Occurrence of fungi and cytotoxicity of the species: Aspergillus ochraceus, Aspergillus niger and Aspergillus flavus isolated from the air of hospital wards.

OBJECTIVES: The basic care requirement for patients with weakened immune systems is to create the environment where the risk of mycosis is reduced to a minimum. MATERIAL AND METHODS: Between 2007 and 2013 air samples were collected from various wards of a number of hospitals in Kraków, Poland, by means of the collision method using MAS-100 Iso MH Microbial Air Sampler (Merck Millipore, Germany). The air mycobiota contained several species of fungi, and almost 1/3 of it was made up of the species of the Aspergillus genus. Sixty-one strains of species other than A. fumigatus were selected for the research purposes, namely: 28 strains of A. ochraceus, 22 strains of A. niger and 11 strains of A. flavus species. Selected fungi underwent a cytotoxicity evaluation with the application of the MTT colorimetric assay (3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide). The assay assesses cell viability by means of reducing the yellow tetrazolium salt to insoluble formazan. A semi-quantitative scale for cytotoxicity grading was adopted: low cytotoxic effect (+) with half maximal inhibitory concentration (IC50) for values ranging from 31.251 cm2/ml to 7.813 cm2/ml, medium cytotoxic effect (++) for values ranging from 3.906 cm2/ml to 0.977 cm2/ml and the high one (+++) for values ranging from 0.488 cm2/ml to 0.061 cm2/ml. The absence of cytotoxicity was determined when the IC50 values was at ≥ 50. RESULTS: For 48 samples the analyzed fungi displayed the cytotoxic effect with A. ochraceus in 26 out of 28 cases, with 11 strains displaying the high cytotoxic effect. The lowest cytotoxicity was displayed by fungi of A. niger in 13 out of 22 cases, and the major fungi of A. flavus species were toxic (9 out of 11 cases). CONCLUSIONS: A half of the fungi displayed the low cytotoxic effect. On the basis of the comparison of average cytotoxicity levels it was determined that there were significant differences in the levels of cytotoxicity of the analyzed fungi. However, such statement may not provide grounds for a definite conclusion about the compared species of fungi that display a more cytotoxic effect than others. Int J Occup Med Environ Health 2017;30(2):231-239.

21-year retrospective study of the prevalence of Scopulariopsis brevicaulis in patients suspected of superficial mycoses.

INTRODUCTION: In the genus Scopulariopsis, Scopulariopsis brevicaulis is the most common aetiological agent of infections in humans. It usually affects nails and is one of the commonest moulds associated with onychomycoses. Other forms of infections (skin, subcutaneous, deep tissues, and disseminated infections) have also been described. AIM: To examine the prevalence of S. brevicaulis in clinical materials obtained from patients suspected of keratinized tissues mycoses. MATERIAL AND METHODS: The analysis of the prevalence of S. brevicaulis in clinical specimens was based on mycological test's results carried out for patients who were referred with a suspicion of superficial mycoses to the Department of Mycology, Chair of Microbiology, Jagiellonian University Medical College from 1992 till 2012. RESULTS: In the years 1992-2012 16,815 clinical samples (nail scrapings, nail swabs, skin scrapings, skin swabs, hair) were collected. Pathogenic fungi were detected in 7193 samples and S. brevicaulis was present in 255 (3.5%). The prevalence of S. brevicaulis in males and females was comparable. The species was most often isolated from toenails (80%), both from males and females. In the analysed period we observed a decrease in the prevalence of S. brevicaulis. In most cases (60%) S. brevicaulis occurred alone in 40% of S. brevicaulis positive cultures, other fungi were also isolated. The fungi most frequently isolated with S. brevicaulis were Trichophyton rubrum, T. mentagrophytes, Penicillium sp., Candida sp., and Aspergillus sp. CONCLUSIONS: Scopulariopsis brevicaulis is not a common cause of superficial fungal infections of keratinized tissues, but is a typical mould associated with toenail onychomycosis. A proper identification of this species in onychomycoses is essential for the implementation of effective antifungal therapy.

Rare zoonotic infection with Microsporum persicolor with literature review.

