin ; Xanthomonadaceae ; Yeasts

BACKGROUND: Candidemia has increased with an increasing number of people in the high risk group and so has become more important. This study was conducted to investigate the isolation rate of Candida species from candidemia patients and the change in rate of antifungal resistance. METHODS: At a single tertiary care hospital, 1,120 blood cultures positive for Candida species from 1997 to 2016 were investigated according to date of culture, gender, age, and hospital department. RESULTS: During the investigation period, the number of candidemia patients increased from 14 in 1997 to 84 in 2016. The most common organism identified during the two decades was Candida albicans (40.8%), followed by Candida parapsilosis (24.1%), Candida tropicalis (13.2%), and Candida glabrata (12.8%). C. glabrata was relatively common in females (45.5%) compared to males. The age group 40-89 years was more frequently infected than other age groups, and the most frequent isolates according to age group were C. albicans in neonate (66.7%), C. parapsilosis in 1-9-year-olds (41.7%), and C. glabrata in those aged ≥60 years (range; 13.3%–20.0%). According to the visited departments, C. albicans, C. glabrata, and Candida haemulonii were more common in medical departments, while C. parapsilosis was more common in surgical departments. In the antifungal susceptibility test, a rising trend of azole resistance among C. albicans and C. glabrata was observed in recent years. CONCLUSION: In this study, it was confirmed that the isolation rate of Candida species in blood is different by age, gender, and hospital department, and the distribution of isolated Candida species changed over time. The resistance patterns of antifungal agents are also changing, and continuous monitoring and proper selection of antifungal agents are necessary.
Antifungal Agents ; Candida albicans ; Candida glabrata ; Candida tropicalis ; Candida* ; Candidemia* ; Danazol ; Drug Resistance, Fungal* ; Female ; Hospital Departments ; Humans ; Infant, Newborn ; Male ; Prevalence* ; Tertiary Healthcare*

Candida spp. is an invasive infectious fungus, a major risk factor that can increase morbidity and mortality in hospitalized patients. In this study, 2,508 Candida spp. were isolated from various clinical specimens collected from university hospitals from July 2011 to October 2014. They were identified in order to determine isolation frequencies and characteristics by specimen, gender, age group, year, season, and month. The strain-specific isolation rate of Candida spp. is in the order of Candida albicans (1,218 strains, 48.56%), Candida glabrata (416 strains, 16.59%), Candida utilis (305 strains, 12.16%), Candida tropicalis (304 strains, 12.12%), and Candida parapsilosis (116 strains, 4.63%) and these five species accounted for more than 94% of the total strains. Of the specimens, Candida spp. were most frequently isolated from urine-catheter, followed by urine-voided, blood, sputum, other, open pus, vaginal discharge, Tip, ear discharge, bronchial aspiration and bile, in that order. Looking at the age distribution, the detection rate of patients in their 60s and older was significantly higher at 75.8% (1,900/2,508). The detection rate of patients in their 20s and younger was shown to be very low at 2.55% (64/2,508). By year, the detection rate of non-albicans Candida spp. showed a tendency to gradually increase each year compared with C. albicans. As isolation of Candida spp. from clinical samples at the specie level can vary depending on characteristics of the patient, sample, season, etc., continual studies are required.
Age Distribution ; Bile ; Candida albicans ; Candida glabrata ; Candida tropicalis ; Candida* ; Ear ; Fungi ; Hospitals, University ; Humans ; Mortality ; Risk Factors ; Seasons ; Sputum ; Suppuration ; Vaginal Discharge

Renal papillary necrosis(RPN) is a 4bointerstitial nephropathy accompanied by compromised medullary blood flow that ultimately results in a focal or diffuse ischemic necrosis of segments of the renal medulla. Renal papillary necrosis is infrequently reported as complication of fungal infections. Underlying condi- tions such as prematurity, immunosuppressive therapy, neoplastic disease, previous antibiotic therapy, diabetes mellitus, extensive burn and indwelling vascular catheters were found in candidal RPN. Candidal renal papillary necrosis is a extremely rare and fatal disease. Only 20 cases were reported over the past. There were only three survivors which were diagnosed were treated with antifugal agents early in the clinical course. As far as we know, this case is the first case of candidal RPN treated with bilateral nephrectomy. We report a case of candidal renal papillary necrosis in a 66-year-old diabetic woman treated with bilateral nephrectomy, along with review of the literatures.
Aged ; Burns ; Candida tropicalis ; Candidiasis ; Diabetes Mellitus ; Female ; Humans ; Necrosis* ; Nephrectomy ; Survivors ; Vascular Access Devices

Xylitol, a five-carbon sugar alcohol, has many interesting applications in the food, pharmaceutical, and odontological industries, owing to its high sweetening power, its anticariogenic properties, and its insulin-independent metabolism. The bioconversion of detoxified hemicellulosic hydrolysate to xylitol by microorganisms could be a cheaper alternative to the current chemical process, since it is a simple process, with great specificity and low energy requirements. However, the success of fermentations for xylitol production depends on the productivity of the strain and its tolerance to different toxic or inhibitory compounds existing in the hydrolysates. In addition, a number of culture process parameters proved to have significant effects on xylitol production in hemicellulosic hydrolysate media. One of the most important control variables in this bioconversion is the aeration level, which affects the biochemical pathways in the xylose metabolism. The production of biomass is favored by aerobic conditions, while under anaerobic conditions xylose cannot be assimilated by yeast, whereas xylitol is formed in oxygen-limited incubation conditions. An adapted Candida sp. with enhanced resistance to the inhibitors in the hydrolysate can directly ferment the simply detoxified corn cob hemicellulosic hydrolysate to xylitol. In the present study, the combined effects of shaking speed, C/ N ratio, initial pH, and inoculum level on the fermentation of corn cob hemicellulosic hydrolysate to xylitol by an adapted Candida sp. were investigated using an orthogonal experimental design in flask. As a result, the optimum fermentation conditions were as follows: 180 r/min, a C/N ratio of 50, initial pH 5.5, and an inoculum level of 5% (volume ratio). Moreover, the optimum concentration factor of hydrolysate varied between 3.0 and 3.72 was obtained. Based on these results, in order to evaluate the effect of aeration rate on the fermentation of corn cob hemicellulosic hydrolysate to xylitol in fermentor, batch fermentations were carried out in a 3.7 L stirred fermentor using four different aeration strategies, including three kind of two-stage aeration strategies, which provided relatively high aeration rate in the early stage but reduced it in the later stage, and including a one-stage aeration strategy provided a constant aeration rate. With respect to xylitol yield, the results indicated that two-stage aeration strategy was significantly superior to one-stage aeration strategy. The highest xylitol yield (0.75 g/g) was obtained with oxygen supply strategy C (3.75 L/min for first 24 h, then lowered it to 1.25 L/min, 2.5 L fermentation medium was employed). In this process, without extensive detoxification of hydrolysate, an adapted Candida sp. can efficiently ferment the simply treated corn cob hemicellulosic hydrolysate to xylitol under the optimized fermentation conditions. This work should help the development of an efficient process for producing xylitol from corn cob hemicellulosic hydrolysate on a larger scale by bioconversion.
Aerobiosis ; Candida tropicalis ; metabolism ; Fermentation ; Hydrolysis ; Polysaccharides ; metabolism ; Xylitol ; biosynthesis ; Zea mays ; metabolism