**3.1 Geographical distribution of dermatophytes in Poland**

Studies on epidemiology of dermatomycoses in different parts of the world show how large changes can occur in the fungal biota in just a few decades. This phenomenon concerns also Poland and it is affected by changing environmental factors, including the formation of ever larger urban agglomerations, permanently changing profiles of the economy, and also clearly present in the last 15 - 20 years the changes in climatic conditions (Kobierzycka et al., 2005; Macura & Pawlik, 1998; Szepietowski & Baran, 2005). Of great importance is also easy to move to distant climatic - geographical regions – both tourist travel and mass migration

Epidemiology of Dermatomycoses in Poland over the Past Decades 39

*capitis* caused by *Trichophyton schoenleinii* in Poland now is mainly associated with progressive, improved sanitation in the second half of the twentieth century (Szepietowski

Given the fact that people are constantly exposed to the possibility of contact with dermatophytes, since infectious material is commonly present in the environment, in the case of infection with widespread antropophilic species it is difficult to identify the source and route of infection. Conversely, if the fungal infection is caused by zoophilic dermatophyte with a relatively narrow specificity of the species (*Microsporum canis*, *Trichophyton verrucosum*), and the number of actual cases is not large, the epidemiological investigation may allow to trace the spread of infection and determine its source

Many years of studies of mycological biota indicate that one of its characteristics are constant changes in time, related to the presence of particular species of fungi in the natural environment and their involvement in causing infections of the skin and its appendages in human. Changing mycological biota varies in different geographical regions. Moreover, it was found that the clinical forms of fungal infections in different parts of the world are caused by different species of fungi (Chong & Sinclair, 2000; Cribier & Paul, 2001; Gupta, 2001). Tracing this variability is essential for epidemiological research, as it allows to prove the existence of variation ranges of the different species of dermatophytes. It also has no less important from the standpoint of public health, makes it possible to forecast the development of fungal infections in the population. Although Poland is a relatively small territory, epidemiological studies conducted in different parts of the country consistently

Baran and Szepietowski analyzed results of mycological examinations from years 1988 – 1992, conducted across the country, updating epidemiological map of Poland (Baran & Szepietowski, 1994). These researchers have demonstrated a definite advantage in the incidence of anthropophilic dermatophytes (64.3% of all dermatophytes) over zoophilic dermatophytes (35%). In addition, they found that infections with geophilic dermatophytes

Anthropophilic dermatophytes dominance was observed in almost all regions of the country, but particularly clearly in the centraleastern region (75.9%), midwestern region (75.5%), southwestern region (72.1%) and southeastern region (70.4%). Only in the northern

show the changes in the fungal biota during the last 50 years.

occured occasionally (0.7% of all isolated pathogens) (Figure 1).

Fig. 1. Dermatophytes in Poland in years 1988-1992.

& Baran, 2005).

(Kobierzycka et al., 2005).

for economic reasons. Thereby, various species of fungi appear far beyond the borders of the endemic areas.

The accumulated epidemiological data indicate how much the fungal biota of the given area, including Poland, changes over time. In the first half of the twentieth century in Central and Western Europe dominated zoophilic dermatophyte *Trichophyton mentagrophytes*, and today the predominant species is *Trichophyton rubrum,* antropophilic dermatophyte originating from Asia (Bajcar & Ratka, 2002; Glinski et al., 2002, Szepietowski et al., 2001). Currently it is the most common etiological agent of fungal infections of toenails in Poland.

The increasing dominance of infections caused by *Trichophyton rubrum* appears to be a negative phenomenon, because these types of diseases are particularly chronic and often recurrent. As fungal infections of the skin and its appendages in different regions of the world are caused by different species of fungi, mycological biota present in the skin lesions is associated with changes in the natural environment and man's artificial environment. It is known that *Trichophyton rubrum* came to Poland during the mass migration after World War II (Macura&Pawlik, 1998). This species was rare then, but over the years it has achieved a dominant position, while causing a permanent reduction in the participation of other dermatophyte infections of the skin and its appendages. Similarly, the major change relates to the presence on Polish territory The fungus *Trichophyton schoenleinii*. Today infections caused by this species are not found in Poland, but they occurred very often throughout the country in the first half of the twentieth century. Between 50`s and 60`s it caused only 5.7% of fungal infections, and in the late 90`s its isolation has already belonged to the casuistic rarity (Macura & Pawlik, 1998; Szepietowski & Baran, 2005). Increasing number of infections caused by other antropophilic dermatophyte was observed instead. Although *Epidermophyton floccosum* was only 0.7% of all isolated dermatophytes in the 70`s, then after 20 years the percentage of fungal infections increased 3-fold, up to 2.23%. Moreover, in place of *Microsporum gypseum*, which was only sporadically isolated in the 70`s of the twentieth century, occured an unprecedented then species *Microsporum canis*, taking the 3rd position among the dermatophytes (2.64%) (Macura&Pawlik, 1998).

