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Vol 26, No 6 (2021)

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Fungal complications with the new coronavirus infection COVID-19

Avdeeva M.G., Zotov S.V., Kulbuzheva M.I., Moshkova D.Y., Zhuravleva Y.V.


BACKGROUND: The growth of fungal pathology observed in the last decade, including life-threatening invasive mycoses, is associated with the spread of immunodeficiency states of various etiologies. The COVID-19 pandemic has made a negative contribution, causing a significant increase in the number of patients with fungal complications.

AIM: To characterize the types of fungal complications in the acute period of a new coronavirus infection COVID-19 based on an analysis of the clinical course and therapeutic tactics for managing the underlying disease.

MATERIALS AND METHODS: The results of a bacteriological study of 1284 cultures from sputum samples of patients with suspected secondary pneumonia in COVID-19 are considered. The study included 404 cultures of various types of fungi. The analysis of the clinical picture was carried out in 70 patients with fungal complications of various localization, who were treated in a regional covid hospital. This group included the results of microbiological examination of sputum, bronchoalveolar lavage (BAL), scrapings from lesions in the oropharynx, urine, blood, biopsy and autopsy material. The study was conducted from April 01, 2020 to December 31, 2021. The patients were divided into subgroups depending on the isolated pathogen: Candida spp. ― 64 patients, and fungi (Aspergillus spp. and Mucor spp.) ― 6 patients; outcome of the disease: favorable — 66, lethal — 4.

RESULTS: In the microbial landscape of the respiratory tract in patients with COVID-19, gram-negative microbial flora prevailed, one third of the cultures were represented by fungi. During the two years of the pandemic, the proportion of fungal cultures increased from 26.9% in 2020 to 34.2% in 2021, while maintaining sensitivity to amphotericin B and fluconazole in most cases. In 2021, there was a negative growth trend in the sputum of molds of the species Aspergillus spp. (5 cultures) and Mucor spp. (1 culture).

Typical fungal complications of COVID-19 were: candidiasis stomatitis caused by Candida albicans (71%), candidiasis of other urogenital localizations in the form of candiduria (20%), lung damage of mixed viral-fungal etiology in isolated cases, leading to death due to invasive mycosis. Only fungal flora was isolated in 57.1% of cases, various combinations of fungal and bacterial flora — in 42.9%. Candidiasis stomatitis was diagnosed on average on day 11.6±1.08 of COVID-19, which corresponded to days 2-3 of hospitalization. Preceding outpatient treatment, in most cases, included antibiotics and hormonal therapy with glucocorticosteroids. Urogenital Urogenital fungal infection was diagnosed on the 17.7±5.17 day of illness, on the second week of hospital treatment (8.0±3.11 days). Fungal flora in sputum was determined on average on the 18.5±4.33 day of illness, on the second — third week of hospitalization against the background of intensive immunosuppressive therapy.

CONCLUSION: Risk factors for the development of fungal complications are the age of patients older than 50 years, overweight and hypertension, uncontrolled use of antibiotics and glucocorticosteroids at the prehospital stage. Mycoses are recorded in both severe and moderate COVID-19. An additional factor in their development is immunosuppressive therapy of the underlying disease. The most formidable complication of the course of COVID-19, worsening the prognosis of survival, is the addition of fungi with invasive growth — Aspergillus spp., Mucor, as well as the development of fungal-bacterial associations with damage to the lung tissue.

In the context of the ongoing SARS-CoV-2 pandemic, the use of immunomodulatory agents, including the combined use of corticosteroids and targeted immunosuppressive drugs, it is important to develop a risk-based approach in diagnosis and treatment for patients at risk of generalized and invasive mycoses.

Epidemiology and Infectious Diseases. 2021;26(6):252-269
pages 252-269 views

Etiological structure of infectious complications and microbial colonization in patients of COVID-19 hospital of a multidisciplinary federal medical institution

Petrova L.V., Mironov A.Y., Gusarov V.G., Kamyshova D.A., Khakulova A.E., Zamyatin M.N., Suranova T.G.


