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The mycological examination of 2242 stool specimens sampled form patients with non-specific gastrointestinal tract ailments was focused on the spectrum of fungal species isolated in culture, the frequency of isolation of the particular species high enough to indicate microbiological imbalance in the gut flora as well as evaluation of the fungal susceptibility to the antifungal agents. Fungal presence was detected in 61.5% of the specimens tested. The fungal flora isolated was as follows: C. albicans 70.9% of the isolates, Candida non-albicans 20.8% (including C krusei 3.40%, C. parapsilosis 1.88%, C. glabrata 1.59%), other genera 8.34% (including S. cerevisiae 5.58%, Geotrichum sp. 1.16%, and Trichosporon sp. 1.01%). The results of semiquantitative evaluation of the intensity of growth of the fungi isolated from the stool revealed that imbalance in the gut flora occured in 20.8% of the cases. Candida strains tested using Fungitest were less susceptible to azoles than to amphotericin B and 5-fluorocytosine. Decreased susceptibiliy or resistance to antimycotics was relatively often found among Candida non-albicans strains.

Patients with renal failure are more frequently at risk of fungal infections than the healthy individuals. The aim of the study was: (1) Evaluation of the prevalence of fungi in biological materials obtained from different ontocenoses from patients with end-stage and chronic renal failure undergoing haemodialysis and conservative treatment, respectively. (2) Species determining of isolated fungal strains and evaluation their morphological and biochemical features with regard to biotyping. (3) Examining the connection between intraspecies features of fungal strains isolated from different ontocenoses of the same patient. The study group comprised 136 persons, including 56 patients with end-stage renal failure dialysed for the mean period of 36.2 (+/- 1.62) months--all patients were on chronic haemodialysis therapy (4 hours sessions, 3 times per week), 50 patients with chronic renal failure undergoing conservative treatment and 30 persons with the negative history of any renal disease--control group. At the moment of the evaluation and collection of samples all patients were in good condition, none of the patients revealed symptoms suggesting possible fungal infection. Material for mycological examinations included washings from the oral cavity and samples of urine and faeces. In order to evaluate morphological and biochemical features of fungi the following methods were applied: (1) macrocultures in solid Sabouraud medium, (2) direct microscopic slides, (3) API 20 C AUX test and (4) API ZYM test (bioMérieux). Totally 385 samples for mycological examinations were collected from different ontocenoses, from which 161 fungal strains were isolated and classified to 17 species from 5 genera. Most strains belonged to the genus Candida 96.9% and the most frequently occurring species was C. albicans (60.3%). Other species from this genus composed 39.7%, among which in 11.8% of cases C. parapsilosis was determined, and the following were: C. guilliermondii and C. humicola--both species isolated in 5.59%, C. glabrata (4.35%), C. rugosa and C. tropicalis (both species were isolated in 2.48%). The remaining isolated fungal strains (3.11 +/- 1.37%) belonged to genera Cryptococcus, Geotrichum, Saccharomyces and Trichosporon. The prevalence of fungi in collected biological materials from chronic dialysed patients, treated conservatively and persons from control group was determined at the level of 96.4%, 64.0% and 63.3%, respectively. In all examined groups fungi were found in high percentage in the ontocenoses of oral cavity and gastrointestinal tract; in dialysed patients (40.7%), treated conservatively (34.4%) and in persons with negative history of any renal disease (42.1%). It should be expressed that in 9.37% of patients with chronic renal failure undergoing conservative treatment fungi were determined at the same time in materials obtained from three ontocenoses--oral cavity, gastrointestinal tract and urinary tract. The majority of C. albicans strains (34.0%) was described by the use of code AUX 2 576 174; code 2 566 174 was found in 23.4% of species. Strains with code AUX 2 576 174 in 96,9% were isolated from chronic haemodialysed patients whereas code 2 566 174 characterized strains (68.2%) obtained from patients treated conservatively. Examined fungal strains from genus Candida obtained from all persons revealed the activity of 10 to 17 enzymes in the API ZYM test. Strains of genus Candida albicans obtained from patients with chronic renal failure treated conservatively and undergoing haemodialysis in majority belonged to biotype A (58.8%) and D3 (40.4%), respectively.

In 77 diabetic patients the detection of fungi was carried out in the oral cavity, digestive tract, genital organs and skin lesions. Patient age ranged from 39 to 82 years, with the Body Mass Index (BMI) from 22 to the highest values of 46.5. Diabetes control was assessed by determination of the glucose level in serum after overnight fasting and after lunch, as well as by determination of the HbA(1c) level. Fungi were diagnosed in 61 patients (79.6%). The total of 111 fungal strains were isolated in 319 cultures evaluated from 12 biological materials. Fungal strains were detected in the highest percentage in oral cavity (77.9%), in the lower percentage in anus (33.8%), vagina discharge (11.6%) and the region of vulva (14.3%). Fungi were observed in one focus--exclusively in the oral cavity--in 28 (36.4%) patients, whereas they occurred in multifocal infections in 33 (42.9%) patients. The isolated fungal strains were classified into 4 genera (Candida, Saccharomyces, Trichosporon, Aspergillus) and 12 species. The most frequently detected fungi were C. albicans (55.2%), followed by C. glabrata (12.4%), C parapsilosis (10.5%) and C. tropicalis (9.5%). Relatively low percentage of fungi identified in vagina was associated, among others, with the fact that most of the female patients with diabetes were at the postmenopausal period. In all the patients in whom fungi were isolated from the vagina contents, these fungi were also found in other ontocenoses. The increase in percentage of fungal strains from genera other than Candida in patients with a higher risk is of clinical importance, as some of them are resistant in vitro to azole derivatives e.g. fluconazole. The digestive tract is thought to be the most frequent fungal habitat. A considerable prevalence of fungi, multifocal infections, particularly related to oral cavity and anus, and occurrence of high percentage of strains different from C. albicans species of Candida genus in female patients with type 2 diabetes indicate the necessity of the special mode of diagnostic and therapeutic management.