Mycotic Lesions Research Articles

Characteristics of infectious complications in moderate and severe forms of atopic dermatitis

Atopic dermatitis (AD) is a multifactorial, genetically determined disease with a chronic relapsing course and a predisposition to hyperimmunoglobulinemia E. Abnormal colonization of Staphylococcus aureus, Malassezia furfur, and Herpes Simplex plays a significant role in maintaining inflammation in AD. Objective — to determine the frequency of bacterial, mycotic and viral complications in a group of patients with moderate and severe AD. Materials and methods. From 2018 to 2023, 80 patients with AD (moderate and severe forms) aged from 1 year to 53 years (average age 14.6 years) were under our observation. Patients with a SCORAD index ≥ 25 were included in the study. To confirm the nature of the infectious complication, additional examination methods were used: microscopy, bacteriological culture, amplification methods of research, dermatoscopy, immunoenzyme analysis. Results and discussion. An analysis of the total number of relapses of AD during the year was carried out, depending on the age and gender of the patients. The largest number of relapses was observed in the age group from 6 to 10 years — 9.4 ± 0.6. The frequency of AD relapses had a certain correlation with the severity of the course of dermatosis — the SCORAD index increased to 31.2 ± 0.4 in the group of patients with the highest frequency of disease relapses (9.4 ± 0.6) per year and, as a result, increase in the frequency of infectious complications. The conducted analysis showed that each age group of AD patients had its own characteristic spectrum of bacterial, mycotic and viral complications. The most frequent infectious complications of AD observed in the examined patients were streptostaphyloderma (18.8 %), molluscum contagiosum (11.3 %), mycotic lesions (10.0 %), herpes infection (6.3 %), Coxsackie virus (3.8 %), EBV ­infection (2.5 %). Conclusions. As a result of the clinical study, it was established that infectious complications in AD have age, gender, and topographic features that can change the course and prognosis of dermatosis. Against the background of reduced immunoreactivity, the risk of disseminated, life­threatening forms of infections increases in patients with atopic dermatitis.

Guttural Pouch Mycosis: A Three-Step Therapeutic Approach.

The temporary ligation of the common carotid artery is performed as an emergency aid in cases of guttural pouch mycosis. Its usefulness is put into perspective after an anatomical summary of arterial vascularization involving a guttural pouch. It helps to better understand the need for the cranial (cerebral) and caudal (cardiac) occlusion of an arterial rupture by embolization in order to achieve maximum success in preventing and treating an hemorrhage. Topical oxygen therapy used alone or in a multimodal approach with embolization surgery is performed to promote healing of the inflammatory and mycotic lesions observed when an individual is affected. In conclusion, this three-step therapeutic approach should enable the equine practitioner to better orient their decision tree when faced with this condition which, while rare, can be potentially fatal if poorly treated.

Possibilities of CT in the diagnosis of pulmonary aspergillosis in patients with COVID-19 (literature review)

Aim: to analyze the latest research in the field of CT diagnostics of pulmonary aspergillosis in patients with COVID-19 according to domestic and foreign literature.Results. Pulmonary aspergillosis is one of the most common life-threatening fungal diseases that is caused by inhalation of Aspergillus mold spores and affects all parts of the respiratory system. In recent years, there has been a sharp increase in cases of invasive mycotic processes. During the COVID-19 pandemic, according to a number of authors, the incidence of pulmonary aspergillosis reached 34.4%, and the mortality rate was 74%. The World Health Organization calls for “minimizing the disproportionate use of corticosteroids and antibiotics for mild and moderate cases”. She explained that corticosteroids in severe cases do save lives, but their massive use can cause fungal infections. This complication is increasingly common in patients after corticosteroid and antibiotic therapy, with immunodeficiency states, as well as those treated in intensive care units. The COVID-19 pandemic has created additional challenges in the diagnosis, treatment and prevention of fungal complications. The clinical and radiographic features of fungal infections are largely similar to typical pulmonary manifestations of COVID-19. A comparative analysis of CT signs of various forms of pulmonary aspergillosis before and during the COVID-19 pandemic was carried out according to the literature. The main CT symptoms of mycotic lung lesions among patients who have undergone COVID-19 have been identified. Currently, computed tomography is crucial, first of all, to detect and monitor complications of COVID-19, including the addition of a secondary fungal infection.Conclusion. To make a conclusion about mycosis in the early stages, special vigilance and high qualification of the radiologist are required, which in turn will contribute to the timely appointment of antifungal therapy, which will reduce morbidity and mortality.