BACKGROUND: Despite the proven importance of secondary bacterial infections influencing the severity of viral respiratory diseases, their etiology is still not well understood. There is a gap in knowledge about the nature, frequency, and antimicrobial resistance profiles of bacterial pathogens in the current COVID-19 pandemic.

AIM: To describe the species spectrum of microorganisms in patients of the COVID-19 Hospital on the basis of a multidisciplinary federal medical institution.

MATERIALS AND METHODS: Clinical samples (blood, lower respiratory tract discharge, urine, other biological materials) from patients with COVID-19 who were treated at the COVID-19 Hospital at a multidisciplinary federal medical institution were obtained and processed.

RESULTS: The bacteriological laboratory received 1821 samples of biomaterial from 452 patients, microorganisms were isolated from 620 (38.0%) samples. Most of the biomaterial was represented by blood — 35.9% and discharge from the lower respiratory tract — 31.7%. The structure of microorganisms was dominated by Candida albicans — 19.7%, Staphylococcus aureus — 10.2%, Klebsiella pneumoniae — 10.1%, Enterococcus faecalis — 7.9%. At the beginning of the period of operation of the Hospital, the most frequently identified microorganisms were S. aureus and Haemophilus influenzae — 19.7% and 7.9%, respectively, while in the final period there was a change in the spectrum of microorganisms to nosocomial ESKAPE -pathogens with multiple drug resistance, the structure was dominated by Acinetobacter baumannii — 24.3%. Antibiotic consumption in the hospital increased from 18.3 DDD/100 patient days in 2019 to 28.8 DDD/100 patient days in 2020.

CONCLUSION: Significant colonization of various loci of patients with COVID-19 by fungi of the genus Candida was revealed. There has been a change in the microbial spectrum of infectious agents from community-acquired (H. influenzae and S. pneumoniae) to nosocomial ESKAPE pathogens with multiple drug resistance. The consumption of antibiotics has increased significantly.

Epidemiology and Infectious Diseases. 2021;26(6):270-282
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Vaccines against new coronavirus infection in Russia and the world

Danilov A.N., Eremin V.I., Filippova N.A., Denisova E.G.


The article is devoted to the review of vaccines against new coronavirus infection in the world and Russia.

Vaccination is an affordable and cost-effective way to reduce morbidity and mortality from COVID-19. The importance of vaccination is beyond doubt and is a method of creating active artificial immunity based on the formed immunological memory to an infectious agent. Conventionally, vaccines can be divided into two groups: classical (recombinant, peptide and virusinactivated), and gene vaccines (vector and mRNA vaccines). Classical vaccines are based on the introduction of ready-made antigens into the body, which can be purified viral proteins, fragments of viral proteins (peptides) or whole inactivated (killed) viral particles. Inactivated whole-virion vaccines contain a weakened or inactivated virus that promotes the development of antiviral immunity. Subunit vaccines contain only surface antigens (specific fragments — subunits), which reduces the amount of protein in the vaccine and thereby reduces its allergenicity. Vector vaccines use safe viruses that are unable to reproduce in the human body (vectors), in which a gene is embedded ― a small section of the coronavirus genome. Vector vaccines effectively cause a cellular and humoral immune response, since the vector, entering the cell, is perceived by the body as a viral infection. Gene vaccines differ significantly from classical ones and produce an immune response at the gene level, since they contain not the virus or protein itself, but the genetic material of the SARS-CoV-2 coronavirus. An RNA-based vaccine delivers a specific set of instructions to the body’s cells for the synthesis of a specific protein, to which the body’s immune system must give an immune response.

The criterion for the effectiveness of the vaccine is the immune response that it creates. The more pronounced and stable it is, the higher the protection against infection. So far, no drugs have been developed that have 100% protection against infection, since the immune response depends on numerous reasons, including individual characteristics of the body, general health, age, etc.

At the present stage, the tasks of vaccination are complicated by such factors of the epidemiological process as the emergence of new highly pathogenic strains of coronavirus.

