Objective. To study the features of invasive aspergillosis (IA) due to A. non-fumigatus versus A. fumigatus in adult (≥ 18 years) recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 2016-2021. Materials and methods. The study included 33 patients with IA caused by A. non-fumigatus (n = 20) and A. fumigatus (n = 13). A comparative analysis of cases of IA, the results of therapy and outcomes in patients after allo-HSCT in the RM Gorbacheva Research Institute was performed. Diagnostic criteria EORTC / MSGERC 2020 were used. Results. Invasive aspergillosis caused by A. non-fumigatus made up the majority (60.6 %) of IA cases with an identified pathogen registered in patients after allo-HSCT in the period from 2016 to 2021. The main etiological agents in the A. non-fumigatus group were A. niger in 13 (65 %) patients, A. flavus – in 4 (20 %). The median day of diagnosis of A. non-fumigatus IAwas + 110 days (17–2093), for A. fumigatus it was + 46 days (2–866) (p = 0.171). Overall 12-week survival was 55 % and 59.2 % in the A. non-fumigatus and A. fumigatus groups, respectively (p = 0.617). The majority of patients in both the A. fumigatus (n = 10, 77 %) and A. non-fumigatus (n = 16, 80 %) groups received voriconazole as initial antifungal therapy. Second-linetherapy was required in 2 (10 %) patients with A. non-fumigatus IA: liposomal amphotericin B and echinocandins with or with-out posaconazole, and 2 (15 %) patients in the A. fumigatus group: liposomal amphotericin B and voriconazole in combination with echinocandins. A comparative analysis showed that in patients from the two groups, none of the assessed signs (gender, age, underlying disease, disease status at the time of transplantation, time from diagnosis to allo-HSCT, source of hematopoietic stem cells, conditioning regimen, donor type, antifungal prophylaxis, cytomegalovirus reactivation, severe acute and chronic graft-versus-host disease) did not differ significantly. Conclusions. A. niger is the main causative agent of IA caused by A. non-fumigatus. Patients characteristics, their treatment and outcomes did not differ significantly between the A. non-fumigatus and A. fumigatus groups.

The aim of the work is to attract the attention of specialists: dentists, oncologists, hematologists to thorough sanitation of the oral cavity of patients preparing for chemotherapy treatment, to transplantation of hematopoietic stem cells. Two clinical cases described in the article were observed at the R.M. Gorbacheva First Saint-Petersburg State Medical University from 2010 to 2019. They confirm the possibility of the occurrence of infectious complications with damage to the maxillofacial region caused by rare pathogens of invasive mycosis, which debuted as an odontogenic inflammatory process. The success of the treatment of Invasive Mycosis depends on early diagnosis and antimycotic therapy; active surgical tactics in relation to the affected tissues in a controlled course of the underlying disease and the restoration of effective hematopoiesis.

AbstractCurrently, 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.

Malassezia spp.is a commensal yeast that represents normal microflora in humans and some animals. However,Malassezia spp.can cause life-threatening invasive mycosis. Evidence on Malassezia spp. infections is limited mostly to a case reports describing disease in newborns and premature infants, because lipid infusions (total parenteral nutrition) given through central venous catheter is a major risk factor. Here, we report two cases of CNS infection caused by Malassezia species in non-neonates with acute leukemia.