Results of Thoracic Surgery in HIV-infected Patients

The objective: substantiation of the possibility of surgical treatment of various lung diseases in HIV-infected patients.Subjects and Methods. Comorbidities, medical history, bad habits, ongoing antiretroviral therapy (ARVT), viral load and CD4+count before and after lung surgery were assessed. Blood loss during the operation, intra- and postoperative complications was analyzed. Causes of postoperative lethality were analyzed.Results. According to results of the study, planned surgical treatment for chronic abscess, tuberculosis, cancer, mycotic pulmonary lesions and cicatricial stenosis of the trachea in HIV-infected patients is justified, and should be performed based on indications common for these diseases. This is confirmed by the level of postoperative complications in HIV-negative patients. The vast majority of complications were temporary, not severe, and were resolved by conservative treatment. Achievment of the best results is facilitated by ongoing ART.

Analysis of chronic pathology of the pharynx according to the results of pathohistological findings

Objective. To analyze the incidence of lymphoid structures of the pharynx among the adult population during the period from January 2021 to August 2022 in three nosological forms: chronic decompensated tonsillitis (CDT), hypertrophy of pharyngeal tonsils (HPT), hypertrophy of lingual tonsillitis (HLT). To determine the relationship of the above pathology between the age and sex of patients at the present stage. To evaluate the role of mycobiota in the structure of pharyngeal morbidity.Materials and methods. The object of the study was 96 patients with chronic pathology of the lymphoid structures of the pharynx aged from 17 to 70 years, who were on inpatient treatment at the Gomel Regional Clinical Hospital (GRCH) during the period from January 2021 to August 2022. All patients underwent surgical intervention followed by an assessment of the pathohistological conclusions of postoperative samples of pharyngeal lymphatic formations. The patients were divided into 3 nosological study groups: CDT; HPT; HLT. Statistical data processing was performed using software: MS Excel and the programming language for statistical data analysis R (version 4.2.1), packages tidyverse (version 1.3.1), rstatix (version 0.7.0), ggstatsplot (version 0.9.5).Results. The study revealed the most common nosological groups among patients with pathology of the pharyngeal lymphatic ring of Pirogov-Waldeyer: CDT (44%) and HPT (38%). A significant difference was revealed between the incidence rates of pathology of the Pirogov-Waldeyer pharyngeal lymphatic ring in the study age groups from 17 to 25 years (p=0.0008); from 26 to 35 years (p=0.0021); 56 years and older (p=0.008). The median age of patients in the study group was 35 years (LQ 24.0; UQ 48.5), whereas in some nosological forms: CDT – 30 years (LQ 23.0; UQ 41.0), namely 28 years among women and 36 years among men; HРT – 32.5 years (LQ 24.0; UQ 43.25), namely 34.5 years among women and 31.5 years among men; HLT – 57 years (LQ 49.0; UQ 63.0), and it is 56.5 years among women and 57 years among men. Morphological examination revealed only 2 (2%) cases of mycotic lesions of the removed lymphoid masses.Conclusion. The relationship between the pathology of lymphoid structures of the pharynx in three nosological forms (CDT, HPT, HLT) and the age of patients was revealed. The role of mycobiota in the overall study group in the structure of pharyngeal morbidity at the present stage was evaluated.

Widespread dermatophytosis after combined immunosuppressive therapy in a patient with COVID-19

Mycotic diseases of human skin are frequently diagnosed reaching 2025% of the population prevalence. The leading factor in the mycotic prevalence is the high survival rate of fungi in various environmental conditions. Up to 30 genera of fungi constantly live on human skin and mucous membranes. This constant balance of their presence on the body and interaction with it is called a mycobiome. If the balance between it and the macroorganism is disturbed, the reproduction of fungi begins and mycotic skin lesions develop.
 The study included the patient V. 75 years old, who came in with complaints of widespread rashes on the skin of the body and limbs accompanied by peeling after a COVID-19 infection. Microscopy revealed mycelium of pathogenic fungi. The patient received systemic and topical antifungal therapy until the end of hospitalization. He continued to receive terbinafine on an outpatient basis in combination with a topical antimycotic after discharge. Short review on baricitinib and levilimab is presented. According to the results of the study, a 6070% regression of the skin process was achieved after 2 weeks at discharge. One month later a complete regression of the skin process was achieved due to the therapy.
 The use of the combination of janus-kinase inhibitors with biological drugs and systemic glucocorticosteroids in COVID-19 patients has a powerful immunosuppressive effect on the body. It leads to the development of a common fungal skin lesion, which was observed in our patient.

