Sofya N. Khostelidi

Objective. Study of a clinical case of chronic mucormycosis of the paranasal sinuses in the Perm region, analysis of publications on the topic. Material and methods. This article describes a clinical case of chronic mucormycosis of the paranasal sinuses, diagnosed in the otolaryngology department of the Perm Regional Clinical Hospital in 2021. An analysis of scientific papers on the topic of “chronic mucormycosis of the paranasal sinuses” was performed in the electronic search databases eLibrary and PubMed as of September 2025, using the keywords: chronic mucormycosis of the paranasal sinuses, chronic rhino-orbital mucormycosis, chronic rhino-orbito-cerebral mucormycosis (we used Russian and English languages). Results. Chronic mucormycosis of the paranasal sinuses developed in a 68-year-old patient with insulin-dependent type 2 diabetes mellitus. The diagnosis of mycosis was established in the Department of otorhinolaryngology of the Perm Regional Clinical Hospital 6.5 months after the onset of complaints and was verified by pathohistological examination of intraoperative material from the left maxillary sinus. Treatment included left extranasal maxillary sinusotomy, antifungal therapy with posaconazole, and correction of glycemic levels. A search query in the eLibrary gave a negative result. Two reviews from 1996 and 2016, as well as case reports, were found in the PubMed database. Publications lack a classification of mucormycosis that identifies uniform time criteria for the chronic form; some indicate a duration of more than 4 weeks. The average disease duration worldwide is approximately 7 months. The causes of this chronic, sluggish course of the disease are not fully understood.

A clinical case of postoperative endophthalmitis caused by hyalohyphomycetes in a 75-year-old patient with type 2 diabetes mellitus and chronic kidney disease is presented. The disease developed 10 days after routine cataract phacoemulsifcation with intraocular lens implantation and was accompanied by severe infammation that was resistant to antibiotic therapy and repeated vitreoretinal interventions. Progression of the process to panophthalmitis required enucleation of the eyeball. The etiology of the identifed disease (septated hyphae and conidial structures characteristic of hyalohyphomycetes) was confrmed by the review of histological preparations in the mycological reference center.

Delayed-type metal hypersensitivity, according to the current classification, is classified as subtype IVa. With the introduction of new dental devices, the number of patients with intolerance to metal alloys has increased. The aim of this study was to identify the pathogenesis and clinical manifestations, the main risk factors for the development of delayed-type hypersensitivity to metal structural components, and optimal diagnostic methods in patients in dental practice. A search was conducted on PubMed and e-library (as of February 2026) using the following keywords: adverse effects of dental alloys, skin patch testing, contact allergy to metals, dental materials, allergic reactions, lichenoid reaction. Forty-seven scholarly sources were analysed using bibliographic search, source selection and screening, comparative analysis, and data synthesis. Various diagnostic methods are used to identify these hypersensitivity reactions. A literature review showed that patch testing is the most informative diagnostic method for detecting hypersensitivity reactions to metals used in the fabrication of dental restorations and denture components. They allow for the identification and confirmation of the involvement of a specific causative factor in the development of clinical symptoms in a patient. Delayed-type hypersensitivity is most common to metals such as nickel, cobalt, and chromium. A similar mechanism of hypersensitivity to nickel is recorded in 17% of women and 3% of men, while hypersensitivity to cobalt and chromium is reported in 1-3% of both sexes. An increase in delayed-type hypersensitivity to other metals, such as aluminum, beryllium, copper, gold, iridium, mercury, palladium, platinum, rhodium, and titanium, has also been observed. Patients with immunemediated pathologies are at high risk for developing delayed-type metal hypersensitivity Гиперчувствительность замедленного типа к металлам в соответствии с современной классификацией относят к IVа подтипу. C внедрением новых стоматологических конструкций отмечается увеличение числа пациентов с непереносимостью металлических сплавов. Целью исследования было определить особенности патогенеза и клинических проявлений, основные факторы риска развития гиперчувствительности замедленного типа к металлическим конструкционным элементам и оптимальные методы ее диагностики у пациентов в стоматологической практике. Поиск информации проводился на платформах PubMed и e-library (по состоянию на февраль 2026 г.) по следующим ключевым словам: побочные эффекты стоматологических сплавов, кожные патч-тесты, контактная аллергия на металлы, стоматологические материалы, аллергические реакции, лихеноидная реакция. В рамках работы было проанализировано 47 научных источников. В исследовании применялись методы библиографического поиска, отбора и скрининга источников, сравнительного анализа, систематизации и обобщения научных данных. Для выявления этих реакций гиперчувствительности применяются различные методы диагностики. Обзор литературы показал, что патч-тесты являются наиболее информативным диагностическим методом выявления реакций гиперчувствительности на металлы, используемые при изготовлении стоматологических реставраций и компонентов зубных протезов. Они позволяют идентифицировать и подтвердить участие конкретного причинного фактора в развитии клинических симптомов у пациента. Выявлено, что наиболее часто гиперчувствительность замедленного типа встречается к таким металлам, как никель, кобальт и хром. Аналогичный механизм гиперчувствительности к никелю зарегистрировано у 17% женщин и 3% мужчин, к кобальту и хрому – у 1-3% представителей обоих полов. Отмечено также увеличение гиперчувствительности замедленного типа к другим металлам, таким как алюминий, бериллий, медь, золото, иридий, ртуть, палладий, платина, родий, титан. Группу высокого риска по развитию гиперчувствительности замедленного типа к металлам составляют пациенты с иммуноопосредованной патологией