Aspergillus fumigatus is the most common etiologic agent of invasive aspergillosis (IA) reported in severely immunocompromised patients. Aspergillosis caused by non-fumigatus Aspergillus species is poorly studied. We design the retrospective study in order to investigate the epidemiology of IA caused by Aspergillus non-fumigatus as a single agent in large cohort of patients after HSCT and chemotherapy from 2013 to 2018 in CIC725. During the observation period 30 patients with IA caused by Aspergillus non-fumigatus were identified and included into analysis. The median age was 26 (3-60) y.o., males – 53%. The median follow up time was 10 months; for survivors – 17,5 months. A. non-fumigatus IA was more common diagnosed in allo-HSCT recipients (90%) then after chemotherapy (10%). Most of the patients at the moment of IA diagnosed received antifungal prophylaxis with fluconazole (83%) or echinocandins (6,7%). Breakthrough IA (prophylaxis with voriconazole – 2, posaconazole – 1) was diagnosed in 10% of patients. Etiology agents were Aspergillus niger – 60%, A. flavus – 34%, A. glaucus – 3%, and A. terreus – 3%. The main sites of infection were lungs (80%), paranasal sinuses (10%), or combination lungs and paranasal sinuses (10%). A. non-fumigatus IA developed in combination with bacterial or other fungal infections in 20% (n=6). The median time of onset of A. non-fumigatus IA after allo-HSCT was 155 (19-922) days. Antifungal therapy was used in all patients: voriconazole – 73,3%, lipid amphotericin B – 6,7%, posaconazole – 6,7%, combination therapy – 13,3%. A. non-fumigatus IA developed on the background of acute graft-versus-host diseases (GVHD) grade 2-3 + glucocorticoids therapy (25%) and CMV reactivation (19%). Overall survival at 12 weeks from the diagnosis of A. non-fumigatus IA was 83,3%. Death could be attributed to IA was registered in one case. Aspergillus non-fumigatus IA affected allo-HSCT recipients (90%). Aspergillus niger was the main etiology agent. Aspergillus non-fumigatus IA was a late complication and developed on the background of CMV reactivation and acute GVHD. Overall survival at 12 weeks from the IA diagnosis was 83,3%.

Invasive fungal diseases (IFD) are a major cause of morbidity and mortality in hematological patients, but prognosis of IFD has improved recently, due to introduction of new antifungals and efficient diagnostic procedures.Number of patients with IFD who are candidates for allogeneic hematopoietic stem cell transplant (allo-HSCT) increased.However, publications on the field are limited and there are no data on results of pediatric allo-HSCT patients with prior IFD.This study focuses on the outcomes of allo-HSCT in children and adults with prior IFD.

Background. Despite of modern methods of diagnosing, prevention and treatment, invasive fungal disease (IFD) remains actual problem after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Data of IFD in adolescents and young adults (15–25 y.o.) after allo-HSCT are limited. The aim of the study was to estimate of incidence, etiology, clinical signs and outcome of IFD in adolescents and young adults recipients of allo-HSCT. Materials and methods. In retrospective single center study from Jan 2013 to Dec 2014 were included 80 pts after first allo-HSCT in the clinic of Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg. EORTC/MSG 2008 criteria for IFD diagnosis were used. “Active IFD” means IFD diagnosed just before HSCT. Results. Incidence of IFD before allo-HSCT was 18.8 % (n = 15): invasive aspregillosis (IA) (n = 11), invasive candidiasis (IC) (n = 3) and 1 patient had two IFD (IA + IC). Complete response to antifungal therapy was in 40 %, partial – 26.7 %, “active” IFD – 33.3 %. Secondary antifungal prophylaxis was made predominantly with voriconazole (80%). Patients without IFD before HSCT (n = 65) received primary antifungal prophylaxis predominantly with fluconazole (85 %). Cumulative incidence of IFD-events at 1 year after allo-HSCT was 15 %, at 2 years – 18.8 % including new cases of IFD (n = 14) and relapse of IFD (n = 1) after allo-HSCT with median day of oncet +43 (14–577). Incidence of IA was 15 %, IC – 2.5 %, pneumocystis pneumonia (PCP) – 1.25 %. IFD risk factors after allo-HSCT (< 0.05) were: age < 18 years, non-malignant diseases, active disease at the moment of HSCT, neutropenia grade IV more than 20 days, acute “graft-versus-host” disease. First-line therapy were: IA – voriconazole (58.3 %), IC – echinocandins (100 %), PP – co-trimoxazole (100 %). 12-weeks overall survival (OS) from day of IFD diagnosis after allo-HSCT was 93.3 %, IA – 91.7 %. All patients with IC and PCP alive. 100-days OS after allo-HSCT was 85 %, 2-year OS after allo-HSCT – 67.5 %. There was no difference in OS in patients with or without IFD before allo-HSCT. Conclusion . Incidence of IFD in adolescents and young adults before allo-HSCT was 18.8 %. Only one patient relapsed with IA after allo-HSCT. Incidence of IFD after allo-HSCT (1 year) was 15 %. The main IFD was invasive aspergillosis. 12-weeks overall survival from IFD diagnosis after allo-HSCT was 93.3 %. IFD before and after allo-HSCT did not impair the outcome of the transplantation in adolescents and young adults.