P216 Rare isolates from subcutaneous mycotic lesions; A study from tertiary care center in Chhattisgarh, India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMAims and ObjectiveTo identify the causative agents of suspected subcutaneous mycosis patients attending to a tertiary care hospital, Chhattisgarh, India.IntroductionSubcutaneous mycoses are a group of fungal infections of dermis and subcutaneous tissue caused by both melanized and hyaline molds. It often affects patients with immunosuppressive conditions. It consists of Sporotrichosis, Chromoblastomycosis, Phaeohyphomycosis, Hyalohyphomycosis, Mycetoma, subcutaneous zygomycosis, Rhinosporidiosis, Lobomycosis, and disseminated Penicilliosis. There are proven pathogenic agents causing subcutaneous mycosis though are not regularly isolated and reported. Few of them are commonly come across in the laboratory. Herewith, emphasized on the unusual clinical isolates from the patients having subcutaneous mycotic lesions with their clinical details.MethodIt is a retrospective descriptive analysis of data of subcutaneous mycosis cases of duration January 2019 to March 2022.Total 52 clinical specimens from the suspected subcutaneous mycotic lesion were studied. Male dominance was observed amongst the patients. Amongst 52, 31% were detected positive for fungal elements by direct microscopy in 20% KOH mount, 55.7%, 25% positivity was observed in Culture and by both KOH wet mount and culture. Samples were processed and identified by using standard protocol.The significant unusual isolates identified were Conidiobolus coronatus from subcutaneous cyst from buttocks, Medicopsis romerai from fine needle aspiration from the nodule of left thumb, Rhytidhysteron rufulum from right lateral malleolus, Aquastroma magniostiolata species from subcutaneous cyst on lateral aspect of left lower leg above lateral malleolus, Aspergillus tamorii, Aspergillus glaucus, Chetomium species, Aspergillus montevidensis, Cladosporium sphaerospermum. Phenotypically unidentified isolates were sent to NCCPF PGI, Chandigarh for final identification.ConclusionThere is diversity in the etiological agents of subcutaneous mycoses. Every case is different and rare. With the help of molecular techniques, it became possible to identify unusual fungal isolates from subcutaneous infection. Awareness and extensive studies are required to evidence the pathogenicity and associated complication due to these fungal infections. It will also help to regulate the therapeutic management and to know the geographical distribution of unusual fungal agents.

D1 MTE2 Case 5: An adrenal mass...

A 35-year-old woman presented with weight gain (10kg), increased appetite, hirsutism, amenorrhoea, and deepening of voice for 8 months. On examination, blood pressure was 180/110 mm Hg, wide (1.5-2 cm), purple striae over anterior abdomen, hirsutism (mFMG score: 14), temporal baldness, clitoromegaly and proximal myopathy were noticed. Investigations revealed loss of circadian rhythm of cortisol with markedly elevated 24h- urinary cortisol (1371 μg) and serum testosterone (212.20 ng/dl) suggesting adrenocortical carcinoma (ACC). A non-contrast CT Abdomen showed a 65*63 mm well-defined hypo-dense left adrenal mass with homogeneous enhancement. She underwent laparoscopic left adrenalectomy and histopathology confirmed ACC with mitotic activity of 2-3/10 HPF. Post-operatively patient had features of adrenal insufficiency which was managed appropriately and discharged on oral prednisolone 5mg/day and fludrocortisone 100 μg/day. She discontinued medications a year later. Ten years later, she presented to us with similar complaints for 6 months. Her blood pressure was 112/86 mm Hg and mFGS score was 8. There were no striae, bruises, mycotic lesions, or proximal muscle weakness. Investigations revealed suppressed ONDST cortisol (9.55 μg/dl), elevated DHEAS (549.9 μg/dl), elevated total testosterone (143.16 ng/dl) and suppressed plasma ACTH (7.7 pg/ml). A CECT abdomen showed normal right adrenal with no evidence of recurrent or residual lesions in the abdomen. But, FDG-PET CT scan showed an FDG avid heterogeneously enhancing soft tissue mass of 9.3*7.5*8.7 cm (max SUV: 9.5) in the omentum-mesentry of the left middle quadrant of abdomen, likely representing metastasis. Patient underwent laprotomy and lesion was excised, which was confirmed to be low-grade ACC (mitotic activity: 6-8/10 HPF). Post-operatively, serum 8:00am cortisol was 0.43 μg/dl, DHEAS was 6.8 μg/dl and total testosterone < 10 ng/dl suggesting complete remission. She was replaced with glucocorticoids. Mitiotane therapy was offered but the patient deferred. She had documented remission at 1 year follow-up.