We report a case of dermatophytosis caused by Microsporum persicolor in a 38-year-old male from Poland. Direct microscopic examination revealed high amounts of fungal hyphae from the right elbow material. The mould recovered in multiple cultures was identified as Microsporum persicolor by molecular identification based on partial of ß-tubulin gene (BT2), internal transcribed spacer, partial small ribosomal subunit (SSU) and large ribosomal subunit, partial translation elongation factor (TEF1) and RNA polymerase second largest subunit (RPB1) loci sequence data. The patient was treated with terbinafine. Clinical and mycological cure was achieved with this regimen and the patient was subsequently followed for 1 year without relapse. Microsporum persicolor is a very rare causative agent of dermatophytosis worldwide. The source of infection for the patient remained unclear and zoonotic transmission could not be confirmed.

In vitro antifungal susceptibility of Scopulariopsis brevicaulis isolates.

In humans, Scopulariopsis is mainly associated with onychomycoses, rarely with cutaneous infections or with invasive mycoses. However, during the last two decades, deep infections caused by members of this genus have been increasing. Scopulariopsis brevicaulis is the most common species described as an etiologic agent of human disease. Previous antifungal susceptibility studies indicate that this species is resistant in vitro to the broad-spectrum antifungal agents that are available today. Here, we describe the antifungal activity of amphotericin B, terbinafine, ciclopirox, itraconazole, ketoconazole, and voriconazole against 40 S. brevicaulis isolates. Antifungal susceptibility tests were performed using a modified Clinical and Laboratory Standards Institute M38-A2 procedure. The results showed that itraconazole had the highest minimal inhibitory concentration (MIC) of >16 mg/l; amphotericin B, voriconazole, and ketoconazole MICs were ranging from 4 to >16 mg/l, 8 to >16 mg/l, and 8 to >16 mg/l, respectively; and the best activity was found with terbinafine and ciclopirox with MICs ranging from 0.5 to 16 mg/l and 1 to 8 mg/l, respectively.

Distribution of Malassezia species on the skin of patients with atopic dermatitis, psoriasis, and healthy volunteers assessed by conventional and molecular identification methods.

BACKGROUND: The Malassezia yeasts which belong to the physiological microflora of human skin have also been implicated in several dermatological disorders, including pityriasis versicolor (PV), atopic dermatitis (AD), and psoriasis (PS). The Malassezia genus has repeatedly been revised and it now accommodates 14 species, all but one being lipid-dependent species. The traditional, phenotype-based identification schemes of Malassezia species are fraught with interpretative ambiguities and inconsistencies, and are thus increasingly being supplemented or replaced by DNA typing methods. The aim of this study was to explore the species composition of Malassezia microflora on the skin of healthy volunteers and patients with AD and PS. METHODS: Species characterization was performed by conventional, culture-based methods and subsequently molecular techniques: PCR-RFLP and sequencing of the internal transcribed spacer (ITS) 1/2 regions and the D1/D2 domains of the 26S rRNA gene. The Chi-square test and Fisher's exact test were used for statistical analysis. RESULTS: Malassezia sympodialis was the predominant species, having been cultured from 29 (82.9%) skin samples collected from 17 out of 18 subjects under the study. Whereas AD patients yielded exclusively M. sympodialis isolates, M. furfur isolates were observed only in PS patients. The isolation of M. sympodialis was statistically more frequent among AD patients and healthy volunteers than among PS patients (P < 0.03). Whether this mirrors any predilection of particular Malassezia species for certain clinical conditions needs to be further evaluated. The overall concordance between phenotypic and molecular methods was quite high (65%), with the discordant results being rather due to the presence of multiple species in a single culture (co-colonization) than true misidentification. All Malassezia isolates were susceptible to cyclopiroxolamine and azole drugs, with M. furfur isolates being somewhat more drug tolerant than other Malassezia species. CONCLUSIONS: This study provides an important insight into the species composition of Malassezia microbiota in human skin. The predominance of M. sympodialis in both normal and pathologic skin, contrasts with other European countries, reporting M. globosa and M. restricta as the most frequently isolated Malassezia species.

Mycobiota of the air in hospital rooms and the fungal colonisation of tracheostomy tubes used by patients diagnosed with larynx cancer--preliminary research.