Mass migrations are particularly important and confirmed by epidemiological importance. It contributes to a large extent with spreading of fungal pathogens, especially antropophilic dermatophytes. The example is the African species (*Trichophyton soudanense*), and in the recent decades continuously isolated in Europe from immigrants coming from endemic areas. Similarly, in the U.S. athlete's foot cases caused by *Trichophyton violaceum* in immigrant from Asia, where this fungus is found endemic, were reported (Kobierzycka et al., 2005).

Interestingly, some species of dermatophytes found throughout the world, such as *Microsporum audouinii* and *Trichophyton schoenleinii*, are now very rare in the U.S. and Western Europe, although they are common in the other areas, particularly in Africa (Kobierzycka et al, 2005). Epidemiological data indicate that the changes that constantly occur in the distribution of pathogenic fungal biota are dependent on many factors. In addition to the progressive migration and climate change, social and economic conditions that affect skin exposure to fungal pathogens, and therapeutic methods are also important Szepietowski & Baran, 2005). These factors significantly affect the changes in the proportion of different species of fungi at the time in a given area. Extremely rare occurrence of *tinea* 

for economic reasons. Thereby, various species of fungi appear far beyond the borders of the

The accumulated epidemiological data indicate how much the fungal biota of the given area, including Poland, changes over time. In the first half of the twentieth century in Central and Western Europe dominated zoophilic dermatophyte *Trichophyton mentagrophytes*, and today the predominant species is *Trichophyton rubrum,* antropophilic dermatophyte originating from Asia (Bajcar & Ratka, 2002; Glinski et al., 2002, Szepietowski et al., 2001). Currently it is the most common etiological agent of fungal infections of toenails

The increasing dominance of infections caused by *Trichophyton rubrum* appears to be a negative phenomenon, because these types of diseases are particularly chronic and often recurrent. As fungal infections of the skin and its appendages in different regions of the world are caused by different species of fungi, mycological biota present in the skin lesions is associated with changes in the natural environment and man's artificial environment. It is known that *Trichophyton rubrum* came to Poland during the mass migration after World War II (Macura&Pawlik, 1998). This species was rare then, but over the years it has achieved a dominant position, while causing a permanent reduction in the participation of other dermatophyte infections of the skin and its appendages. Similarly, the major change relates to the presence on Polish territory The fungus *Trichophyton schoenleinii*. Today infections caused by this species are not found in Poland, but they occurred very often throughout the country in the first half of the twentieth century. Between 50`s and 60`s it caused only 5.7% of fungal infections, and in the late 90`s its isolation has already belonged to the casuistic rarity (Macura & Pawlik, 1998; Szepietowski & Baran, 2005). Increasing number of infections caused by other antropophilic dermatophyte was observed instead. Although *Epidermophyton floccosum* was only 0.7% of all isolated dermatophytes in the 70`s, then after 20 years the percentage of fungal infections increased 3-fold, up to 2.23%. Moreover, in place of *Microsporum gypseum*, which was only sporadically isolated in the 70`s of the twentieth century, occured an unprecedented then species *Microsporum canis*, taking the 3rd position

Mass migrations are particularly important and confirmed by epidemiological importance. It contributes to a large extent with spreading of fungal pathogens, especially antropophilic dermatophytes. The example is the African species (*Trichophyton soudanense*), and in the recent decades continuously isolated in Europe from immigrants coming from endemic areas. Similarly, in the U.S. athlete's foot cases caused by *Trichophyton violaceum* in immigrant from Asia, where this fungus is found endemic, were reported (Kobierzycka et

Interestingly, some species of dermatophytes found throughout the world, such as *Microsporum audouinii* and *Trichophyton schoenleinii*, are now very rare in the U.S. and Western Europe, although they are common in the other areas, particularly in Africa (Kobierzycka et al, 2005). Epidemiological data indicate that the changes that constantly occur in the distribution of pathogenic fungal biota are dependent on many factors. In addition to the progressive migration and climate change, social and economic conditions that affect skin exposure to fungal pathogens, and therapeutic methods are also important Szepietowski & Baran, 2005). These factors significantly affect the changes in the proportion of different species of fungi at the time in a given area. Extremely rare occurrence of *tinea* 

among the dermatophytes (2.64%) (Macura&Pawlik, 1998).

endemic areas.

in Poland.

al., 2005).