Etiology of community-acquired and hospital-acquired pneumonia associated with COVID-19

PurposeThe COVID-19 pandemic is accompanied by a high incidence of community-acquired pneumonia (CAP). Patients with a new coronavirus infection have an increased risk of developing hospital-acquired pneumonia. Aim: to study the etiological structure of CAP during the epidemic spread of COVID-19, to assess the risks of joining the pathogens of pneumonia associated with the provision of medical care.Methods & MaterialsBiological material from 1085 hospitalized patients with CAP was conducted from August 2020 - June 2021 in Rostov-on-Don (Russia). Verification of respiratory viruses including SARS-CoV-2 RNA was performed by polymerase chain reaction in nasopharyngeal smears. Bacteriological analysis of sputum was performed via classical methods, identification of isolated pathogens was carried out using time-of-flight mass spectrometry on an Autoflex (Bruker Daltonics) with BioTyper 3.0 software.ResultsCases of type 3 parainfluenza virus (7.8±0.9%), other types of coronaviruses (HKU-1, OC43, HL-63 and 229Е) (2.7±0.5%), respiratory syncytial virus (1.9±0.5%) were detected in patients with COVID-19. Fungi of the genus Candida (35.6±1.8%) and Staphylococcus aureus (9.1±1.1%) were prevailing in the microbiota structure. Should be noted that the number of Streptococcus pneumoniae cultures decreased from 5.5 % in August 2020 to 1.1 % in June 2021, possibly due to pneumococcal vaccination. Gramm-negative enterobacteria were presented predominantly by Klebsiella pneumoniae (3.5±0.7%), Escherichia coli (2.9±0.6%), and non-fermenting Gramm-negative bacteria – Pseudomonas aeruginosa (1.5±0.5%) and Acinetobacter baumannii (1.2±0.4%). In 30.6% of patients treated in the hospital there was a secondary infection probably associated with compromised immune system and the transmission of infection from the hospital environment. Secondary infection with Candida spp., non-fermenting Gramm-negative bacteria (A. baumannii, and P. aeruginosa) and K. pneumoniae, including those characterized by multiple drug-resistance, prevailed. The most frequently registered resistance to penicillins, cephalosporins of 3rd generation.ConclusionA feature of CAP in patients with laboratory-confirmed COVID-19 is a higher incidence of mixed infection of both viral and bacterial etiology. Patients with COVID-19 represent a high risk group for the development of mycotic lung lesions, possibly against the background of treatment with antibacterial drugs. There is a significant risk of the formation of nosocomial infections in patients.

Surgical treatment of ruptured right middle cerebral artery mycotic aneurysm and central nervous system aspergillosis: Clinical case and literature review

Background: Central nervous system (CNS) aspergillosis is more often met in patients with expressed immune suppression. Still, in 50% of cases of meningitis caused by Aspergillus spp., it is observed in patients without expressed immune suppression. The prognosis of CNS aspergillosis is unfavorable with the general rate of lethality around 70%.Case Description: Clinical case of a 58-year-old man who developed an Aspergillus abscess in the chiasmosellar region and an associated mycotic aneurysm of the right middle cerebral artery (MCA) and intracerebral hemorrhage. Microsurgical clipping of the fusiform-ectatic aneurysm of the right MCA in the conditions of rupture was performed. An extra-intracranial micro anastomosis was formed on the right. An open biopsy of the neoplasm in the chiasmosellar region was made. The neoplasm was yellow and destroyed the bone plate of the skull base. Biopsy results: Mycotic lesion (aspergillosis). The analysis of surgical treatment for mycotic aneurysms in the acute period of hemorrhage in patients with aspergillosis revealed a high rate of lethality. The issue of the feasibility and effectiveness of complicated revascularization interventions in the patients with hemorrhage and aspergillosis remains unsolved.Conclusion: The lack of generally accepted tactics of the treatment of this pathology requires further studies and systemic analysis. A high risk of the lethal outcome in patients with invasive mycotic infection and rupture of mycotic aneurysm highlight the importance of timely diagnostics and the beginning of antimycotic therapy. WThe issue of the evaluation of the revascularization methods effectiveness in patients after surgical treatment of a mycotic aneurysm associated with cerebral aspergillosis remains poor.

