In Korea, ringworm, tinea versicolor and cutaneous candidosis are the principal fungal infections.
Around the outbreak of the Korean War, tinea capitis was the most frequent clinical type of ringworm due to its nation-wide epidemic, but it has been rapidly reduced since 1960. In recent years, tinea pedis and manuum as a whole, occupy over half of the total cases of ringworm; tinea cruris, tineafaciei and corporis have an increasing tendency to show atypical clinical manifestations.
In the last 10 years the aspect of dermatophytic flora has remarkably changed compared with that seen around World War II. While Trichophyton ferrugineum, the principal causative organism of tinea capitis and tinea corporis in the past, has been abruptly decreasing in frequency since 1960. Microsporum canis has spread all over the country and T. rubrum is increasing. The number of tinea capitis due to M. canis, which was isolated for the first time in 1957, has been increasing steadily every year especially since 1978.
During 10 years from 1976 to 1985, the total number of cases with dermatophytoses observed at Chilgok Catholic Skin Clinic in Taegu was 34, 261, representing 14.2% of the total new out-patients. Of these, tinea pedis was the most frequent (40.4%), followed by tinea cruris (23.8%), tinea faciei and corporis (12.9%), tinea unguium (10.7%), tineamanuum (8.5%), tinea capitis (3.7%) and tineafavosa (2 cases).
The total number of dermatophytes isolated during the same 10-year-period was 21, 754 strains, composed of T. rubrum (77.6%), T. mentagrophytes (10.8%), M. canis (7.2%), Epidermophyton floccosum (3.7%), M. gypseum (0.4%), T, ferrugineum (0.3%) and T. schoenleinii (2 strains).
In viewing of teleomorphic state, M. canis exhibited only Nannizzia otae “-” mating type. Among 474 strains of T. mentagrophytes, 225 were Arthroderma vanbreuseghemii “+” mating type, with the remaining 249 being “-”. “+” Type of A. vanbreuseghemii was frequently identified in tinea pedis and unguium, while “-” type in tinea capitis, tinea faciei and corporis, tinea manuum. In case of M. gypseum, N. incurvata and N. gypsea have been isolated at almost the same rate.
Sporotrichosis is rare but occurs sporadically throughout the country, showing no evidence of increasing. Inrecent years, although very rare, infections due to Cryptococcus neoformans, Phoma species, Fusarium species, Paecilomyces lilacinus, Wangiella dermatitidis have been reported.
Deep mycoses seem very rare. Pulmonary infections due to Aspergillus, Cryptococcus, Candida albicans and Pseudallescheria boydii have been observed.
Diseases such as tinea imbricata, tinea nigra, chromomycosis and coccidioidomycosis, which are observed in the other nations, have not been described.

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It is an honor to have opportunity to address in the 30th Annual Meeting of the Japanese Society for Medical Mycology (JSMM) and the Commorative Ceremony for the 30th
Anniversary of the Establishment of JSMM, such a distinguished audience, assembled to promote the knowledge of medical mycology, beginning with the lectures, symposia and general discussions which will be held in this Meeting.
As a visitor, with only a superficial understanding of lower fungi especially the Mucorales, Zygomycetes and fungal diseases of fish in Taiwan, I propose to present a brief outline of the education in medical mycology of Taiwan, indicating those aspects, as an introduction to medical schools of Taiwan, encluding curriculum, libraries and textbooks, educational activities, and human resource of active research mycologists in our country that might be relevant details to Taiwan for your consideration.

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In order to get insight into the present status and sutural trend of basic researches in the field of medical mycology in Japan, almost all the papers dealing with the basic problems and subjects in this discipline which had been presented in the Annual Congress of the Japanese Society for Medical Mycology in the past ten years were collected, categorized and reviewed.
The major categories of reviewed papers referring to medically important fungi and/or mycotic diseases are as follows : (i) life cycle, taxonomy and nomenclature; (ii) asexual reproduction, especially formation of asexual spores; (iii) ultrastructure and cytology; (iv) sexual reproduction and genetics; (v) dimorphism; (vi) physiology and biochemistry; (vii) evaluation of pathogenicity or virulence; (viii) fungal toxins or toxic metabolites assumably associated with pathogenicity; (ix) host-parasite relationship; (x) experimental fungal infections and animal models for mycoses; (xi) biological response modifiers of fungal or bacterial origin (xii) biological and chemical characterization of fungal antigenic components; (xiii) isolation and characterization of fungi from clinical materials; (xiv) techniques for conservation of fungal strains; and (xv) basic problems of antifungal agents and chemotherapy.