*capitis* caused by *Trichophyton schoenleinii* in Poland now is mainly associated with progressive, improved sanitation in the second half of the twentieth century (Szepietowski & Baran, 2005).

Given the fact that people are constantly exposed to the possibility of contact with dermatophytes, since infectious material is commonly present in the environment, in the case of infection with widespread antropophilic species it is difficult to identify the source and route of infection. Conversely, if the fungal infection is caused by zoophilic dermatophyte with a relatively narrow specificity of the species (*Microsporum canis*, *Trichophyton verrucosum*), and the number of actual cases is not large, the epidemiological investigation may allow to trace the spread of infection and determine its source (Kobierzycka et al., 2005).

Many years of studies of mycological biota indicate that one of its characteristics are constant changes in time, related to the presence of particular species of fungi in the natural environment and their involvement in causing infections of the skin and its appendages in human. Changing mycological biota varies in different geographical regions. Moreover, it was found that the clinical forms of fungal infections in different parts of the world are caused by different species of fungi (Chong & Sinclair, 2000; Cribier & Paul, 2001; Gupta, 2001). Tracing this variability is essential for epidemiological research, as it allows to prove the existence of variation ranges of the different species of dermatophytes. It also has no less important from the standpoint of public health, makes it possible to forecast the development of fungal infections in the population. Although Poland is a relatively small territory, epidemiological studies conducted in different parts of the country consistently show the changes in the fungal biota during the last 50 years.

Baran and Szepietowski analyzed results of mycological examinations from years 1988 – 1992, conducted across the country, updating epidemiological map of Poland (Baran & Szepietowski, 1994). These researchers have demonstrated a definite advantage in the incidence of anthropophilic dermatophytes (64.3% of all dermatophytes) over zoophilic dermatophytes (35%). In addition, they found that infections with geophilic dermatophytes occured occasionally (0.7% of all isolated pathogens) (Figure 1).

Fig. 1. Dermatophytes in Poland in years 1988-1992.

Anthropophilic dermatophytes dominance was observed in almost all regions of the country, but particularly clearly in the centraleastern region (75.9%), midwestern region (75.5%), southwestern region (72.1%) and southeastern region (70.4%). Only in the northern

Epidemiology of Dermatomycoses in Poland over the Past Decades 41

dominated infections caused by *Microsporum canis* (30.5% of isolated dermatophytes)

The results of this analysis showed how great epidemiological changes took place in relation to the occurrence of fungal pathogens, at a relatively small area of Poland in about 30 years. In the earlier years (1952-1967) a distinct advantage of zoophilic dermatopytes, representing 69.6% of the total dermatophytes over antropophilic (30.3%) and geophilic dermatophytes (0.1%) was observed (Figure 2). At that time, the dominance of zoophilic fungi did not concern only the region of Bialystok, where antropophilic dermatophytes accounted for

In the following years (1974-1979) more pronounced changes were observed in Poland, and the incidence of infections due to zoophilic and antropophilic dermatophytes became similar and amounted to 50.9% and 48.1%, respectively (Lange et al., 2002). Geophilic

In the region of Olsztyn (northeastern Poland) incidence of zoophilic dermatophytes decreased from 51.7% in 1978-1981 to 48.8% in 1982-1986 (Nowicki & Bykowska, 2006).

Increased frequency of isolation of anthropophilic fungi in relation to the zoophilic species, is confirmed by other studies – Ratka (1977-1988) and Baran *et al* in Lower Silesia (southwestern Poland) region (1977-1991) (Baran et al, 1993; Ratka, 1990). Over the years steadily increased the frequency of isolation of anthropophilic fungi among the dermatophytes. Previous studies showed that more than 40 years ago, most often isolated fungus in Poland was zoophilic *Trichophyton mentagrophytes* and Baran and Szepietowski showed that nowadays the most common species in Poland is *Trichophyton rubrum* (Baran &

In the years 1987-1996 Kaszuba *et al*, studied fungal infections of the skin and its appendages in the Lodz region (Central Poland), they found that in the 51.7% of cases dermatophytes were the etiologic agent, including genera: *Trichophyton* (75.39%), *Microsporum* (15.35%) and *Epidermophyton* (9.35%). Compared with studies from the years 1982-1986 the authors pointed out an increase in isolation of dermatophyte fungi in the Lodz region. The main etiological agent was *Trichophyton rubrum* (34.15%), the second most common pathogen was *Trichophyton mentagrophytes* (33.19%), and further were *Microsporum canis* and *Epidermophyton floccosum*. An interesting observation of the authors was significant change in the isolation frequency of *Trichophyton mentagrophytes* and *Trichophyton rubrum* species. It

dermatophytes constituted then only 1% (Hryncewicz-Gwozdz et al, 2005).

