Contrasts between mucormycosis and aspergillosis in oncohematological patients.

In retrospective multicenter study from years 2007-2017, we evaluated 59 oncohematological patients with mucormycosis and 541 with invasive aspergillosis (IA). Mucormycosis developed more often in children and adolescents (P = .001), as well as after the emergence of graft versus host disease (P = .0001). Patients with mucormycosis had more severe neutropenia (88% vs 82%), the median duration was 30 versus 14 days (P = .0001) and lymphocytopenia (77% vs 65%), with a median duration (25 vs 14 days, P = .001) as compared to patients with IA. The lung infection was less frequent in patients with mucormycosis than in IA patients (73% vs 97%, P = .02), but more frequent was involvement of 2 or more organs (42% vs 8%, P = .001) and involvement of paranasal sinuses (15% vs 6%, P = .04). Typical clinical features of mucormycosis were localized pain syndrome (53% vs 5%, P = .0001), hemoptysis (32% vs 6%, P = .001), pleural effusion on lung CT scan (53% vs 7%, P = .003), lesions with destruction (38% vs 8%, P = .0001), and a "reverse halo" sign (17% vs 3%). The overall 12-week survival was significantly lower in patients with mucormycosis than for IA patients (49% vs 81%, P = .0001). In both groups unfavorable prognosis factors were ≥2 organs involvement (P = .0009), and concomitant bacterial or viral infection (P = .001, P = .008, respectively). In mucormycosis patients favorable prognosis factor was remission of underlying disease (P = .006).

Etiology of invasive candidosis agents in Russia: a multicenter epidemiological survey.

A multicenter prospective epidemiological survey on the etiologic agents of invasive candidosis was conducted in Russia in the period of 2012-2014. Samples were collected from 284 patients with invasive candidosis and Candida species isolated by culture. The species were identified by DNA sequencing and MALDI-TOF massspectrometry. A total of 322 isolates were recovered, in which 96% of Сandida species belonged to six major species, namely, C. albicans (43.2%), C. parapsilosis (20.2%), C. glabrata (11.5%), C. tropicalis (9.6%), C. krusei (6.2%), and C. guilliermondii (5.3%). Most Candida species were isolated from blood samples (83.23%). Notably, the prevalence rate of C. albicans reduced from 52.38% to 32.79% (2012 vs. 2014) (P = 0.01) whereas that of non-C. albicans increased from 47.62% (2012) to 67.21% (2014) (P < 0.01). Species distribution differed among geographical regions; specifically, the prevalence rate of C. albicans as an etiologic agent of invasive candidosis in Siberian Federal region was significantly higher than that in other Federal regions. Results indicated a shift from C. albicans to non-C. albicans. Therefore, a detailed investigation on the contributing factors and appropriate treatment of invasive candidosis is needed.

[Invasive mucormycosis in patients with hemoblastosis in St.-Petersburg].

Thirty four patients with mucormycosis in 10 hospitals of St. Petersburg were observed in 2004-2013. The most frequent underlying diseases of mucormycosis were acute leukoses (64%). In 100% of the patients mucormycosis developed as a nosocomial infection. The risk factors, etiology, basic clinical signs and strategy in the treatment of mucormycosis were analyzed.

[The possibilities for using combined methods in typing Candida albicans for establishing epidemiological relationships]. / Vozmozhnosti primeneniia kombinirovannykh metodov tipirovaniia Candida albicans dlia ustanovleniia épidemiologicheskikh sviazei.

An outbreak of candidiasis caused by C. albicans was registered in a neonatal intensive care unit of one of the hospital of St.-Petersburg at the period of August 12-October 8, 1992. C. albicans were isolated from 21 out of 87 patients. To achieve their more detailed deciphering and to establish epidemiological relationships, the intraspecific typing of C. albicans was carried out by DNA typing and by the electrophoretic spectrum of exoproduct proteins. The analysis of the results of this typing revealed that strains classified with the same biotype belonged to different electrophoretic groups and, vice versa, strains of the same electrophoretic group could belong to different biotypes. The analysis of the data obtained by taking into account the results of typing by the two methods, the time of the patients stay in the unit, the number of the maternity clinic from which an individual patient arrived, the number of the reanimation place and the number of the apparatus for artificial lung ventilation made it possible to establish epidemiological relationships between the patients in all cases.

[An outbreak of nosocomial candidiasis in a hematology ward]. / Vspyshka vnutribol'nichnogo kandidoza v gematologicheskom otdelenii.

The aim of the present investigation was the study of the epidemic process of hospital candidiasis. The study was carried out from October 1991 to May 1992 in a hematological ward of one of the hospitals of St.-Petersburg on 9 patients with generalized forms of candidiasis: in 4 of them the disease was caused by C. albicans and 5--by C. parapsilosis. Intestinal dysfunction as one of the first manifestations of candidosepsis caused by C. albicans, the isolation of C. albicans from feces, ulcero-necrotic colitis (established by postmortem examination), as well as the incapacity of these patients of immune response (in 2 serologically examined patients the titer of antibodies to fungi of the genus Candida was found to be lower than the diagnostic titer), were indicative of the dissemination of fungi from the gastrointestinal tract. The cases of fungemia caused by C. parapsilosis were due to the fungal contamination of vascular catheters in these patients. This infective agent was also isolated from washings obtained from the hands of nurses carrying out treatment and from medical rubber gloves. Moreover, some violations in the rules of the preparation of disinfecting solutions and the treatment of the hands of the personnel were established.

Meningitis caused by Rhodotorula rubra in an HIV-infected patient.

Meningitis caused by Rhodotorula spp. in HIV-infected patients has not been reported previously. We present a brief review of the literature regarding medically important species of Rhodotorula and a case of meningitis caused by Rhodotorula rubra in an HIV-infected patient. The diagnosis was confirmed by the isolation of the fungus from the CSF. The course of Rhodotorula-induced meningitis was characterized by gradual development over several months, severe headache and high body temperature. No signs of damage to the meninx or inflammatory changes were observed. Therapy with 5-fluorocytosine for 15 days was successful in eliminating the yeast from the CSF. Eight months later the meningitis relapsed with R. rubra being recovered from the CSF. Suppressive therapy with itraconazole (400 mg daily during 3 months) followed by maintenance therapy (200 mg daily) eradicated the infection.

[Methodologic problems in the biotyping of Candida albicans]. / Metodicheskie voprosy biotipirovaniia Candida albicans.

The biotyping of 284 C. albicans strains has been carried out in accordance with the system of three tests, proposed by F.C. Odds and A. B. Abbott. The reliability of the epidemiological conclusions made as the result of this work has been analyzed. The independence of the signs of C. albicans used in biotyping and the asymmetrical character of the test for its sensitivity to 5-fluorocytosine have been shown. The change of this test for a more symmetrical one is proposed. The study has shown that in the process of prolonged storage with periodic subculturing the proportion of C. albicans strains resistant to pH 1.40 and possessing proteolytic activity is decreased. The distribution of different biotypes among C. albicans strains isolated from candidiasis patients and from carriers has proved to be the same.