A tracheotomy tube, as well as the stoma through which it is inserted into the patient's throat, may represent a potential risk of fungal infections for patients suffering from larynx cancer. The study was aimed at evaluating the influence of the hospital room environment on the fungal colonisation of tracheotomy tubes in the case of patients diagnosed with larynx cancer and operated on in the Laryngology ward. The mycological research was carried out in the rooms of the Laryngology ward, from which 105 air samples were collected. Twenty-two Portex and metal tracheostomy tubes collected from 13 patients diagnosed with larynx cancer. Fungi were cultured on 15 tracheostomy tubes: moulds were isolated from 3 of these tubes, and fungi belonging to the genus Candida from the remaining 12. The simultaneous occurrence of the same moulds in the air and on the tracheotomy tubes was observed only in one case (Aspergillus flavus). In conclusion, the same moulds observed in the air can sometimes also be found on the tracheotomy tubes used by patients diagnosed with larynx cancer. Yeast-like fungi are isolated from tracheotomy tubes much more frequently than moulds, and this requires further mycological research.

[Fungi isolated from the vagina and their susceptibility to antifungals]. / Grzyby izolowane z pochwy i ich wrazliwosc na leki przeciwgrzybicze.

INTRODUCTION: Because of the presence of various fungi and changes in their spectrum in the mycosis of vagina it is necessary to perform periodic overviews including testing their susceptibility to antifungal agents. OBJECTIVE: The objective of the study was to evaluate susceptibility of the fungi isolated from vaginas to antifungal drugs and to analyse the fungi responsible for vaginal mycosis in patients referred during a 7-year study MATERIALS AND METHODS: The study was carried out in a group of patients suspected of vaginal mycosis between January 1, 2005 and December 31, 2011. An analysis of the fungi isolated from their vaginas was performed. The susceptibility of the fungi to six antifungals (5-fluorocytosine, amphotericin B, miconazole, ketoconazole, itraconazole and fluconazole) was evaluated using a semiquantitative Fungitest. RESULTS: A total of 4775 mycological test results were evaluated. Fungi were present in 30.6% of the material. C. albicans was the most frequently isolated fungal species (80.2%), followed by C. glabrata (5.8%), and S. cerevisiae (5.5%). Itraconazole turned out to be the least effective drug. C. krusei. was the species most resistant to antifungals, including fluconazole. CONCLUSIONS: 1. C. albicans is the species most frequently isolated from a vagina. It is highly susceptible to azoles, the antimycotics generally used in the treatment of vaginal mycosis. 2. Out of the azoles under study ketoconazole was the most active against fungi in vitro while itraconazole was the least active. 3. The Candida non-albicans species, and particularly C. krusei, are less susceptible to antimycotics. 4. Amphotericin B and 5-fluorocytosine are most effective against Candida strains and S. cerevisiae, however they are not used in the treatment of vaginal mycosis because of their high toxicity

Air-conditioning vs. presence of pathogenic fungi in hospital operating theatre environment.

Infections related to modern surgical procedures present a difficult problem for contemporary medicine. Infections acquired during surgery represent a risk factor related to therapeutical interventions. Eradication of microorganisms from hospital operating theatre environment may contribute to reduction of infections as the laminar flow air-conditioning considerably reduces the number of microorganisms in the hospital environment. The objective of the study was to evaluate the occurrence of fungi in air-conditioned operating theatre rooms. The study was carried out in one of the hospitals in Krak6w during December 2009. Indoor air samples and imprints from the walls were collected from five operating theatre rooms. A total of fifty indoor air samples were collected with a MAS-100 device, and twenty five imprints from the walls were collected using a Count Tact method. Fungal growth was observed in 48 air samples; the average numbers of fungi were within the range of 5-100 c.f.u. in one cubic metre of the air. Fungi were detected only in four samples of the wall imprints; the number of fungi was 0.01 c.f.u. per one square centimetre of the surface. The mould genus Aspergillus was most frequently isolated, and the species A. fumigatus and A. versicolor were the dominating ones. To ensure microbiological cleanness of hospital operating theatre, the air-conditioning system should be properly maintained. Domination of the Aspergillus fungi in indoor air as well as increase in the number of moulds in the samples taken in evenings (p < 0.05) may suggest that the room decontamination procedures were neglected.

