Multilocus sequence typing (MLST) was used to characterize the genetic profiles of 51 Candida albicans isolates collected from 12 hospitals in Taiwan. Among the 51 isolates, 16 were epidemiologically unrelated, 28 were isolates from 11 critically ill, human immunodeficiency virus (HIV)-negative patients, and 7 were long-term serial isolates from 3 HIV-positive patients. Internal regions of seven housekeeping genes were sequenced. A total of 83 polymorphic nucleotide sites were identified. Ten to 20 different genotypes were observed at the different loci, resulting, when combined, in 45 unique genotype combinations or diploid sequence types (DSTs). Thirty (36.1%) of the 83 individual changes were synonymous and 53 (63.9%) were nonsynonymous. Due to the diploid nature of C. albicans, MLST was more discriminatory than the pulsed-field gel electrophoresis-BssHIIrestricted fragment method in discriminating epidemiologically related strains. MLST is able to trace the microevolution over time of C. albicans isolates in the same patient. All but one of the DSTs of our Taiwanese strain collections were novel to the internet C. albicans DST database (http://test1.mlst.net/). The DSTs of C. albicans in Taiwan were analyzed together with those of the reference strains and of the strains from the United Kingdom and United States by unweighted-pair group method using average linkages and minimum spanning tree. Our result showed that the DNA type of each isolate was patient specific and associated with ABC type and decade of isolation but not associated with mating type, anatomical source of isolation, hospital origin, or fluconazole resistance patterns.

One hundred seventy-nine Streptococcus pyogenes isolates recovered from scarlet fever patients from 1996 to 1999 in central Taiwan were characterized by emm, Vir, and pulsed-field gel electrophoresis (PFGE) typing methods. The protocols for Vir and PFGE typing were standardized. A database of the DNA fingerprints for the isolates was established. Nine emm or emm-like genes, 19 Vir patterns, and 26 SmaI PFGE patterns were detected among the isolates. Among the three typing methods, PFGE was the most discriminatory. However, it could not completely replace Vir typing because some isolates with identical PFGE patterns could be further differentiated into several Vir patterns. The prevalent emm types were emm4 (n ‫؍‬ 81 isolates [45%]), emm12 (n ‫؍‬ 64 [36%]), emm1 (n ‫؍‬ 14 [8%]), and emm22 (n ‫؍‬ 13 [7%]). Some emm type isolates could be further differentiated into several emm-Vir-PFGE genotypes; however, only one genotype in each emm group was usually predominant. DNA from nine isolates was resistant to SmaI digestion. Further PFGE analysis with SgrAI showed that the SmaI digestion-resistant strains could be derived from indigenous strains by horizontal transfer of exogenous genetic material. The emergence of the new strains could have resulted in an increase in scarlet fever cases in central Taiwan since 2000. The emm sequences, Vir, and PFGE pattern database will serve as a basis for information for the long-term evolutionary study of local S. pyogenes strains.Streptococcus pyogenes causes a variety of human diseases ranging from relatively mild skin infections to severe invasive diseases, such as acute rheumatic fever, glomerulonephritis, puerperal sepsis, necrotizing fasciitis, meningitis, and streptococcal toxic shock syndrome (9,29). Among the diseases caused by this pathogen, scarlet fever, characterized by a strawberry tongue, skin rash, and sore throat, is most prevalent in schoolchildren aged 4 to 7 years. In Taiwan, scarlet fever is a notifiable disease, with 150 to 230 confirmed cases per year from 1996 to 1999. Since only 9% of the medical centers, regional hospitals, and district hospitals in central Taiwan had ever reported cases to the health authorities from 1996 to 1999, the number of scarlet fever cases should be severely underreported. Scarlet fever outbreaks are not uncommon at daycare centers, kindergartens, and elementary schools (5, 16). However, the molecular epidemiology of this disease has not been well studied in Taiwan.Analysis of the clonal relationships between clinical isolates from patients by various typing methods is a practical approach to elucidation of the epidemiology of a disease. To date, a number of phenotyping and genotyping methods have been described for S. pyogenes (1, 3, 10, 13, 18-20, 22, 26, 27, 30, 33). Among these methods, M serotyping has been taken as the "gold standard" for the characterization of S. pyogenes strains, in light of its importance to streptococcal virulence. However, application of M serotyping is restricted due to the lack of a comprehensive set...