Mucormycosis is one of the most aggressive invasive mycoses. The mortality rate of patients with mucormycosis, depending on clinical form and background disease, varies from 30% to 100%. This article provides the first description of mucormycosis in Russia after infection caused by SARS-CoV-2, as well as a review of literature reports on mucormycosis in patients with COVID-19 (as of September 2021).

We studied the risk factors, etiology, clinical manifestations, and treatment outcomes of COVID-19-associated invasive candidiasis (COVID-IC) in adult patients admitted to six medical facilities in St. Petersburg. (November 2020–December 2022). In this retrospective study, we included 72 patients with COVID-IC with a median age of 61 years (range 29–96), 51% of whom were women. The predisposing factors for COVID-IC were a central venous catheter (CVC) for more than 10 days (the odds ratio (OR) = 70 [15–309]), abdominal surgical treatment performed in the previous 2 weeks (OR = 8.8 [1.9–40.3]), bacteremia (OR = 10.6 [4.8–23.3]), pulmonary ventilation (OR = 12.9 [5.9–28.4]), and hemodialysis (OR = 11.5 [2.5–50.8]). The signs and symptoms of COVID-IC were non-specific: fever (59%), renal failure (33%), liver failure (23%), and cardiovascular failure (10%). Candida albicans (41%) predominated among the pathogens of the candidemia. The multidrug-resistant Candida species C. auris (23%) and C. glabrata (5%) were also identified. Empirical therapy was used in 21% of COVID-IC patients: azole-93%, echinocandin–7%. The majority of COVID-IC patients (79%) received, after laboratory confirmation of the diagnosis of IC, fluconazole (47%), voriconazole (25%), echinocandin (26%), and amphotericin B (2)%. The 30 days overall survival rate was 45%. The prognosis worsened concomitant bacteremia, hemodialysis, and long-term therapy by systemic glucocorticosteroids (SGCs), bronchial colonization with Candida spp. The survival prognosis was improved by the early change/replacement of CVC (within 24 h), the initiation of empirical therapy, and the use of echinocandin. Conclusions: We highlighted the risk factors that predispose COVID-19 patients to candidiasis and worsen the survival prognosis. Their individual effects in patients with COVID-19 must be well understood to prevent the development of opportunistic co-infections that drastically lower chances of survival.

Invasive fungal infection is a major cause of morbidity and mortality in patients who receive treatment for acute myeloid leukemia (AML). We present the case of successful treatment of Acremonium spp. pneumonia in patient with acute myeloid leukemia who underwent chemotherapy.

Fungal infections caused by rare pathogens are becoming an increasingly pressing problem in modern healthcare due to the severe course of the disease, high incidence of disability and mortality of patients. To study clinical and laboratory features and treatment of severe fungal infections caused by rare yeast-like pathogens in adult patients. The prospective observational non-interventional study (2004-2022) included 310 adult patients with severe fungal infections in the Kashkin Research Institute of Medical Mycology based on North-Western State Medical University named after I.I. Mechnikov, Saint-Petrsburg, Russian Federation (from October 2004 to December 2022). To identify the pathogen, we used direct microscopy, microscopy with calcofluor white, culture isolation from blood and tissue biopsies, cerebrospinal fluid or BAL fluid. Micromycete cultures were identified to species based on morphological characteristics and PCR-test. We treated 310 adult patients with severe fungal infections -10% of them caused by rare yeast-like pathogens (n=30). Analysis of the data presented a general portrait of the patient: a 30-year-old man who has been in the ICU for more than 14 days (93%). Most often, the pathogen was isolated from the blood or biofilm of the central venous catheter (77%). Isolated damage to organs and tissues (without fungemia) was diagnosed in 23% of patients (involving the central nervous system, lungs and skin). Trichosporon spр. and Rhodotorula spр. were the main pathogens (together - 73%). Despite treatment, mortality remains very high - 37%. It is necessary to examine the biological substrate from the lesion daily for fungi if there is no effect from standard therapy. It is necessary to perform species identification of the pathogen and determine sensitivity to antimycotics.

Isavuconazole is a new generation triazol that has been using for the treatment of mucormycosis in the Russian Federation since 2021. A clinical case and results of a prospective multicenter study of the clinical features and results of mucormycosis treatment in patients receiving isavuconazole are presented. The study included 22 adult patients with mucormycosis, the median age of patients was 62 years (18 – 91), men – 64%. Тhe main underlying diseases were COVID-19 (77%), diabetes mellitus (45%), and hematological diseases (18%). The main locations of mucormycosis were paranasal sinuses (82%) and associated osteomyelitis (63%), orbit (50%), central nervous system (36%), lungs (18%), skin and soft tissues (18%), and kidneys (5%). Isavuconazole was used in all patients, as a monotherapy – in 45% of patients. To make a diagnosis of mucormycosis, the EORTC/MSG ERC criteria for the diagnosis of mycoses, 2020 were used. Survival of patients receiving isavuconazole was 95% (all-cause mortality).

Invasive aspergillosis is a serious disease that can occur in organ transplant recipients. Most often, this complication develops in recipients of lung, heart, and liver transplants. Kidney transplant recipients are less likely to develop the disease. However, given that kidney transplantation is the most common type of transplantation, the number of patients with invasive aspergillosis in this category of patients is comparable to other types of internal organ transplantation. The article presents one case of invasive aspergillosis in kidney transplant recipient. An analysis of the literature was carried out, reflecting the features of the treatment of invasive aspergillosis in this category of patients.