ENDOTHELIAL DYSFUNCTION AND POLYHYPOVITAMINOSIS IN PATIENTS WITH COMPLICATED DESTRUCTIVE ONYCHOMYCOSIS AND THE COMORBID METABOLIC SYNDROME

In the pathogenesis of chronic infectious fungal processes, an important role is determined by the weakening of the body's protective factors. There are endogenous and exogenous that contribute to the transformation of fungi from vegetation to pathogenic. Endogenous factors (age, general infections, metabolic diseases, hypo- and avitaminosis, metabolic syndrome, gastrointestinal diseases, neuropathy) are define some clinical variants. Destructive fungal lesions predominate in middle-aged and elderly people, in elderly patients nail pathology is half of all observations of purulent-necrotic chronic lesions of the distal parts of the hand and foot. The purpose of the work was to introduce minimally invasive nail removal or resection of nails by block-shaped eponychectomy access with the use of pedicure instruments, study of biochemical changes in the background of pathology, detection of correlations between hypo- and avitaminosis with the development of destructive onychomycosis. It has been established that conservative, podiatric and orthopedic treatment of mycotic surgical lesions and secondary nail incarnation are not very effective, while some classical methods are Dupuytren's nail removal, Emmert-Schmiden operation and others in 2-20% of cases (depending on the absence or presence of onychocryptosis and associated fungal lesions) determine recurrences. Instead, the proposed low-trauma removal or resection of nails by block-shaped eponychectomy access using pedicure instruments, excision of dermatophytoma with partial marginal matrixectomy, which significantly reduces the number of recurrences of ingrowth (respectively 1-3% in the early stages and , 3,25% та 6,42% periods of growth, χ2 = 28,17, p<0,01) and determines the improvement of quality of life. The study of endothelial function revealed the presence of endothelial dysfunction in most patients, which confirms our previous studies and literature data. Blood lipid spectrum was significantly higher in both groups of patients (main and comparison group), compared with almost healthy individuals (p<0.01 for both groups, compared with controls), which is consistent with the literature. It was found that the supply of vitamins B1, B2, PP, B6 and C directly correlated with the severity of the underlying disease. In patients with polyonychomycosis with significant symptoms of background polyhypovitaminosis , some purulent complications of mycotic onychodestruction were detected – subungual abscess / panaritium, complicated nail incarnation and mycotic-associated paronychia with purulent onychia / onycholysis of more than three nail plates. For comparison, in the other half of the sample of persons with less pronounced symptoms of polyhypovitaminosis, some purulent complications were found in only 37.5% of the subsample, which suggests that there is a relationship between the manifestations of multivitamin deficiency and the severity of necrotic complications. Low-traumatic mobilization of the nail through a block-like eponihectomy and nail plates removal or resection (some nail incarnation ) of through areas of onycholysis/onychomadesis, or resection of nails through hyperkeratosis / onycholized structures using our methods, according to our comp lex analysis, due to reduction of intraoperative injury, determines increasing the rate of wound healing ( χ 2=32,14, p<0,01) and statistically significant minimization of the risk of mixed and reinfection of adjacent anatomical structures.

Isolation Of Dermatophytes From Infected Stray Cats In Selangor

Background: Dermatophytosis is the most prevalent fungal infection found in cats and one of the most serious infectious skin diseases that affect this species. Dermatophytosis can be endemic in cats, particularly in poor environments, and it is difficult to eradicate in such cases. Purpose: The aim of this research was to determine the macroscopic and microscopic identification of various types of dermatophytes present in stray cats. Methods: The research was designed as a laboratory-based study. The sample was determined through physical examination of stray cats infected with fungi and was selected based on the infection site (nail, hair, and skin) of infected cats. A total of 125 samples were collected from infected stray cats through skin scraping, haircutting, and nail clipping. The collected samples were then cultured in Sabouraud Dextrose Agar (SDA) medium and incubated for two weeks at 26°C. Following incubation, fungi were stained using Lacto-phenol Cotton Blue (LPCB) for microscopic identification. Results: The identification showed that Trichophyton spp. is the most common isolated fungal species on the hair, nails, and skin of stray cats. This is followed by Aspergillus spp. and Microsporum spp. The least common dermatophytes include Curvularia spp., Absidia spp., Epidermophyton spp., Neosytallidium spp., Alternaria spp., Scopulariopsis spp., Mucor spp., and Penicillium spp. Conclusion: The research focussed exclusively on stray cats with clinical evidence of mycotic lesions and confirmed the role of stray cats in transmitting dermatophytosis through their hair, nails, and skin. The prevalence of dermatophytes on stray cats was identified in the Selangor region.