(Baran & Szepietowski, 1994).

58.2% (Wronski & Nowicki, 2000).

Fig. 2. Dermatophytes in Poland in years 1952-1967.

Szepietowski, 1994; Wronski & Nowicki, 2005) .

region of the country, this advantage was small, anthropophilic fungi accounted for only 54.6% of the total number of dermatophytes (Szepietowski & Baran, 2005; Baran & Szepietowski, 1994).

Quite different results were obtained in the province of Bialystok. Only in this region anthropophilic dermatophytes formed a minority, accounting for just 45.1% of all dermatophytes isolated in the area. It also appeared that the zoophilic fungi were the most common dermatophytes (54.9%) in Bialystok province (northeastern Poland) (Szepietowski & Baran, 2005; Baran & Szepietowski, 1994). Authors found a clear upward trend in a southerly direction for the anthropophilic dermatophytes, closely associated with the occurrence of an inverse trend for zoophilic fungi (Szepietowski & Baran, 2005). It turned out that zoophilic dermatophytes are the most commonly reported in the northern region (45.4%) and least often in the middleeastern region (24.1%). Baran and Szepietowski thus agreed that the distribution of zoophilic dermatophytes is the reverse of the map of anthropophilic dermatophytes distribution (Szepietowski & Baran, 2005; Baran & Szepietowski, 1994).

Among the anthropophilic fungi *Trichophyton rubrum* was isolated most frequently, it accounted for 45.5% off all dermatophytes and for anthropophilic dermatophytes – 70.8%. This species occurred most frequently in the southwestern region (59.1% of all dermatophytes), midwestern region (55.8%) and southeastern region (53.4%). Least often it was isolated in the northern region (7.7% of all dermatophytes ascertained in this area). The second in the order, *Trichophyton interdigitale* usually occurred in the northern region (34.0% of all dermatophytes), slightly less often (24.5%) in the central-eastern parts of the country, but only occasionally - in the West (0.6%). *Epidermophyton floccosum* was found the most frequently in the northeastern region (19.5%) and the midwestern region (15.6%), with a clear decrease in the incidence in the southern direction. Other species of anthropophilic dermatophytes were very rare, they were isolated only sporadically. In the group of zoophilic fungi *Trichophyton mentagrophytes* was mostly isolated. It accounted for 22.4% of all dermatophytes and among zoophilic dermatophytes it accounted for 64.4%, and most occurred in the northeastern region (31.5% of all dermatophytes), and the least in the region of central-western and south-western regions. Isolated somewhat less *Microsporum canis* constituted 9.7% of all dermatophytes and 27.6% of zoophilic dermatophytes. This fungus was typically found mostly in the northern region (21.5% of dermatophytes in this area), in the central region (12.1%) and least often in the centraleastern region and northeastern regions (3.8 % and 0.5%, respectively) (Baran & Szepietowski, 1994).

Among the geophilic fungi, *Microsporum gypseum* was isolated most often. It represented only 0.6% of all dermatophytes and among geophilic dermatophytes - 82.8%, and most frequntly occurred in the central region (Szepietowski & Baran, 2005; Baran & Szepietowski, 1994).

The authors analyzed the results of mycological examinations from the years 1988-1992 conducted across the country. The most often isolated fungus was antropophilic *Trichophyton rubrum*. Only in the northeastern region, in the province of Bialystok *Trichophyton mentagrophytes* was the most frequently observed species (40.7% of all dermatophytes in the province). In the northern part of the Poland dominated *Trichophyton interdigitale* (34% of all dermatophytes), although in the Gdansk region

region of the country, this advantage was small, anthropophilic fungi accounted for only 54.6% of the total number of dermatophytes (Szepietowski & Baran, 2005; Baran &

Quite different results were obtained in the province of Bialystok. Only in this region anthropophilic dermatophytes formed a minority, accounting for just 45.1% of all dermatophytes isolated in the area. It also appeared that the zoophilic fungi were the most common dermatophytes (54.9%) in Bialystok province (northeastern Poland) (Szepietowski & Baran, 2005; Baran & Szepietowski, 1994). Authors found a clear upward trend in a southerly direction for the anthropophilic dermatophytes, closely associated with the occurrence of an inverse trend for zoophilic fungi (Szepietowski & Baran, 2005). It turned out that zoophilic dermatophytes are the most commonly reported in the northern region (45.4%) and least often in the middleeastern region (24.1%). Baran and Szepietowski thus agreed that the distribution of zoophilic dermatophytes is the reverse of the map of anthropophilic dermatophytes distribution (Szepietowski & Baran, 2005; Baran &