Background: Human metapneumovirus (hMPV) is an increasingly recognized respiratory pathogen in immunocompromised patients, but its impact in haematological malignancies is poorly defined. Unlike influenza or SARS-CoV-2, hMPV has no specific treatment or vaccine, contributing to underdiagnosis and underestimation of its clinical relevance. Method: We performed a multicentre retrospective cohort study within the Epidemiology of COVID-19 in patients with hematological malignancies: A European Haematology Association Survey/ Epidemiology of respiratory viral infections in patients with hematological malignancies: A European Haematology Association Survey registry of haematological patients with hMPV (January 2023–December 2024), comparing clinical features and outcomes with matched influenza and SARS-CoV-2 cohorts. Results: The study included 130 patients with hMPV. Median age was 58.5 years; 57% were male. Plasma cell neoplasms (25%), lymphoma (23%), and acute myeloid leukemia (20%) were the most common hematological malignancies. Hospitalization occurred in 64%, intensive care unit (ICU) admission in 19%, and 30-day mortality was 8%. Most cases (73%) received supportive care only. Secondary infections were common (24%). Chronic renal disease significantly increased mortality risk (hazard ratio 20.9 11.05, P = .014). Compared with influenza and SARS-CoV-2, hMPV patients had comparable severity and outcomes, with 18.5% ICU admission rates versus 25.9% for influenza (P = .316) and 20.9% versus 4.7% for SARS-CoV-2 (P = .006), and 30-day mortality of 5.6% versus 11.1% for influenza (P = .489) and 7.0% versus 2.3% for SARS-CoV-2 (P = .277), yet received fewer targeted interventions. Conclusions: hMPV causes clinically significant disease in patients with hematological malignancy, often necessitating hospital and ICU care, and leading to mortality. In the absence of specific treatments or vaccines, this virus remains an underrecognized pathogen in patients with hematological malignancy. Enhanced clinical awareness and investment in diagnostics, prevention, and therapeutics are needed.

