medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-13-177-184medsovet-6417Research ArticleИНФЕКЦИИINFECTIONSРецидивирующий вульвовагинальный кандидоз на фоне пандемии COVID-19: алгоритм ведения пациентокRecurrent vulvovaginal candidiasis during COVID-19 pandemic: medical algorithmhttps://orcid.org/0000-0001-9499-7654НазароваН. М.NazarovaN. M.

Назарова Нисо Мирзоевна, д.м.н., ведущий научный сотрудник научно-поликлинического отделения

117997, Россия, Москва, ул. Академика Опарина, д. 4

Niso M. Nazarova, Dr. Sci. (Med.), Leading Researcher of the Research Outpatient Department

4, Academician Oparin St., Moscow, 117997, Russia

grab2@yandex.ruhttps://orcid.org/0000-0003-3895-8225ГусаковК. И.GusakovK. I.

Гусаков Кирилл Ильич, к.м.н., научный сотрудник научно-поликлинического отделения

117997, Россия, Москва, ул. Академика Опарина, д. 4

Kirill I. Gusakov, Cand. Sci. (Med.), Researcher of the Research and Polyclinic Department

4, Academician Oparin St., Moscow, 117997, Russia

kigusakov@gmail.comhttps://orcid.org/0000-0002-1313-7079ПавловичС. В.PavlovichS. V.

Павлович Станислав Владиславович, к.м.н., доцент

117997, Россия, Москва, ул. Академика Опарина, д. 4

Stanislav V. Pavlovich, Cand. Sci. (Med.), Associate Professor

4, Academician Oparin St., Moscow, 117997, Russia

st.pavlovich@mail.ruhttps://orcid.org/0000-0003-2835-6685ДовлетхановаЭ. Р.DovletkhanovaE. R.

Довлетханова Эльмира Робертовна, к.м.н., старший научный сотрудник научно-поликлинического отделения

117997, Россия, Москва, ул. Академика Опарина, д. 4

Elmira R. Dovletkhanova, Cand. Sci. (Med.), Senior Researcher of the Research and Polyclinic Department

4, Academician Oparin St., Moscow, 117997, Russia

eldoc@mail.ruНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian Federation202116102021013177184Copyright © Назарова Н.М., Гусаков К.И., Павлович С.В., Довлетханова Э.Р., 20212021Назарова Н.М., Гусаков К.И., Павлович С.В., Довлетханова Э.Р.Nazarova N.M., Gusakov K.I., Pavlovich S.V., Dovletkhanova E.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6417

В обзорной статье представлены данные о распространенности кандидоза различной локализации на фоне перенесенной коронавирусной инфекции (COVID-19). Проанализированы предрасполагающие факторы, провоцирующие развитие и рецидивирование кандидоза у пациентов после терапии коронавирусной инфекции. В отделениях интенсивной терапии (ОИТ) Candida является одним из наиболее часто встречающихся патогенов, которые поражают от 6 до 10% пациентов, и некоторые исследования отметили тенденцию к увеличению кандидемии. Проанализированные нами данные литературы показали, что среди пациентов с тяжелым течением COVID-19 наиболее распространенными видами грибковой инфекции являлись C. albicans, далее C. auris, C. glabrata, C. parapsilosis, C. tropicalis, S. cerevisiae, C. krusei и Rhodotorula spp. Причиной смерти наиболее часто являлись виды Candida non-albicans, в частности C. glabrata, C. auris. В схемах лечения пациентов с COVID-19 ранее использовались антибиотики, в настоящее время все чаще используются кортикостероиды, которые оказывают иммуносупрессивное действие и, соответственно, предрасполагают к развитию кандидоза. Повреждение эпителия, вызванное SARS-CoV-2, также способствует прикреплению Candida к базальной мембране, вызывая в последующем развитие кандидоза слизистых оболочек. Поскольку системный и местный кандидозы обусловлены общими иммунными механизмами, которые затрагивает коронавирусная инфекция, вульвовагинальный кандидоз (ВВК) может рецидивировать на фоне терапии COVID-19. Своевременная диагностика и лечение грибковых инфекций у пациентов, перенесших COVID-19, имеют первостепенное значение для достижения положительного клинического результата. Представлены алгоритм ведения пациенток при рецидивирующем ВВК, принципы действия противогрибковых препаратов, их приемлемость и эффективность.

The review article presents data on the prevalence of candidiasis of various localization against the history of coronavirus infection (COVID-19). The predisposing factors for the development and recurrence of candidiasis in patients after therapy for coronavirus infection have been analysed. Candida is one of the most common pathogens in intensive care units (ICUs), affecting 6 to 10% of patients, and some studies have reported an increasing trend in the prevalence of candidemia. The literature data that we analysed showed that the most common types of fungal infection among patients with a severe course of COVID-19 were C. albicans, then C. auris, C. glabrata, C. parapsilosis, C. tropicalis, S. cerevisiae, C. krusei and Rhodotorula spp. Candida non-albicans species, in particular C. glabrata, C. auris, were the most common causes of death. The previous treatment regimens for patients with COVID-19 included antibiotics, but at present time corticosteroids are more often used, which have an immunosuppressive effect and, accordingly, predispose to the development of candidiasis. The epithelial injury caused by SARS-CoV-2 also enables Candida to attach to the basement membrane, subsequently triggering the development of mucosal candidiasis. As the systemic and local candidiasis are conditioned by common immune mechanisms that are affected by coronavirus infection, vulvovaginal candidiasis (VVC) may recur during COVID-19 therapy. The timely diagnosis and treatment of fungal infections in patients who underwent COVID-19 are crucial for achieving a positive clinical outcome. The article provides an algorithm for the management of patients with recurrent VVC, the principles of action of antifungal drugs, their acceptability and efficacy.

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The authors declare that there are no conflicts of interest present.