Svetlana O. Strokova

Fungi of the genus Malassezia are involved in the development of seborrheic dermatitis, atopic dermatitis and pityriasis versicolor. The use of molecular genetic methods for their detection represents a promising diagnostic approach. Objective is to determine the detection rate and species composition of Malassezia fungi using real-time PCR in patients with seborrheic dermatitis and pityriasis versicolor. Materials and methods. A total of 35 patients aged 10 to 76 years (median 25 years) were examined: 17 with seborrheic dermatitis and 18 with pityriasis versicolor. Skin scrapings were analyzed by RT-PCR for the detection and quantification of Malassezia spp., M. restricta, M. globosa, M. sympodialis, and M. pachydermatis. Results. The majority of samples from patients with seborrheic dermatitis and pityriasis versicolor were positive for Malassezia spp., M. restricta, and M. globosa. The detection rates of Malassezia spp. (M. restricta, and M. globose) in seborrheic dermatitis were 100 % (100 %, and 82.4 %, respectively); in pityriasis versicolor, they were 94.4 % (72.2 %, and 83.3 %, respectively). In contrast, M. sympodialis was detected in only one patient (5.9 %) with seborrheic dermatitis and one patient (5.6 %) with pityriasis versicolor. M. pachydermatis was not detected in any patient in the study group. Conclusions. The use of real-time PCR allowed the detection of Malassezia spp. in the majority of patients with seborrheic dermatitis and pityriasis versicolor. M. restricta predominates in seborrheic dermatitis, whereas mixed communities of M. restricta and M. globose are frequently found in pityriasis versicolor.

Allergic reactions of the lower genital tract in women cause significant chronic vulvovaginal discomfort and require active diagnosis and treatment. Modern approaches to therapy, which combine allergen elimination and anti-inflammatory therapy, can achieve improvement or cure in most cases. Obstetricians-gynecologists are recommended to involve dermatovenerologists and allergists for joint management of patients in case of non-standard cases of vaginitis. From a scientific point of view, further studies of immune mechanisms in the genital tract and the development of new methods of specific therapy and prevention remain relevant. In the future, the results of such studies will help to develop more accurate clinical guidelines and improve the effectiveness of care for these patients. Successful treatment of allergic diseases of the vulva and vagina significantly improves the quality of life, restores a woman's confidence and comfort in everyday and intimate life. Developing an interdisciplinary approach, education, and a thoughtful method for addressing symptoms can help overcome many difficulties in diagnosing and treating this condition. The identified unresolved issues will serve as the starting point for new research and progress in this field of medicine.

Background. Fungi of the genus Malassezia are part of the human skin microbiome, however, the leading role of these fungi in the development of local and systemic mycoses has been shown. A special group is premature infants, among whom the most vulnerable category of patients in terms of the development of systemic fungal infections are children with very low and extremely low birth weight. Mycosis caused by yeast-like fungi of the genus Candida and Malassezia is considered one of the most common fungal infections registered in newborns. The aim of this exploratory study was to study the dynamics of colonization of various biotopes by Malassezia fungi in newborns undergoing treatment in the neonatal departments of the Center. Materials and methods. The study included 1139 newborns hospitalized at the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, from whom 2257 samples of biological material were taken. For species identification of yeast fungi by molecular genetic methods, the MycosoScreen REAL-TIME PCR Detection Kit (DNA-Technology, Russia) was used, as well as a purpose-developed test system for species identification of Malassezia fungi. Results. We have shown Malassezia fungi to colonize most often the mucous environment of the gastrointestinal tract with maximum colonization by 3—5 weeks of life in newborns leaving the neonatal hospital. The most frequently detected species was M. furfur. Colonization of extremely premature infants (GA ≤28 weeks) with M. furfur contributed to the worsening of the severity of multiple organ failure in this category of newborns, which was reflected in an increase in the NEOMOD score of 7 or more points. Conclusion. The conducted study demonstrated the feasibility of using molecular genetic research methods in daily clinical practice, which allow using minimally invasive techniques to track both the dynamics of the colonization process of the gastrointestinal mucosa and the occurrence of invasive mycoses, resulting in prompt targeted antimycotic therapy.

ЦЕЛЬ ИССЛЕДОВАНИЯ Анализ сведений современной научной литературы об инфекциях, вызванных грибами рода Malassezia, использовании методов клинической лабораторной диагностики и особенностях терапии у новорожденных различного гестационного возраста. МАТЕРИАЛ И МЕТОДЫ В обзор включена информация из международных рецензируемых баз данных за последние 10 лет, которая касается распространенности разных видов грибов рода Malassezia на коже и слизистых оболочках людей различного возраста, особенности у новорожденных детей, современных методах диагностики и лечения малассезиа-ассоциированных заболеваний. РЕЗУЛЬТАТЫ Установлен вклад грибов Malassezia в развитие системных микозов новорожденных, описаны пути наиболее вероятного распространения инфекции в отделениях реанимации и интенсивной терапии новорожденных, проанализированы особенности стандартных методов микробиологической диагностики (их возможности и ограничения), обозначены перспективы использования молекулярно-генетических методов исследования у новорожденных при подозрении на системную грибковую инфекцию, вызванную грибами рода Malassezia. ЗАКЛЮЧЕНИЕ Анализ данных литературы показал целесообразность применения в ежедневной клинической практике молекулярно-генетических методов исследования, позволяющих в кратчайшие сроки с использованием малоинвазивных методик диагностировать у новорожденных системный грибковый процесс, вызванный грибами рода Malassezia, своевременно назначать таргетную терапию и контролировать эффективность проводимого лечения.