Among the anthropophilic fungi *Trichophyton rubrum* was isolated most frequently, it accounted for 45.5% off all dermatophytes and for anthropophilic dermatophytes – 70.8%. This species occurred most frequently in the southwestern region (59.1% of all dermatophytes), midwestern region (55.8%) and southeastern region (53.4%). Least often it was isolated in the northern region (7.7% of all dermatophytes ascertained in this area). The second in the order, *Trichophyton interdigitale* usually occurred in the northern region (34.0% of all dermatophytes), slightly less often (24.5%) in the central-eastern parts of the country, but only occasionally - in the West (0.6%). *Epidermophyton floccosum* was found the most frequently in the northeastern region (19.5%) and the midwestern region (15.6%), with a clear decrease in the incidence in the southern direction. Other species of anthropophilic dermatophytes were very rare, they were isolated only sporadically. In the group of zoophilic fungi *Trichophyton mentagrophytes* was mostly isolated. It accounted for 22.4% of all dermatophytes and among zoophilic dermatophytes it accounted for 64.4%, and most occurred in the northeastern region (31.5% of all dermatophytes), and the least in the region of central-western and south-western regions. Isolated somewhat less *Microsporum canis* constituted 9.7% of all dermatophytes and 27.6% of zoophilic dermatophytes. This fungus was typically found mostly in the northern region (21.5% of dermatophytes in this area), in the central region (12.1%) and least often in the centraleastern region and northeastern

Among the geophilic fungi, *Microsporum gypseum* was isolated most often. It represented only 0.6% of all dermatophytes and among geophilic dermatophytes - 82.8%, and most frequntly occurred in the central region (Szepietowski & Baran, 2005; Baran & Szepietowski,

The authors analyzed the results of mycological examinations from the years 1988-1992 conducted across the country. The most often isolated fungus was antropophilic *Trichophyton rubrum*. Only in the northeastern region, in the province of Bialystok *Trichophyton mentagrophytes* was the most frequently observed species (40.7% of all dermatophytes in the province). In the northern part of the Poland dominated *Trichophyton interdigitale* (34% of all dermatophytes), although in the Gdansk region

regions (3.8 % and 0.5%, respectively) (Baran & Szepietowski, 1994).

Szepietowski, 1994).

Szepietowski, 1994).

1994).

dominated infections caused by *Microsporum canis* (30.5% of isolated dermatophytes) (Baran & Szepietowski, 1994).

The results of this analysis showed how great epidemiological changes took place in relation to the occurrence of fungal pathogens, at a relatively small area of Poland in about 30 years. In the earlier years (1952-1967) a distinct advantage of zoophilic dermatopytes, representing 69.6% of the total dermatophytes over antropophilic (30.3%) and geophilic dermatophytes (0.1%) was observed (Figure 2). At that time, the dominance of zoophilic fungi did not concern only the region of Bialystok, where antropophilic dermatophytes accounted for 58.2% (Wronski & Nowicki, 2000).

Fig. 2. Dermatophytes in Poland in years 1952-1967.

In the following years (1974-1979) more pronounced changes were observed in Poland, and the incidence of infections due to zoophilic and antropophilic dermatophytes became similar and amounted to 50.9% and 48.1%, respectively (Lange et al., 2002). Geophilic dermatophytes constituted then only 1% (Hryncewicz-Gwozdz et al, 2005).

In the region of Olsztyn (northeastern Poland) incidence of zoophilic dermatophytes decreased from 51.7% in 1978-1981 to 48.8% in 1982-1986 (Nowicki & Bykowska, 2006).

Increased frequency of isolation of anthropophilic fungi in relation to the zoophilic species, is confirmed by other studies – Ratka (1977-1988) and Baran *et al* in Lower Silesia (southwestern Poland) region (1977-1991) (Baran et al, 1993; Ratka, 1990). Over the years steadily increased the frequency of isolation of anthropophilic fungi among the dermatophytes. Previous studies showed that more than 40 years ago, most often isolated fungus in Poland was zoophilic *Trichophyton mentagrophytes* and Baran and Szepietowski showed that nowadays the most common species in Poland is *Trichophyton rubrum* (Baran & Szepietowski, 1994; Wronski & Nowicki, 2005) .