Prevalence of Pulmonary Mycotic Lesions and Antifungal Susceptibility Pattern of Fungi Isolated from Nigerian Trade Cattle

Pulmonary mycosis is a major cause of deaths in many livestock herds, especially in immune-compromised animals. A total of 138 lung samples (6mm in size) were collected from cattle slaughtered for meat at Nsukka abattoir. Swab sticks were dipped into each lung sample and streaked on freshly prepared Sabouraud Dextrose Agar (SDA) for fungal isolation. Isolated fungi were identified using morphological and microscopic features. Disc diffusion method was used to test the antifungal susceptibility pattern of a randomly selected isolates with voriconazole (1μg), fluconazole (25μg) and methanol extract of Garcinia kola, using disc diffusion method. The lung samples were examined for lesions using histopathological procedures. Out of the 138 lung samples, 23 had fungal growths while 115 had no growth of any sort. A total of 34 fungi were isolated as pure cultures. Aspergillus spp. had the highest frequency of isolation, 44.92%, followed by Penicillium spp. 11.76%, Trichophyton spp. 5.88%, Conidiobolus and Sporothrix species had 2.94% isolation rate each. About 29.6% of the isolated fungi could not be identified. Fungal positive lungs showed acute to sub-acute inflammatory responses with bronchiolar septal, alveolar interstitium and peribronchial inflammatory cell infiltration and thickening of the lung tissues. All the screened fungal isolates were sensitive to voriconazole with the zone of inhibition ranging from 12-27mm. The fungal isolates were all resistant to fluconazole and G. kola extract, except one that showed sensitivity to the extract. Voriconazole showed strong antifungal effect on all the fungi; but the efficacy of the G. kola on the fungal isolates was very low compared to voriconazole.

Topical therapy of onychomycosis in patients with psoriasis

Objective — to study the effectiveness of the method of treating onychomycosis using only local agents in patients suffering from psoriasis and having contraindications to the use of systemic antifungal agents.&#x0D; Materials and methods. The study involved 52 patients with psoriasis and lesions of the nail plates, aged 21 to 67 years. The duration of the disease was from 1 to 27 years.To verify the fungal infection of the nail plates, a microscopic examination of nail scales with 20 % KOH and molecular genetic studies using pan-fungal primers were carried out.Among 52 examined patients with psoriasis who had clinical signs of lesions of the nail plates, there were 37 people with mycotic infection lesions of the nail plates.Due to the somatic burden, the use of systemic antifungal agents was contraindicated. Treatment of onychomycosis in such patients was carried out using only local therapy and sanitary-hygienic measures. As a topical antifungal therapy, 1 % solution and 1 % cream of naftifine hydrochloride were prescribed in combination with drugs that improve the structure of the nail plates (Volvit, 5 mg once a day and Cytoflavin, 2 tablets 2 times a day for 1.5 months).&#x0D; Results and discussion. 1 month after the beginning of the use of the proposed method for the treatment of nail fungal infection in case of psoriasis of the scales of the nail plates, mycelium and fungal spores were absent in 6 (16.2 %) patients with distal lesions of the nail plates. After 4 months of treatment they were absent in 16 (43.4 %) patients with distal-lateral lesions of the nail plates, after 6 months — in 21 (56.7 %) patients, after 9 months — in 26 (70.2 %) patients.&#x0D; Conclusions. The proposed complex method is quite effective and of higher priority for the treatment of onychomycosis in patients with comorbid conditions that make it impossible to treat a fungal infection with systemic antimycotics.