Introduction: Mucormycosis is a severe infection that mainly develops in immunocompromised patients. During the COVID- 19 pandemic, there was an increase in the incidence of mucormycosis, high prevalence was observed in many countries of the world, for example, in India. The number of publications on mucormycosis in electronic libraries has increased more than 1.5 times over the past four years. Patients with COVID-associated mucormycosis (COVID-M) predominantly develop lesions of the paranasal sinuses — up to 96%. Mucormycosis of the paranasal sinuses is characterized by high disability and mortality of up to 80%. Objective : To analyze the results of multispiral computed tomography (MSCT) and magnetic resonance imaging (MRI) in patients with COVID-associated rhinocerebral mucormycosis to improve the effectiveness of disease diagnosis. Materials and methods: The registry of patients with mucormycosis included 100 patients with COVID-associated paranasal sinus mucormycosis. The criteria of EORTC/MSG, 2020 were used to make the diagnosis of «invasive mycosis». Retrospectively, using the Weasis v4.5.0 program, the multispiral computed tomography data of 41 patients were analyzed in dynamics. The median age of the patients was 61 years (22–83), 56% of them men. CT-studies were performed using a GE Bright Speed 16 tomograph, GE Revolution HD, Philips Ingenuity Core 64, Aquilion PRIME 1. Statistics: Statistical data analysis was performed using the Microsoft Office Excel 2019. Survival analysis was performed using the Kaplan-Mayer method. Results: The main clinical symptoms were swelling of the soft tissues of the face and eyes (93%), local pain syndrome (88%), facial numbness (78%), paresthesia (76%), visual impairment (66%). Thickening of the mucous membranes (100%) was observed in the nasal cavity with the formation of necrotic masses and a characteristic «black scab» (90%). The main radiological signs were: hypertrophy of the mucous membranes of the paranasal sinus — 100%, destructive changes in the walls of the sinuses and bones of the skull — 100%; edema, thickening of the soft tissues of the face, orbit and brain — 93%. Destructive changes of the maxillary sinuses were detected in 100% of patients, the walls of the orbits — 95%, the latticed bone — 93%, the maxilla — 85%, the walls of the main sinus and the sphenoid bone — 83%, the frontal sinuses — 37%. The lesion of the optic nerve is in 66%. According to the central nervous system, damage to the frontal lobe was detected in 32% of cases, damage to the temporal lobe — 15%. Cavernous sinus thrombosis — 46%. In case of orbital damage, CT-signs were determined on day 12 (median 12.5±4.9 days) from the onset of clinical manifestations, involvement of the optic nerve in the infectious process also on day 12 (median 12±4.1 days). CT-changes from the central nervous system were observed on day 18 (median 18±10.45 days). The survival rate of patients within 3 months was 88%, and within 1 year — 78%. Discussion : The main underlying diseases in mucormycosis today are COVID-19 (46%) and oncohematological pathology (37%). When analyzing the risk factors for the development of rhinocerebral mucormycosis, the main importance is the presence of concomitant diabetes mellitus (88%), as well as long-term use of glucocorticosteroids (GCS) in high doses (90%). The main CT-signs of rhinocerebral mucormycosis were the destruction of the walls of the paranasal sinuses and cranial bones, which occurs on days 7–12 from the onset of the first clinical symptoms. Conclusion: Radiation examinations are the leading imaging methods for rhinocerebral mucormycosis. The examination protocol must include a MSCT scan of the paranasal sinuses and an MRI scan of the brain. Early radiological diagnostics reduces mortality and disability of patients.