In the years 1987-1996 Kaszuba *et al*, studied fungal infections of the skin and its appendages in the Lodz region (Central Poland), they found that in the 51.7% of cases dermatophytes were the etiologic agent, including genera: *Trichophyton* (75.39%), *Microsporum* (15.35%) and *Epidermophyton* (9.35%). Compared with studies from the years 1982-1986 the authors pointed out an increase in isolation of dermatophyte fungi in the Lodz region. The main etiological agent was *Trichophyton rubrum* (34.15%), the second most common pathogen was *Trichophyton mentagrophytes* (33.19%), and further were *Microsporum canis* and *Epidermophyton floccosum*. An interesting observation of the authors was significant change in the isolation frequency of *Trichophyton mentagrophytes* and *Trichophyton rubrum* species. It

Epidemiology of Dermatomycoses in Poland over the Past Decades 43

Further studies conducted in Gdansk (midsouthern region of Poland) in years 2003-2005 showed an increase in the number of infections and variability of pathogenic fungi species. Among dermatophytes *Trichophyton rubrum* and *Trichophyton mentagrophytes* were recognized the most often (43.9% and 35.6%, respectively). These fungi were isolated mainly from toenails. *Microsporum canis* was isolated from 8.4% of patients, mostly from children it caused infections of the scalp (65.7%) and glabrous skin (34.3%) (Nowicki & Bykowska, 2006). Moreover, this dermatophyte is the most common fungal pathogen among

Kalinowska *et al* studied dermatomycoses in Lower Silesia in years 2004 – 2008. The author found, that pathogen isolated most fequently (59.27%) was antropophilic *Trichophyton rubrum*, sencond most frequently isolated fungus was *Trichophyton mentagrophytes* (22.09%). Interestingly, the incidence of dermatomycoses caused by *Trichophyton tonsurans* increased, and this dermatophyte was placed on the third position (10.45%), followed by *Microsporum* 

Previous mycological research carried out in different regions of Poland indicate the need for constant observation and epidemiological analyses, to monitor ongoing changes of the

International Studies (Achilles project) conducted in 1989-1999 showed that Poland takes 4th place after Russia, Hungary and the Czech Republic in the incidence of fungal infections in

Among the 40,000 surveyed Poles 42% of them were diagnosed with athlete's foot and 21% with onychomycosis. The results of these studies additonally support the view that the epidemiological data of fungal infections must be constantly updated to confirmed

From the 50`s of the past centrury, mycoses caused by zoophilic species represented up to almost 70% of diagnosed mycoses, whereas infections caused by antropophilic dermatophytes represented 30% and infections caused by geophilic dermatophytes represented 0.1% of all dermatomycoses. This situation has changed entirely in next decades, so different data are shown in literature from 1980s and 1990s – the most common were antropophilic dermatophytes (64.3%), less common zoophilic dermatophytes (35.0%) and infections caused by geophilic dermatophytes represented 0.7%. Among antropophilic dermatophytes, *Trichophyton rubrum* is in the lead over past fifty years, this species is commonly responsible for onychomycosis. Among zoophilic dermatophytes, most frequently *Trichophyton mentagrophytes* was isolated. Among geophilic dermatophytes

Nowadays, depending on geographical region of Poland, antropophilic species represent

Fungal infections are now a major epidemiological and social problem worldwide. According to various data relating to different geographical regions, they concern from 10 to 40% ofthe world's population (Bolinski et al., 2003; Foster et al., 2004; Kaszuba et al., 1997; Szepietowski & Baran, 2005). Research conducted among people living in moderate climate

about 45 – 75 % of all dermatophytes and zoophilic species represent about 30 – 55%.

**3.2 Epidemiology of different types of dermatomycoses in Poland** 

children in Gdansk region since 1984 (Wilkowska & Nowicki, 1991).

*canis* (4.74%) (Kalinowska et al., 2010).

European countries (Glinski et al, 2002).

fungal biota and its contribution to infections in human.

variations of fungal biota in the natural environment.

*Microsporum gypseum* was isolated most frequently.

has been found a decrease of the incidence of *Trichophyton mentagrophytes* from over 50% to 33%, while the number of isolation of *Trichophyton rubrum* has increased from 25% to 34% which places this species in the first place among diagnosed dermatophytes (Kaszuba et al., 1997).

Between 1995-1999 survey of fungal infections in the Wroclaw (Lower Silesia) region conducted Sikora *et al* (Sikora et al., 2000). A large variety of mycological biota was found. Among the dermatophytes, most often because 62.7% of infections concerned *Trichophyton mentagrophytes*, *Trichophyton rubrum* was isolated less frequently (27.8%), *Epidermophyton floccosum* (6.2%) and least often *Microsporum canis* (3%). An important observation was a significant decrease in the number of infections caused by *Trichophyton rubrum* (32.9%) and *Epidermophyton floccosum* (25.6%). Moreover, the frequency of isolation of *Trichophyton mentagrophytes* grew by 61.5%. In the case of *Microsporum canis* infections with this species increased to 1997, with subsequent later decrease of the number of infections (Sikora et al., 2000).

