Young Kwon Kim

National surveillance of antifungal susceptibility of Candida species in South Korean hospitals.

We investigated the species distribution and antifungal susceptibility of Candida isolates from tertiary and non-tertiary hospitals in South Korea from 2002-2004. Of the 612 Candida isolates that were collected, Candida albicans, C. parapsilosis, C. tropicalis, and C. glabrata occurred most frequently, accounting for 97.3% and 96.8% of the isolates in tertiary and non-tertiary hospitals, respectively. C. albicans was the most common isolate, but the incidence of non-C. albicansCandida species was higher than that of C. albicans in tertiary hospitals. The Candida species had much lower MIC(90) to voriconazole (tertiary hospitals: 0.5 microg/ml, non-tertiary hospitals: 0.25 microg/ml) than to fluconazole (tertiary hospitals: 8 microg/ml, non-tertiary hospitals: 4 microg/ml). The MIC(90) of Candida isolates to 5-flucytosine in non-tertiary hospitals was two times higher than that observed in tertiary facilities. The C. glabrata isolates showed a tendency toward strong resistance to fluconazole, but C. parapsilosis isolates were susceptible to all of the evaluated antifungal agents. Voriconazole showed strong in vitro activity against Candida species, especially C. krusei, which is resistant to fluconazole and 5-flucytosine. To our knowledge, this is the first report of Candida antifungal susceptibility that includes non-tertiary hospitals in South Korea.

Prevalence of fungal infections using National Health Insurance data from 2009-2013, South Korea.

OBJECTIVES The symptoms of fungal infections vary from minor to severe. According to recent reports, fungal infection prevalence is increasing due to increases in the aging population and in patients with compromised immune systems. However, the total prevalence of fungal infections in South Korea is unknown. We investigated the recent 5-year prevalence of each type of fungal infection in South Korea across age, sex, and regional groups. METHODS Nationwide data from the National Health Insurance of South Korea were used. The target population included patients who had received treatment for a fungal infection that was listed as the main disease. For each patient, multiple treatments were counted as one case per year in the data analysis. RESULTS The annual prevalence of all-type mycoses increased from 6.9% in 2009 to 7.4% in 2013. Among the specific groups, the prevalence of dermatophytosis was highest (5.2%), followed by that of opportunistic mycoses (1.7%) and superficial mycoses (0.2%). The prevalence of subcutaneous mycoses and generalized mycoses was very low (8 cases per 100,000 persons and 3 cases per 1 million persons, respectively). CONCLUSIONS Every year, approximately 7.1% of the Korean population receives treatment for fungal diseases. Cases of opportunistic mycoses are assumed to increase each year. Therefore, further research is needed to understand and monitor the prevalence of mycoses to establish management policies to reduce the burden of fungal diseases.

Epidemiological Characterization of Skin Fungal Infections Between the Years 2006 and 2010 in Korea

Objectives The purpose of this study was to build and provide a basic database of skin fungal infections for the effective management of skin fungal infections in the future. Methods We collected health insurance data between the years 2006 and 2010 from the Health Insurance Corporation (Seoul, Korea) and analyzed the data to determine the prevalence and treatment management of skin fungal infections. Results Skin fungal infections were divided into two groups: namely dermatophytosis and other superficial mycoses. Dermatophytosis showed a higher prevalence (16,035,399 cases) than the other superficial mycoses (794,847 cases) within the study period. The prevalence rate decreased consecutively by 0.01% to 0.19% every year. The prevalence according to region showed that Jeolla-do had a high prevalence distribution. The prevalences in men and women were similar (7.01% vs. 6.26%). It is interesting to note that adults from the 50–79-year age group showed a higher prevalence than children and young adults. The average convalescence time (days) of dermatophytosis was longer than that of other superficial mycoses. The total medical expenses were also much higher in dermatophytosis than in the other superficial mycoses. Conclusion This study provides useful data for study trends of skin fungal infections.

Epidemiological Characterization of Opportunistic Mycoses between the Years 2006 and 2010 in Korea.

In order to perform an epidemiological characterization of opportunistic mycosis infections, we collected health insurance data between the years 2006 and 2010 from the Health Insurance Corporation and analyzed the data to determine the prevalence of opportunistic mycoses and treatment management of opportunistic mycoses. The prevalence within the study increased consecutively by 0.02% to 0.12% every year. The annual prevalence of opportunistic mycoses increased from 2.437% in 2006 to 2.709% in 2010. The average annual prevalence was 2.605%. Candidiasis occurred the most frequently, followed by aspergillosis, zygomycosis, and cryptococcosis. The regions with the highest incidences were the capital areas, Gyeonggi and Seoul. By sex, the prevalence in females (4.851%) was 14 times higher than that in males (0.352%). Interestingly, the adults from the 20- to 49-year-old age group showed higher prevalence than children and the elderly. The average duration of hospitalized treatment was 17.31 days and of outpatient treatment was 2.21 days; 3,577 hundred million won was used in total for medical expenses. This study provides useful data to study trends of opportunistic mycoses.

Superficial mycosis of the foot caused by Cladophialophora boppii

Dear Editor, Dematiaceous fungi are a heterogeneous group of fungi that remain an uncommon cause of infection in humans. However, in recent years, dematiaceous fungi have become increasingly recognized as significant human pathogens in a wide variety of clinical syndromes. Though Cladophialophora is a genus of black yeast-like fungi that are frequently encountered in human infections, ranging from mild cutaneous lesions to fatal encephalitis, Cladophialophora boppii is not commonly encountered in human infections. C. boppii has been isolated

Characterization of Clostridium difficile Strains Isolated from Patients with C. difficile-associated Disease in Korea

Objectives Studies on Clostridium difficile are rare in Korea. We investigated the epidemiological characteristics of C. difficile isolates from patients with C. difficile-associated disease (CDAD) in Korea. Methods Multiplex polymerase chain reaction was performed to detect the presence of tcdA and tcdB toxin genes. Antimicrobial susceptibility test was carried out by the disk-dilution method. C. difficile strains were subtyped by automated repetitive-element palindromic PCR (rep-PCR). Results Among patients with CDAD, 73 (25.8%), 32 (11.3%), 32 (11.3%), and 26 (9.2%) suffered from pneumonia, cancer or neoplasm, diabetes, and colitis, respectively. Of all stool samples, 43 samples (15.2%) were positive for C. difficile strains. We observed two expression patterns of toxin genes: tcdA+/tcdB+ (86% isolates) and tcdA−/tcdB+ (14% isolates), with all isolates expressing tcdB. Furthermore, some isolates were resistant to clindamycin (65%), ampicillin (56%), and cefazolin (40%), but all were susceptible to vancomycin and metronidazole. The tested samples were classified into diverse clusters using automated rep-PCR. Conclusion Our findings revealed the characteristics and antibiotic resistance of C. difficile isolates from patients in Korea. The epidemiological data may provide valuable insight into development of treatment strategies for C. difficile infections in Korea.