Mucormycosis is a rare invasive mycosis caused by fungi of the order Mucorales, the incidence of which increased significantly during the COVID-19 pandemic. The leading localization of the fungal process during the pandemic was the paranasal sinuses. The first four patients with mucormycosis of the paranasal sinuses were identified in the Perm Region. The characteristics of these cases identified in the period from December 2021 to February 2023 are presented, clinical and laboratory features are revealed. The diagnosis of invasive mucormycosis was established according to the criteria of ECMM (European Confederation of Medical Mycology)/MSGERC (Mycoses Study Group Education and Research Consortium) (2020). There were three women and one man; the median age was 70.5 years. The patients were treated in the Department of Otolaryngology of the Perm Regional Clinical Hospital, the average duration of hospitalization is 12 days. The diagnosis of mycosis was established in the period from 36 to 183 days. Treatment included surgical interventions and systemic antimycotic therapy. The diagnosis was established during a pathomorphological examination of intraoperative material after verification at the Kashkin Research Institute of Medical Mycology (Saint Petersburg). The analysis of patient complaints, clinical, radiological and laboratory data was performed, the leading risk factors and background diseases were identified. Conclusions. Mucormycosis of the paranasal sinuses in the Perm Region as chronic invasive left-sided maxillary ethmoiditis with orbital involvement. The disease developed in patients over 65 years of age with diabetes mellitus and cardiovascular disease, who underwent COVID-19 and received immunosuppressive therapy. The combined treatment, which included sinusotomy, long-term systemic antimycotic therapy and correction of risk factors, led to favorable outcomes.

Internal organ transplantation is a high-tech medical intervention that significantly improves patient survival and quality of life. However, infections remain the leading cause of mortality in organ transplant recipients. Invasive aspergillosis (IA) is the second most common invasive fungal infection in this population and is associated with high mortality rates, reaching up to 90%. This article presents a clinical case of IA following heart transplantation (HT), along with an analysis of registry data and institutional experience in managing this serious complication based on registry data. Between September 2010 and October 2024, 23 adult patients with IA following an internal organ transplantation were included in the institutional registry. Most IA cases occurred after heart transplantation (65%), followed by kidney transplantation (31%), and, less commonly, lung transplantation (4%). The lungs were the primary site of IA (96% of cases). Diagnosis was confirmed through direct microscopy of clinical samples, such as bronchoalveolar lavage (BAL) fluid and tissue biopsies, in 50% of patients, while fungal cultures yielded positive results in 35% of cases. The predominant pathogen was Aspergillus fumigatus (73%), followed by Aspergillus niger (18%) and Aspergillus flavus (9%). A positive galactomannan test in BAL was detected in 85% of patients. All patients received targeted antifungal therapy, primarily with voriconazole (87%), while echinocandins and itraconazole were used in 17% and 4% of cases, respectively. Overall 90-day patient survival was 78%. The literature review outlines the main approaches to the diagnosis and management of invasive infections associated with Aspergillus spp.

A clinical case of a rare orbital lesion with mucormycosis, which developed against the background of odontogenic osteomyelitis in a patient with diabetes mellitus, is presented. A comprehensive approach, including antifungal therapy, surgical interventions and correction of carbohydrate metabolism, made it possible to localize the infection and stabilize the patient's condition; however, vision in the right eye could not be restored.

The purpose of the work. To study the clinical and laboratory features of invasive mycotic sinusitis in oncohematological patients in the Russian Federation. Patients and methods. The study included 52 adult patients between 2003 and 2023. Results. The study included 52 patients with invasive fungal sinusitis (62% invasive aspergillosis, 38% mucormycosis). Men — 48%, women — 52%, median age — 46 years (from 18 to 75 years). The main background conditions were: acute myeloblastic leukemia (44%), acute lymphoblastic leukemia (19%), non-Hodgkin's lymphoma (15%), chronic lymphocytic leukemia (10%), lymphogranulomatosis (2%), multiple myeloma (4%), chronic myeloid leukemia (2%), aplastic anemia (2%), myelodysplastic syndrome (2%). The main risk factors for fungal sinusitis in oncohematological patients are polychemotherapy (88%), agranulocytosis (81%) and lymphocytopenia (67%). Organ damage ≥ 2 was detected in 83% of patients: the most common diagnosis was a combination of fungal sinusitis and lung damage (63%). It is possible to isolate the pathogen in culture only in 56% of patients. Antimycotic therapy was used in 96% of patients, surgical treatment in 35%. The overall survival rate of patients within 12 weeks was 71%.