Systemic antimycotic therapy of patients with mycosis of the oral mucosa and periodontal Сandida etiology

Candidiasis is the most common mycosis. Оral candidiasis occurs in the form of stomatitis, including the so-called prosthetic stomatitis. Somewhat less often, fungi of the genus Candida are detected with gingivitis and periodontitis, manifestations of red lichen planus on the oral mucosa.The purpose of the work: to analyze the results of mycological studies and determine the sensitivity of fungi isolated from the oral cavity in vari-ous oral pathologies to the main antimycotics, as well as the formation on this basis of an algorithm for antimycotic therapy of candidal lesions of the oral mucosa and periodontium.Material and methods. The paper uses the results of studies of patients with candidiasis of the oral mucosa (127 patients), prosthetic stomatitis (136 patients), candida-associated periodontitis (168 patients). Primary inoculation was performed quantitatively on Sabouraud’s medium and duplicated on M1297 chromogenic medium (Himedia Labs, India).To study the biofilm formed on the oral mucosa, fixed preparations of gold-coated scrapings were prepared for scanning electron microscopy, which was performed using a Quanta 200 3D bi-beam microscope (USA). Sensitivity to antimycotics was assessed using the traditional method of disks.The results of the study. When studying the species composition of yeast-like fungi isolated from the material, it was found that the species C. albicans was isolated in 80% of patients, in association with other species: C. Krusei, C. guilliermondii and C. glabrata. The second place was taken by the species C. Krusei, which was detected in 13.3% of patients. Representatives of this genus of yeast fungi are characterized by the formation of a biofilm with a pronounced mantle, which protects the microorganism from aggressive factors, including antimycotics and antiseptics. All the studied preparations showed fungicidal activity against these strains of yeast-like fungi. When registering the results, it was found that the most pronounced sensitivity of yeast-like fungi of this species was to drugs from the group of azole derivatives. The most pronounced antifungal activity was noted by us in voriconazole.Conclusion. Based on the obtained data, an algorithm of systemic antimycotic therapy for oral candidiasis has been developed.

STUDY OF HEPATOBILIARY SYSTEM FUNCTIONAL PARAMETERS IN PATIENTS WITH IMPAIRED CARBOHYDRATE TOLERANCE UNDER SYSTEMIC ANTIMYCOTIC THERAPY

Onychomycosis is a long-standing challenging problem. Effective treatment of patients with onychomycosis is a difficult task. Genetically determined resistance of micromycetes to drugs and acquired resistance contribute to problematic treatment. Systemic antimycotic therapy is conducted in case of total or multiple lesions of ungueal plates. The problem of hepatotoxicity of systemic antimycotics is known; however, lesion pattern in patients with onychomycosis and impaired carbohydrate tolerance are still understudied. The purpose of the work is to study functional changes in the main indicators of the hepatobiliary system in patients with impaired carbohydrate tolerance under antimycotic therapy. Materials and Methods. The study enrolled 11 patients with impaired carbohydrate tolerance. They underwent a biochemical blood test before treatment with oral antimycotic drugs and a month after treatment onset. At presentation, 4 patients revealed a slight increase in total bilirubin and ALT; other findings were normal. Patients took systemic antifungal drugs, providing for the identified sensitivity of pathogens. Results. All patients under antimycotic therapy demonstrated a statistically significant increase in liver tests. Conclusion. The revealed changes in the hepatobiliary system under a pronounced load in case of systemic antimycotic therapy allow us to develop an algorithm for diagnosis and treatment of onychomycosis in patients with impaired carbohydrate tolerance. Keywords: onychomycosis, impaired glucose tolerance, liver function tests. Онихомикозы представляют собой давнюю проблему с неубывающей актуальностью. Эффективная терапия больных онихомикозом представляет собой сложную задачу. Трудности лечения обусловлены наличием генетически детерминированной устойчивости микромицетов к препаратам и приобретенной резистентностью. При тотальном или множественном поражении ногтевых пластин проводится терапия системными антимикотическими препаратами. Проблема гепатотоксичности системных антимикотиков известна, однако особенности изменений у больных онихомикозами с нарушенной толерантностью к углеводам остаются малоизученными. Цель работы – изучение функциональных изменений основных показателей гепатобилиарной системы у пациентов с нарушенной толерантностью к углеводам на фоне антимикотической терапии. Материалы и методы. Отобрана группа из 11 пациентов с нарушенной толерантностью к углеводам, которым было проведено биохимическое исследование крови до лечения пероральными антимикотическими препаратами и через месяц после его начала. При первичном обследовании у 4 больных выявлено незначительное повышение общего билирубина и ALT, остальные показатели находились в пределах нормы. Пациенты принимали системные противогрибковые препараты с учетом выявленной чувствительности возбудителей. Результаты. На фоне терапии антимикотическими препаратами у всех пациентов наблюдалось статистически значимое повышение печеночных проб. Выводы. Выявленные изменения состояния гепатобилиарной системы, подвергающейся выраженной нагрузке при применении системных антимикотических препаратов, позволяют разработать алгоритм диагностики и терапии онихомикозов у пациентов с нарушенной толерантностью к углеводам. Ключевые слова: онихомикоз, нарушение толерантности к глюкозе, печеночные пробы.