Between years 1996-2000 in region of Bydgoszcz (Central Poland) antropophilic *Trichophyton rubrum* was isolated in 41.6% of cases, followed by antropophilic *Trichophyton interdigitale* (26.9%). Zoophilic *Microsporum canis* was isolated in 8.2% of cases (Mrotek et al., 2001).

In the years 1996-2001 further studies concerned analysis of mycological biota and assessment of the incidence of fungal infections in patients from the urban environment of Bialystok. Anthropophilic dermatophytes were found in 40.1% of all isolates and among them most often were: *Trichophyton rubrum*, *Trichophyton interdigitale*, and *Epidermophyton floccosum*. Zoophilic dermatophytes represented 34.4% of fungi and most often occurred *Trichophyton mentagrophytes*. The results of studies conducted in region of Bialystok indicated the anthropophilic dermatophytes as the main etiological agents of fungal infections of the skin and its appendages (Bolinski et al., 2003).

Multiannual mycological research (1984-2001) were conducted in the Subcarpathian region (southeastern Poland) by Bajcar and Ratka. They compared in terms of epidemiology two periods: the years 1984-1993 and 1994-2001. Among isolated dermatophytes prevailed *Trichophyton rubrum* (68.9% of all infections), and *Trichophyton interdigitale* was found in 11.3% of cases, *Epidermophyton floccosum* in 9.1% of cases, and *Trichophyton tonsurans* in 6.2% of cases. Zoophilic fungi were isolated rarely, in 4.1% of cases *Trichophyton mentagrophytes* was isolated. Comparing the results of research conducted in the years 1994-2001 with data obtained in the previous decade, Bajcar and Ratka observed in the Subcarpathian region continuing dominance of antropophilic fungi infections. Among the antropophilic dermatophytes was observed a decrease in the number of infections caused by *Trichophyton rubrum* (9.5%) and an increased participation of *Trichophyton interdigitale* (9.4%). An important observation of the authors was the emergence in the region of Subcarpathian an unprecedented *Trichophyton violaceum* species (0.4% of isolates) – species frequent in Eastern Europe. Comparing the two periods also a slight increase of fungal infections with zoophilic fungi was observed: *Trichophyton mentagrophytes* (from 4.1% to 5.5%) and *Trichophyton verrucosum* (from 0.2% to 1.1%) (Bajcar & Ratka, 2002).

In the region of Gdansk Szarmach and Nowicki in years 1994-1998 found large share of dermatophytes as etiological agents of onychomycosis. They accounted for 44.8% of all fungal pathogens and most often isolated species were: *Trichophyton rubrum* and *Trichophyton interdigitale* (Szarmach & Nowicki, 2001).

has been found a decrease of the incidence of *Trichophyton mentagrophytes* from over 50% to 33%, while the number of isolation of *Trichophyton rubrum* has increased from 25% to 34% which places this species in the first place among diagnosed dermatophytes (Kaszuba et al.,

Between 1995-1999 survey of fungal infections in the Wroclaw (Lower Silesia) region conducted Sikora *et al* (Sikora et al., 2000). A large variety of mycological biota was found. Among the dermatophytes, most often because 62.7% of infections concerned *Trichophyton mentagrophytes*, *Trichophyton rubrum* was isolated less frequently (27.8%), *Epidermophyton floccosum* (6.2%) and least often *Microsporum canis* (3%). An important observation was a significant decrease in the number of infections caused by *Trichophyton rubrum* (32.9%) and *Epidermophyton floccosum* (25.6%). Moreover, the frequency of isolation of *Trichophyton mentagrophytes* grew by 61.5%. In the case of *Microsporum canis* infections with this species increased to 1997, with subsequent later decrease of the number of infections (Sikora

Between years 1996-2000 in region of Bydgoszcz (Central Poland) antropophilic *Trichophyton rubrum* was isolated in 41.6% of cases, followed by antropophilic *Trichophyton interdigitale* (26.9%). Zoophilic *Microsporum canis* was isolated in 8.2% of cases (Mrotek et al., 2001).