In vitro antifungal susceptibility testing of Scopulariopsis brevicaulis strains using agar diffusion method.

The genus Scopulariopsis is a common soil saprotroph and has been isolated from air, organic waste and also from plant, animal and human tissues. Scopulariopsis has mainly been associated in humans with superficial mycoses, but it has also been described as the cause of subcutaneous and invasive infections. The most common aetiological agent of infections in humans is Scopulariopsis brevicaulis. This species has been reported to be resistant in vitro to broad-spectrum antifungal agents available today. The aim of the study was to establish in vitro antifungal susceptibility of 35 S. brevicaulis strains against amphotericin B (AMB), flucytosine (FC), caspofungin (CAS), terbinafine (TER), ciclopirox (CIC), voriconazole (VOR), clotrimazole (CTR), miconazole (MCZ), econazole (ECO), ketoconazole (KET), itraconazole (ITR), and fluconazole (FLU). Antifungal susceptibility tests were evaluated by an agar diffusion method (Neo-Sensitabs, Rosco, Denmark). AMB, FC, CAS, ITR and FLU showed no antifungal activity against S. brevicaulis. TER, CIC, CTR, KET, VOR, ECO, and MCZ revealed inhibitory activity for S. brevicaulis, but it varied for each of the drugs. The best antifungal effect was observed for TER and CIC. All isolates had large inhibition zones for TER and CIC. CTR was also inhibitory for all tested S. brevicaulis isolates, but the diameters of inhibition zones were smaller than for TER and CIC. Nearly 89% isolates showed inhibition zones for KET and the mean diameter of the inhibition zone was comparable to CTR. The least antifungal activity exhibited VQR, ECO and MCZ. Because of the multiresistance of S. brevicaulis, infections due to this species may not respond to particular antifungal treatment and other therapeutic approaches should be considered, e.g., combined therapy and/or surgery.

Cytotoxicity of Aspergillus fungi isolated from hospital environment.

The majority of mycotoxins produced by Aspergillus fungi are immunosuppressive agents, and their cytotoxicity may impair defense mechanisms in humans. The objective of the study was evaluation of the cytotoxicity of fungi isolated from an environment where inpatients with impaired immunity were present. The materials comprised 57 fungal strains: Aspergillus fumigatus, Aspergillus niger: Aspergillus ochraceus, Aspergillus flavus, Aspergillus versicolor and Aspergillus ustus isolated from hospital rooms in Cracow. The cytotoxicity of all the strains was evaluated using the MTT test (3-(4,5-dimethylthiazol-2-yl) 2,5 diphenyltetrazolium bromide). To emphasize the differences in cytotoxicity among the particular strains, variance analysis (ANOVA) and Tukey's difference test were used. Out of 57 Aspergillus strains tested, 48 (84%) turned out to be cytotoxic. The cytyotoxicity was high (+++) in 21 strains, mainly in A. fumigatus. The least cytotoxic were A. niger fungi, this being statistically significant (p<0,05). To protect a patient from the adverse effects of mycotoxins, not only his or her immunity status should be evaluated but also the presence of fungi in hospital environment and their cytotoxicity should be monitored (possible exposure).

Drug susceptibility of 64 strains of Rhodotorula sp.

Rhodotorula sp. have emerged as opportunistic pathogens, particularly in immunocompromised patients. Knowledge about the susceptibility of Rhodotorula strains to the common antifungal drugs is essential for the treatment of such new infections. The 68 isolates identified as: Rhodotorula mucilaginosa (47 strains; 69%), R. minuta (14; 21%) and R. glutinis (7; 10%) obtained from various sources (feces, skin and nails, vagina and hospital environment) were tested for susceptibility to 5-fluorocytosine (5FC), amphotericin B (AMB), fluconazole (FLC) and itraconazole (ITR). All of the isolates had low MICs for AMB and 5FC. For ITR, the R. minuta isolates had the lowest MICs within a range 0.125-0.25 mg/l and for FLC all isolates affected within the range 2-64 mg/l. The majority of R. mucilaginosa isolates (82.2%) had MICs in the range 64-128 mg/l for FLC and 95.6% of isolates had MICs above or equal to 2 mg/1 for ITR.