MODERN MICROBIOLOGICAL TECHNOLOGIES IN DIAGNOSIS OF MYCOSES IN OTORHINOLARYNGOLOGICAL PRACTICE

The review article highlights the latest approaches to solve one of the important problems of modern otorhinolaryngology, the diagnosis of opportunistic mycoses of the upper respiratory tract and ear. Opportunistic mycoses of the ENT organs in recent decades have posed a significant challenge for modern clinical medicine not only in Ukraine but also throughout the world. According to the scientific literature, the share of fungal lesions of the ear and upper respiratory tract in the structure of chronic inflammation of these organs makes up 22.1%. The main causative agents of mycotic lesions of the ENT organs are opportunistic fungi of the genera Aspergillus, Рenicillium, Mucor and yeast-like fungi of the genus Сandida, which are characterized by a low level of pathogenicity and are a part of the resident microflora of the macroorganism. Classical methods of microbiological diagnosis have certain limitations in the identification of micromycetes. Therefore, the use of more reliable, fast and accurate methods in clinical practice will contribute to the timely and effective treatment of fungal diseases of the ENT organs. This review presents an analysis of modern microbiological diagnostic technologies, such as biochemical detection of microorganisms using identification plate test systems (ARI RapID, CrystalTM), semi-automatic and automatic microbiological identification using analyzers VITEK, VITEK 2, Walk Away. Identification of fungal pathogens can also be performed by performing direct protein profiling using mass spectrometry, polymerase chain reaction and sequencing. These methods with the highest level of reliability enable to identify the pathogen, as well as to assess its sensitivity to chemotherapeutic drugs. The combination of classical and modern microbiological technologies should become a standard for the diagnosis of fungal diseases, including the upper respiratory tract and ear.

Features of Etiology of Community-Acquired Pneumonia Associated with COVID-19

Objective: comparative study of the etiological structure of community-acquired pneumonia in SARSCoV-2 “+”and SARS-CoV-2 “-“ patients who sought help from medical organizations in the Rostov Region.Materials and methods. Biological material from 508 patients diagnosed with community-acquired pneumonia who were on outpatient treatment or in hospitals in Rostov-on-Don was studied. Verification of respiratory viruses, including SARS-CoV-2 RNA, as well as M. pneumoniae, C. pneumoniae, and L. pneumophila was performed by polymerase chain reaction in nasopharyngeal smears. Bacteriological analysis of sputum was carried out using differential diagnostic media, identification of isolated pathogens was carried out using time-of-flight mass spectrometry on Autoflex (Bruker Daltonics) with BioTyper 3.0 software.Results and discussion. During the spread of a new coronavirus infection in the Rostov Region, the main etiological agent of community-acquired pneumonia is the new SARS-CoV-2 coronavirus. Specific character of pneumonia in patients with laboratory-confirmed COVID-19 is a higher incidence of mixed infection of both viral and bacterial etiology. Against the background of detection of a new coronavirus infection in patients with pneumonia, cases of detection of other types of coronaviruses have been registered (HKU-1,OC43, HL-63 and 229Е). The most common etiological agent of bacterial pneumonia in patients was Streptococcus spp., both in patients with COVID-19-associated pneumonia and in patients who tested negative for SARS-CoV-2. Coronavirus patients represent a high risk group for the development of mycotic lung lesions.

Surgical management of infectious keratitis

Infectious keratitis is one of the most common causes of blindness worldwide. Despite the existence of a wide arsenal of quite effective antimicrobial drugs, some forms of bacterial and viral keratitis are resistant. Advanced acanthamoeba and mycotic lesions of the cornea, as well as mixed forms of infection usually do not respond well to conservative treatment. In the absence of positive dynamics from the applied etiotropic therapy with observed further progression of the microbial process, there is a risk of corneal perforation and spread of infection to the sclera or deep ocular structures with a high probability of irreversible functional disorders or anatomical death of the eye. In such cases, a timely transition to surgical treatment is necessary in order to maintain structural integrity of the eyeball. For this purpose, corneal crosslinking, microdiathermocoagulation, tissue adhesive, autoconjunctival plasty, amniotic membrane, corneoscleral flap coating, various combinations of these methods, as well as therapeutic keratoplasty are used most often in clinical practice. The choice depends on the etiology, size and depth of the lesion, its localization, prognosis of visual outcomes, somatic status of the patient. Therapeutic keratoplasty is the most radical and effective method of surgical intervention that allows eradication of the infectious focus and best possible restoration of the structural integrity of the eyeball. However, in some cases due to inaccessibility of donor material or high risks of the surgery and non-transparent graft engraftment, it is advised to use alternative surgical approaches, and keratoplasty, if necessary, should be carried out for optical purposes at a further, "quiet" period.