RESEARCH ANTIFUNGAL THERAPY OF OROPHARYNGEAL CANDIDIASIS IN HIV-INFECTED PATIENTS

Modern medicine has made significant advances in the treatment of fungal infections. The problem of drug resistance of such a common conditional pathogen as Candida remains relevant for the last decade. The aims of the study were: 1) analysis of species and strain drift of Candida in patients with HIV/AIDS from oropharynx and intestine in two years; 2) the analysis of the dynamics of the sensitivity of Candida to standard antimycotic drugs. Treatment of candidiasis in HIV-infected patients leads to changes in the species and strain composition of Candida. After eradication of C. albicans which is sensitive to fluconazole, more resistant strains of other species (glabratae, krusei. tropicalis) takes its place in the biotope, which is one of the reasons for the low effectiveness of antimycotic therapy.

RESEARCH ANTIFUNGAL THERAPY OF OROPHARYNGEAL CANDIDIASIS IN HIV-INFECTED PATIENTS

Modern medicine has made significant advances in the treatment of fungal infections. The problem of drug resistance of such a common conditional pathogen as Candida remains relevant for the last decade. The aims of the study were: 1) analysis of species and strain drift of Candida in patients with HIV/AIDS from oropharynx and intestine in two years; 2) the analysis of the dynamics of the sensitivity of Candida to standard antimycotic drugs. Treatment of candidiasis in HIV-infected patients leads to changes in the species and strain composition of Candida. After eradication of C. albicans which is sensitive to fluconazole, more resistant strains of other species (glabratae, krusei. tropicalis) takes its place in the biotope, which is one of the reasons for the low effectiveness of antimycotic therapy.

Allergic bronchopulmonary aspergillosis in patients with asthma: dynamics of immunological parameters during antimycotic therapy

Background. To determine the frequency of allergic bronchopulmonary aspergillosis in patients with asthma and to study the dynamics of immunological parameters in patients with allergic bronchopulmonary aspergillosis during antimycotic therapy. Methods. During investigation of 176 patients with asthma the group of patients with allergic bronchopulmonary aspergillosis was isolated. Allergological (skin tests with fungal allergens, serum total IgE, specific IgE to fungal allergens), immunological (IFN-γ, IL-10) and mycological (microscopy and culture of respiratory samples) examination was performed. Computer tomography of the chest was done when indicated. Results. In patients with asthma frequency of sensitization to Aspergillus spp. was 27%, with allergic bronchopulmonary aspergillosis - 4%. The increased activity of T-helper type 2 in patients with allergic bronchopulmonary aspergillosis (n=7) was revealed. After itraconazole treatment during 24 weeks serum total IgE reduced (p=0,04), spontaneous and induced production of IFN-γ ratio was normalized. The reduction of the absolute number of eosinophils in 4 (80%) patients, decreased production of sIgE to Aspergillus spp. in 3 (60%) patients were noted. Conclusion. All patients with severe asthma needed additional allergological and mycological examination for the detection of allergic bronchopulmonary aspergillosis. Itraconazole therapy was effective, reduced fungal burden, and resulted to restoring of Th2/Th1 imbalance in patients with allergic bronchopulmonary aspergillosis.