[Fungi isolated from the stool in patients with gastrointestinal disorders in 2005 - 2009]. / Grzyby izolowane z kalu pacjentów z dolegliwosciami przewodu pokarmowego w latach 2005 - 2009.

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.

[Nail susceptibility to fungal infection in patients with type 1 and 2 diabetes under long term poor glycaemia control]. / Podatnosc paznokci na zakazenie grzybicze u chorych na cukrzyce typu 1 i 2 z dlugoterminowa zla kontrola glikemii.

Onychomycosis is a common disorder in adults. Its prevalence increases also in diabetics. The objective of the study was: 1) evaluation of finger and toe nail susceptibility to Candida albicans and Trichophyton mentagrophytes infection in patients with type 1 and type 2 diabetes with long term glycaemia under poor control as compared with healthy persons, and 2) checking whether or not various aetiology of type 1 and type 2 diabetes may influence the intensity of fungal nail infection. The materials comprised finger and toe nails sampled from 26 patients with type 1 diabetes (20 females and 6 males at average age 51 +/- 10 years), 25 patients with type 2 diabetes (17 females and 8 males at average age 58 +/- 4 years). Twenty two healthy volunteers (18 females and 4 males at average age 47 +/- 14 years) served as controls. All of the diabetics (except one with type 1 diabetes and four with type 2 diabetes) had increased fasting glycaemia; moreover, all of them had poor controlled long term glycaemia because the concentration of glycated haemoglobin HbAlc exceeded 7.5%. The patients with type 1 diabetes were treated with insulin while those with type 2 diabetes with diet only (one person), with gliclazide (sixteen persons), with glimepirid (five persons), and with metformin (four persons). Enhanced fingernail susceptibility to Candida albicans infection was detected in 38.5% of the patients with type 1 diabetes, in 28% of those with type 2 diabetes, and in 22.7% of the controls. Intensive toenail infection was found in 34.6%, 20%, and 22.7% respectively. Enhanced fingernail susceptibility to Trichophyton mentagrophytes infection was found in 30.8% of the patients with type 1 diabetes, in 48% of those with type 2 diabetes, and in 4.54% of the controls while intensive toenail infection in 15.4%, 20%, and 18,2% respectively. Statistical analysis gave evidence of statistically significant higher susceptibility to infection of finger and toe nails with T. mentagrophytes but not with C. albicans in both type 1 and type 2 diabetics, as compared with the controls. In the diabetics, no significant correlation was found between the susceptibility to C. albicans and T. mentagrophytes infection and the age of the patients, metabolic diabetes control (evaluated on the basis of serum glucose level and blood HbAlc concentration), as well as the duration of diabetes.

[Susceptibility of fungi isolated from clinical materials to voriconazole]. / Wrazliwosc na worikonazol grzybów izolowanych z materialu klinicznego.

The objective of the study was evaluation of the susceptibility of 139 fungal strains isolated from clinical materials to Voriconazole, a new antifungal agent of the triazole group. A dilution method was used. The drug was incorporated into the culture medium at concentrations 0.1-100 mg/l. It was found out that the antifungal effectiveness of the drug varied both between various fungal genera and species, and between strains within the same species. Total inhibition of the growth of 20% of the yeast-like fungi and 23.3% of the moulds was achieved at concentration 0.1 mg/l. It was documented that the species Candida guilliermondii, C. kefyr, Saccharomyces cerevisiae and Aspergillus fumigatus, that as a rule are resistant to triazoles, were highly susceptible to Voriconazole. Dermatophytes, too, were highly susceptible to the drug, particularly Trichophyton mentagrophytes and T. rubrum. The drug at concentration 0.1 mg/l totally inhibited 73.5% of the dermatophytes, and at concentration 1 mg/l--97.0% of them after 7 day incubation. After 14 day incubation, 97.0% of the strains were also inhibited at drug concentration not exceeding 1 mg/l.