In the years 1996-2001 further studies concerned analysis of mycological biota and assessment of the incidence of fungal infections in patients from the urban environment of Bialystok. Anthropophilic dermatophytes were found in 40.1% of all isolates and among them most often were: *Trichophyton rubrum*, *Trichophyton interdigitale*, and *Epidermophyton floccosum*. Zoophilic dermatophytes represented 34.4% of fungi and most often occurred *Trichophyton mentagrophytes*. The results of studies conducted in region of Bialystok indicated the anthropophilic dermatophytes as the main etiological agents of fungal

Multiannual mycological research (1984-2001) were conducted in the Subcarpathian region (southeastern Poland) by Bajcar and Ratka. They compared in terms of epidemiology two periods: the years 1984-1993 and 1994-2001. Among isolated dermatophytes prevailed *Trichophyton rubrum* (68.9% of all infections), and *Trichophyton interdigitale* was found in 11.3% of cases, *Epidermophyton floccosum* in 9.1% of cases, and *Trichophyton tonsurans* in 6.2% of cases. Zoophilic fungi were isolated rarely, in 4.1% of cases *Trichophyton mentagrophytes* was isolated. Comparing the results of research conducted in the years 1994-2001 with data obtained in the previous decade, Bajcar and Ratka observed in the Subcarpathian region continuing dominance of antropophilic fungi infections. Among the antropophilic dermatophytes was observed a decrease in the number of infections caused by *Trichophyton rubrum* (9.5%) and an increased participation of *Trichophyton interdigitale* (9.4%). An important observation of the authors was the emergence in the region of Subcarpathian an unprecedented *Trichophyton violaceum* species (0.4% of isolates) – species frequent in Eastern Europe. Comparing the two periods also a slight increase of fungal infections with zoophilic fungi was observed: *Trichophyton mentagrophytes* (from 4.1% to 5.5%) and *Trichophyton* 

In the region of Gdansk Szarmach and Nowicki in years 1994-1998 found large share of dermatophytes as etiological agents of onychomycosis. They accounted for 44.8% of all fungal pathogens and most often isolated species were: *Trichophyton rubrum* and

infections of the skin and its appendages (Bolinski et al., 2003).

*verrucosum* (from 0.2% to 1.1%) (Bajcar & Ratka, 2002).

*Trichophyton interdigitale* (Szarmach & Nowicki, 2001).

1997).

et al., 2000).

Further studies conducted in Gdansk (midsouthern region of Poland) in years 2003-2005 showed an increase in the number of infections and variability of pathogenic fungi species. Among dermatophytes *Trichophyton rubrum* and *Trichophyton mentagrophytes* were recognized the most often (43.9% and 35.6%, respectively). These fungi were isolated mainly from toenails. *Microsporum canis* was isolated from 8.4% of patients, mostly from children it caused infections of the scalp (65.7%) and glabrous skin (34.3%) (Nowicki & Bykowska, 2006). Moreover, this dermatophyte is the most common fungal pathogen among children in Gdansk region since 1984 (Wilkowska & Nowicki, 1991).

Kalinowska *et al* studied dermatomycoses in Lower Silesia in years 2004 – 2008. The author found, that pathogen isolated most fequently (59.27%) was antropophilic *Trichophyton rubrum*, sencond most frequently isolated fungus was *Trichophyton mentagrophytes* (22.09%). Interestingly, the incidence of dermatomycoses caused by *Trichophyton tonsurans* increased, and this dermatophyte was placed on the third position (10.45%), followed by *Microsporum canis* (4.74%) (Kalinowska et al., 2010).

Previous mycological research carried out in different regions of Poland indicate the need for constant observation and epidemiological analyses, to monitor ongoing changes of the fungal biota and its contribution to infections in human.

International Studies (Achilles project) conducted in 1989-1999 showed that Poland takes 4th place after Russia, Hungary and the Czech Republic in the incidence of fungal infections in European countries (Glinski et al, 2002).

Among the 40,000 surveyed Poles 42% of them were diagnosed with athlete's foot and 21% with onychomycosis. The results of these studies additonally support the view that the epidemiological data of fungal infections must be constantly updated to confirmed variations of fungal biota in the natural environment.

From the 50`s of the past centrury, mycoses caused by zoophilic species represented up to almost 70% of diagnosed mycoses, whereas infections caused by antropophilic dermatophytes represented 30% and infections caused by geophilic dermatophytes represented 0.1% of all dermatomycoses. This situation has changed entirely in next decades, so different data are shown in literature from 1980s and 1990s – the most common were antropophilic dermatophytes (64.3%), less common zoophilic dermatophytes (35.0%) and infections caused by geophilic dermatophytes represented 0.7%. Among antropophilic dermatophytes, *Trichophyton rubrum* is in the lead over past fifty years, this species is commonly responsible for onychomycosis. Among zoophilic dermatophytes, most frequently *Trichophyton mentagrophytes* was isolated. Among geophilic dermatophytes *Microsporum gypseum* was isolated most frequently.

Nowadays, depending on geographical region of Poland, antropophilic species represent about 45 – 75 % of all dermatophytes and zoophilic species represent about 30 – 55%.