Mucormycosis of the bones of the facial skull, nasal cavity and par anasal sinuses in patients with COVID19

Abstract Currently, the relevance of the issues of diagnosis and treatment of invasive fungal diseases has increased significantly due to the pandemic of a new coronavirus infection COVID-19 and the massive use of corticosteroids for the treatment. The key success factors in the outcome of invasive fungal diseases are early diagnosis and treatment, including the applying of an adequate systemic antifungal therapy and surgical treatment. Extensive areas of mycotic lesions of the facial bones and paranasal sinuses are lifethreatening conditions due to anatomical proximity to brain structures and a high risk of dissemination of I invasive fungal diseases with a fatal outcome. The objective of this work was to study the risk factors, possible pathogenesis, diagnosis and treatment strategy of invasive fungal diseases of the orofacial region in convalescents of COVID-19. We present case-series data on six patients in the clinics of maxillofacial surgery and otorhinolaryngology of the Pavlov First Saint Petersburg State Medical University over the period of 2021–2022. Predisposing factors, clinical and radiological symptoms, features of diagnosis, therapy and surgical strategy were analyzed. The presented observations confirm the relevance and danger of complications after a COVID-19 in the form of the development of invasive fungal diseases with damage to the maxillofacial region caused by mucormycetes and Aspergillus spp., as well as importance of early diagnosis and treatment.

Foot mycosis: how to help active patients

Mycotic infections of the feet are common fungal infections in our time. According to some reports, about 10% of the world's population suffer from these infections. Men suffer from foot mycosis more often than others. Foot mycosis can manifest itself in three clinical forms: interdigital, plantar and vesiculopapular. Foot mycosis is often combined with onychomycosis or becomes a risk factor for its development. Many diseases, such as diabetes mellitus, vascular diseases, obesity are risk factors for foot mycosis. But what is important is that young and middle-aged people who lead an active lifestyle are at risk. It has long been established that public places such as gyms, swimming pools, baths and saunas are a source of mycotic infections. The internal climatic environment of footwear also has a significant impact on the development of foot mycosis. Closed shoes with high internal temperature and humidity create ideal conditions for dermatophyte growth. That is why people who prefer closed, even cloth shoes, or office workers, who are forced to constantly wear closed shoes, often suffer from foot mycosis and other fungal infections.The main problem in the treatment of foot mycoses is adherence to the prescribed treatment. In our practice, mycotic lesions are more common in people who lead an active lifestyle and are unable to adhere to a long course of therapy. Indeed, the treatment of mycosis often involves a two-week application of some topical antifungal agent. It is optimal to prescribe a single application of terbinafine film forming solution to such patients. This drug ensures the clinical effectiveness of therapy as it keeps antifungi-cidal activity for 13 days from the date of application and high adherence to treatment.

CLINICAL PARALLELS IN INFECTIOUS DISEASES OF THE CENTRAL NERVOUS SYSTEM IN PATIENTS WITH HIV

A retrospective analysis of medical records of 451 patients with HIV infection showed that the most common clinical manifestations of cerebral tuberculosis are as follows: headache, fever ≥ 38.0 °C, meningeal symptoms; in toxoplasmosis encephalitis these are headache, paresis of cranial nerves and extremities, incoordination, cognitive disorders, dysarthria, fever ≥ 38.0 °C and convulsions; in mycotic lesions of the CNS they are headache, coordination disorders, positive meningeal symptoms, disturbances of consciousness, cognitive disorders, visual disorders, cranial nerve deficiency, convulsions and dysarthria. The clinical picture of bacterial (exacted) meningitis was dominated by positive meningeal symptoms, headache, fever, impaired consciousness. At the same time, in such neurological manifestations of central nervous system lesions as cranial nerve paresis, mono− and hemiparesis, visual, coordination and speech disorders, which mostly accompany cerebral toxoplasmosis, cerebrovascular diseases, brain tumors, encephalitis of unspecified etiology. Thus, the analysis suggests that the clinical manifestations of various etiologies of lesions of the central nervous system are often nonspecific and probably are stipulated with common morphological changes in brain tissue, which may be associated with the neuropathological effects of HIV, as well as a large impact co−infection. Key words: HIV infection, opportunistic infections, central nervous system, main symptoms.