[Nail susceptibility to fungal infections in patients with hypothyroidism and hyperthyroidism]. / Podatnosc paznokci na zakazenie grzybicze u chorych z niedoczynnoscia i nadczynnoscia tarczycy.

Onychomycosis is a frequent disorder in adults. The objective of the study was evaluation of finger and toe nails susceptibility to Candida albicans and a dermatophyte Trichophyton mentagrophytes infection in patients with symptomatic hypothyroidism and hyperthyroidism as compared with healthy persons. The materials comprised finger and toe nails from 23 patients with hypothyroidism (in 8 cases postoperative, and in 15 cases caused by Hashimoto type thyroiditis), and from 27 patients with hyperthyroidism (including 17 cases of Graves-Basedow disease, and 10 with nodular goitre). Nails from 22 healthy persons of similar sex and age distribution served as controls. A significantly more frequent and more intensive than in control group toe nail infection with C. albicans was found in the patients with both hypothyroidism and hyperthyroidism. The enhanced toe nail susceptibility to C. albicans infection did not depend on autoimmunological aetiology of both hypothyroidism and hyperthyroidism.

[Exogenous and endogenous infections of genital tract]. / Infekcje egzogenne i endogenne dróg rodnych.

The paper is an overview of etiological factors, clinical manifestations, diagnostics and treatment of genital tract infections. Infections caused by Trichomonas vaginalis, fungi Candida, Saccharomyces and Geotrichum are discussed as well as syphilis, gonorrhea and infections with Chlamydia, mycoplasms and ureaplasms. The problem of vaginal dysbacteriosis and mixed infections is pointed out.

[The extent of immune response impairment vs. the prevalence and clinical form of oral candidiasis in HIV patients]. / Wplyw stopnia uposledzenia odpornosci na wystepowanie i postac grzybicy jamy ustnej u pacjentów zakazonych wirusem HIV.

The objective of the study was a mycological and clinical evaluation of the course of oral cavity fungal infection in HIV patients in relation to the immune response impairment. The patients were examined physically (symptoms and signs) and mycologically (isolation and identification of fungi, semiquantitative evaluation their growth abundance in the cultures); the immunity status was expressed in terms of the number of CD4 lymphocytes. The most frequently isolated fungal species was Candida albicans. The decreasing immunity was conductive to more abundant fungal growth in the oral cavity as well as to more frequent occurrence of clinical manifestations of candidiasis.

Susceptibility to fungal infections of nails in patients with primary antibody deficiency.

Primary antibody deficiencies are rare diseases, which require early treatment with intravenous immunoglobulins to prevent fatal infections. The cell mediated immunity in patients with those immunodeficiencies remains unimpaired and usually they do not develop fungal infections. The aim of the study was to determine the susceptibility to fungal infections of nails in children with X-linked agammaglobulinaemia (XLA) and common variable immunodeficiency (CVID). Nail plate fragments collected from five patients with XLA and five with CVID were experimentally infected with a Candida albicans and Trichophyton mentagrophytes strains. The same procedures were carried out with the nails from a control group of 10 healthy volunteers. The intensity of the infection was evaluated on the basis of hyphae ingrown into the nail fragments. The main finding of the study was the increased susceptibility of antibody deficient patients to experimental nail infection with C. albicans and T. mentagrophytes.

Various patterns of oral mucosa candidiasis treatment in HIV patients.

Oral cavity is the site of numerous HIV infection manifestations. Oral mucosa candidiasis is the most common one. It may be the earliest sign of the underlying disease. Long lasting observations give evidence that antiretroviral therapy is beneficial also in the cases of this opportunistic infection because it reduces both the number and severity of relapses, however, the prolongation of the patients' survival time creates the need of antifungal therapy prolongation, and thorough observation of its effectiveness and methods. We decided to analyze the influence of antiretroviral therapy with at least three drugs on the development of oral mucosa candidiasis in the out- and inpatients of the Jagiellonian University Medical College Clinic of Infectious Diseases (or Outpatient Clinic) in Cracow. The study was carried out in 75 patients with confirmed HIV infection. We have shown a decrease in the number of fungi present in the oral cavity in patients under antiretroviral treatment as well as higher susceptibility to fluconazole.