Epidemiology and Infectious Diseases. 2021;26(6):283-293
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An emergent approach to the formation of a strategy for anti-epidemic preparedness of healthcare organizations in the context of a new epidemiological reality

Bryukhanova G.D., Gorodin V.N., Nosikov D.V., Shestakova I.V., Nezhurin A.V.


The review presents factual data, unguarded digital and qualitative information on cases of infectious diseases and outbreaks of current infections during the COVID-19 coronavirus pandemic. Sources of information: materials of the World Health Organization, Centers for Disease Control (USA, European countries), the Federal Service for Supervision of Consumer Protection and Human Well-Being, conferences and scientific reports, etc.

The review deals with the problem of a new epidemiological reality as a complex, complex, open system with the emergence property inherent in such systems ― the emergence of new phenomena that are not equal to the effects of a simple sum of epidemic processes or their driving forces. Unpredictability of the new epidemiological reality ― from a rapid increase in morbidity to reverse development (and vice versa) when integrating new elements (biological, social, technological) into it, it is largely due to the effects of co-identity (mutual influence of sudden phenomena), which requires an in-depth study of the processes occurring at different hierarchical levels of this system for the successful relief of epidemic complications. To conduct research at the level of the infectious process, it is proposed to create a federal specialized scientific and practical clinical medical center with educational and training modules. The scientific research of the center will focus on the study of the characteristic “systemic qualities” of the infectious process based on knowledge about the properties and relationships between the elements of the system; between the system and the objects of its environment; on diagnosis (including cases of coinfections, superinfections) and identification of modifying and limiting factors in the pathogenetic and clinical manifestation of diseases. The training modules of the center will provide modern opportunities for the training of various professional groups of medical and non-medical specialists (device designers and designers of medical equipment, employees of engineering and operational services of medical institutions) on working under strict anti-epidemic regime, as well as on design tasks, technological preparation for operation and refinement of new models of equipment, means personal protection, consumables.

Thus, a specialized scientific and practical clinical medical center with educational and training modules will become a platform at which, through intersectoral cooperation and interaction, an emergent approach to the formation of an anti-epidemic preparedness strategy of medical organizations will be implemented ― detecting changes in the clinical manifestations of infectious diseases and responding appropriately to future sudden external epidemic challenges.

Epidemiology and Infectious Diseases. 2021;26(6):294-307
pages 294-307 views


Epidemiology and Infectious Diseases journal and its indexation in Russian Science Citation Index

Nikiforov V.V., Philippova E.A., Philippov Y.I.


The “Epidemiology and Infectious Diseases” journal is indexed in a variety of scholarly databases, including the Russian Science Citation Index (RSCI), and is also included in the “LIST of peer-reviewed scientific journal in which the main results of dissertations should be published for the degree of Candidate of Science, for the degree of Doctor of Science” recommended by Higher Attestation Commission of Russian Federation (the List of VAK). At the same time, the List of VAK is structured by branches of science, scientific areas and scientific specialties, while RSCI is not. Since 2021, the indexing of a journal in the RSCI database has been equated in its value to indexing in the Web of Science Core Collection and/or in Scopus, as a criterion for the quality of a journals to be choose by an author for publishing the results of dissertation research. Thus, when preparing a dissertation work in Russian Federation, the list of publications can include those of the applicant’s works that are published in scientific journals from the List of VAK in the relevant specialty, or in scientific journals indexed in RSCI, Web of Science and/or in Scopus (regardless of whether in what scientific specialty and relevant areas of science these journals are included in the List of VAK, and whether they are included at all). Taking this into account, the editors and the publisher continue to publish articles on epidemiology (VAK spatiality code 3.2.2), infectious diseases (3.1.22), virology (1.5.10), medical microbiology (1.5.11) and parasitology (1.5.17) in the ‘Epidemiology and Infectious Diseases’ journal.

Epidemiology and Infectious Diseases. 2021;26(6):308-312
pages 308-312 views

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