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最近10年間の主として,わが国における医学上重要な酵母に関する血清学的研究の進歩を概説した.Candidaの血清学的同定法に関しては7種のCandidaの抗原式が整理され,10種の因子血清によるCandidaの同定法が実用化された.Cr. neoformansに関しては5つの血清型の抗原式が示され,因子血清による同定法が実用化されつつある.酵母細胞壁マンナンの免疫化学的研究に関してはS. cerevisiae, C. pseudotropicalis, C. krusei, C.albicans AとB型,C. parapsilosisなどの抗原決定基の分子モデルが提案された.その結果,酵母の血清学的特異性がマンナン側鎖のオリゴ糖の長さとα 1-2およびα 1-3結合の存在様式によって決定されることが明らかにされた.一方表層マンナンにはアルカリに不安定なβ 1-2結合の側鎖群も存在し,強い沈降反応性を示すことが見出された.Cr. neoformans A-D型の抗原側鎖の分子モデルも提案され,A,A-DおよびD型の特異性が単糖側鎖(キシロース,グルクロン酸)の配列パターンと相関することが示された.最近C. albicans A型の特異抗原に対するモノクローナル抗体(MAb)と,C. albicans AおよびB型の共通抗原に対するMAbが作製された.これらのMAbは未吸収で因子血清として1:1280以上の凝集価を示し,実用化が期待される.クリプトコックス症の血清学的診断法に関しては,プロナーゼ処理血清(髄液)のLAによる抗原検出法がルチン化されつつある.カンジダ症においては市販抗原を用いるCIEとIHAによる抗体検出法がおよそ50%の陽性率を示すことが示された.夏型過敏性肺臓炎のアレルゲンについては論議が多かったが最近Cr. neoformansと共通抗原をもつTrickosporon cutaneumであることがほぼ明らかになった.

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In recent years there has been a considerable increase in the incidence of deep mycoses in the field of internal medicine in Japan. Advances in medical mycology in this area over the past 10 years and future concerns are discussed.
Sustained candidemia caused by candidal suppurativie peripheral thrombophlebitis during prolonged intravenous therapy is curable by excision of the affected vein and by adjunct therapy with antifungal agents.
The latex agglutination test for cryptococcal antigen in the CSF is of diagnostic and prognostic value. The test is also valuable to indicate completion of chemotherapy. Cryptococcuria should be attached great importance in prediction of disseminated cryptococcosis.
A discrete clinical entity and a variant of invasive aspergillosis (such as chronic necrotizing pulmonary aspergillosis or pseudomembranous necrotizing bronchial aspergillosis) have been reported. The natural history of pulmonary aspergilloma is fairly clarified. There have been a considerable numbers of reported cases of acute leukemia with previously normal roentgenographs which subsequently developed air crescents (an appearance mimicking pulmonary aspergilloma) as a manifestation of invasive pulmonary aspergillosis. Such a change in roentgenographic appearance should be kept in mind when diagnosis is discussed with patients. Recenly, diagnosis of invasive aspergillosis by an ELISA for circulating antigen has been attempted.
It remains quite difficult to diagnose and treat pulmonary mucormycosis except for chronic localized pulmonary involvement. It is difficult not to be somewhat pessimistic as one considers our present state of knowledge of mucormycosis.
There have also been large numbers of reported deep mycoses due to species formerly considered nonpathogenic as well as new clinical conditions due to species previously recognized as pathogenic.
Several imported cases of coccidioidomycosis, paracoccidioidomycosis and histoplasmosis have been reported in Japan.
Combined antifungal therapy using amphotericin B and flucytosine is recommended in cryptococcal meningitis and perhaps also in candidosis. Distribution and activity of amphtericin B in humans have been investigated by HPLC and carry promising results. Therapeutic efficacy of liposomal amphotericin B has been demonstrated in a small number of patients with hematologic malignancies complicated by fungal infections. Miconazole is now available and ketoconazole also will be available in the near future in Japan. Further studies in many more cases of deep mycoses are necessary for a full evaluation of medical therapy with these synthetic imidazoles.
Future problems include : (i) serologic diagnosis (especially diagnosis by determinations of fungal antigen titers). (ii) full evaluation of existing antimycotics and of combination therapy with antimycotics. (iii) an institution of ideal empiric chemotherapy in pneumonias including mycotic involvements in immunosuppressed patients. (iv) developments of new antimycotics.

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皮膚科領域では最近10年間に, 医真菌学や真菌症の分野で主に次のような変動や進歩がみられた.1) 日和見感染に代表される, いわゆるcompromised hostにおける真菌症が問題化した.2) 激減していた頭部浅在性白癬やケルスス禿瘡が, 再びみられるようになった.また, 従来の病型にない異型白癬が増加し, ステロイド外用剤の影響が明らかにされた.一方白癬菌相では, Microsporum canisやTrichophyton verrucosumが全国に蔓延した.3) 乳児寄生菌性紅斑が全国的に増加し, ステロイド外用剤の濫用が原因の一つとして指摘されたが, 最近ようやく減少傾向を示してきた.また, 慢性皮膚粘膜カンジダ症の病態解明や治療法についての研究がなされた.4) マラセチア毛包炎が本邦でも報告された.5) スポロトリコーシスにおいて, 組織内菌要素を豊富に認める症例が増加した.6) 黒色真菌感染症では, Exophiala jeanselmei感染症が増加し, Ajelloのいうphaeohyphomycosisの疾患概念について論議をよんだ.また, 黒癬が本邦で初めて観察された.7) コクシジオイデス症, パラコクシジオイデス症などの輸入真菌症の報告がみられた.8) イミダゾール系抗真菌剤を中心に治療薬が開発され, 特に内服可能なケトコナゾールが臨床応用された.

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