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Teacoe DA, Cormoș RC, Toma DA, Ștef L, Cucerea M, Muțiu I, Chicea R, Popescu D, Chicea ED, Boicean AG, Galiș R, Ognean ML. Congenital Sepsis with Candida albicans-A Rare Event in the Neonatal Period: Report of Two Cases and Literature Review. Microorganisms 2024; 12:1869. [PMID: 39338543 PMCID: PMC11433654 DOI: 10.3390/microorganisms12091869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
Candida spp. is rarely found in neonatal early-onset sepsis (EOS) etiology. However, candidemia is associated with increased mortality and morbidity, as in late-onset sepsis. Congenital candidiasis may present as a mucocutaneous infection or, more rarely, as a systemic infection in term and preterm infants. This paper presents case reports of two cases of congenital systemic candidiasis (CSC) caused by Candida albicans and a review of the data in the literature. An electronic search of PubMed, Scopus, and Google Scholar was performed to identify publications on congenital candidiasis. Both neonates were male, born vaginally, with risk factors for congenital candidiasis. One of the infants was born at term and presented with an almost generalized maculopapular rash at birth and congenital candidemia; parenteral fluconazole was used successfully. The other infant was born prematurely at 28 weeks of gestation; blood culture, gastric aspirate, and maternal vaginal cultures sampled at birth were positive for C. albicans. Liver and kidney involvement became apparent on the third day of life, while lung involvement was clinically evident on the fourth day. Prolonged parenteral fluconazole was administered due to multiple organ involvement and persistent candidemia. Our experience with the presented cases, similar to data in the literature, suggests that CSC may occur at any gestational age, with various clinical pictures, sometimes mimicking bacterial sepsis, and even in the absence of the rash. Careful anamnesis and a high index of suspicion are important for the prompt recognition and treatment of CSC, optimizing the short- and long-term outcomes. Further research should focus on CSC to improve its diagnosis.
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Affiliation(s)
- Dumitru Alin Teacoe
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania
- Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania
| | | | | | - Laura Ștef
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania
- Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania
| | - Manuela Cucerea
- Department of Neonatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania
| | | | - Radu Chicea
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania
- Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania
| | - Dragoș Popescu
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania
- Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania
| | | | - Adrian Gheorghe Boicean
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania
- Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania
| | - Radu Galiș
- Department of Neonatology, Clinical County Emergency Hospital Bihor, 410167 Oradea, Romania
- Doctoral School, Poznan University of Medical Sciences, 60-535 Poznan, Poland
| | - Maria Livia Ognean
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania
- Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania
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Soriano-Martín A, Alonso R, Machado M, Reigadas E, Muñoz P, Bouza E. Candida spp.: the burden of a microorganism in a microbiology department. Microbiol Spectr 2024; 12:e0386023. [PMID: 38980031 PMCID: PMC11302065 DOI: 10.1128/spectrum.03860-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 06/04/2024] [Indexed: 07/10/2024] Open
Abstract
There is no precise information available on the entire workload of isolating a specific microorganism in a clinical microbiology laboratory, and the costs associated with it have not been specifically estimated. In this descriptive retrospective study conducted at the microbiology department of a general teaching hospital from January 2021 to December 2022, we assessed the workload associated with identifying Candida species in all types of clinical samples and patients. Costs were estimated from data obtained from the hospital's finance department and microbiology laboratory cost records. In 2 years, 1,008,231 samples were processed at our microbiology department, of which 8,775 had one or more Candida spp. isolates (9,683 total isolates). Overall, 5,151 samples with Candida spp. were identified from 2,383 inpatients. We isolated Candida spp. from 515.3 samples/100,000 population/year and from 92 samples/1,000 hospital admissions/year. By sample type, 90.8% were superficial, mainly mucosal. Only 9.1% Candida spp. were isolated from deep, usually sterile, samples, being mostly from ordinarily sterile fluids. Candida albicans was the main species (58.5%) identified, followed by C. parapsilosis complex, C. glabrata, C. tropicalis, and C. krusei. In admitted patients, the incidences of samples with Candida spp. isolates were 302.7 samples/100,000 population/year and 54 samples/1,000 admissions/year. The average cost of isolating and identifying Candida spp. was estimated at 25€ per culture-positive sample. To our knowledge, this is the first attempt to gage the workload and costs of Candida spp. isolation at a hospital microbiology department. These data can help assess the burden and significance of Candida isolation at other institutions and also help design measures for streamlining. IMPORTANCE We believe that this work is of interest because at present, there is no really accurate information available on the total workload involved in isolating a specific microorganism in a clinical microbiology laboratory. The costs related to this have also not been described. We have described the unrestricted workload of Candida spp. in all types of samples for all types of species and patients. We believe that this information would be necessary to collect and share this information as well as to collect it in a standardized way to know the current situation of Candida spp. workload in all clinical microbiology laboratories.
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Affiliation(s)
- Ana Soriano-Martín
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Roberto Alonso
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Elena Reigadas
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
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Suárez JAG, Calumby RJN, Silva DP, Barbosa VT, Maranhão FCA, Moreira IF, Melhem MSC, Moreira RTF. Neonatal innate immunity response in invasive candidiasis. BRAZ J BIOL 2024; 84:e275155. [PMID: 38808781 DOI: 10.1590/1519-6984.275155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 03/18/2024] [Indexed: 05/30/2024] Open
Abstract
Infections caused by Candida spp. are frequent in critically hospitalized patients, especially among premature neonates, representing one of the most common healthcare-related infections. Although there is considerable production of current knowledge about the mechanisms of immune response, aspects involved in the newborn's innate defense are not fully understood. The aim of this study was to describe the innate immune mechanisms involved in the defense of neonates against invasive candidiasis. This is an integrative literature review from the Scopus, Scifinder, Medline, Web of Science databases and the electronic libraries ScienceDirect and Scielo, in the period between 2002 and 2020, with rescue based on primary descriptor Immunity Innate plus secondary descriptors Candidiasis Invasive AND Infant Newborn. We have observed the involvement of various mechanisms in the neonatal response against invasive candidiasis, including the recognition, signaling, recruitment, and initiation of an effective immune response. These mechanisms encompass the presence of antimicrobial peptides, phagocytosis, synthesis of reactive oxygen species, inflammatory mediators, and complex cell signaling systems mediated by Pattern Recognition Receptors (PRRs). With this study, it is expected to contribute to the expansion of knowledge about the immunological mechanisms involved in the innate immune response of the newborn against disseminated infections caused by Candida species, and in the same sense, highlight the importance of this knowledge as a reflex in the decrease in mortality in the neonatal period.
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Affiliation(s)
- J A G Suárez
- Universidade Federal de Ouro Preto - UFOP, Ouro Preto, MG, Brasil
| | - R J N Calumby
- Universidade Federal de Alagoas - UFAL, Campus A. C. Simões, Maceió, AL, Brasil
| | - D P Silva
- Universidade Federal de Alagoas - UFAL, Campus A. C. Simões, Maceió, AL, Brasil
| | - V T Barbosa
- Universidade Federal de Alagoas - UFAL, Campus A. C. Simões, Maceió, AL, Brasil
| | - F C A Maranhão
- Universidade Federal de Alagoas - UFAL, Campus A. C. Simões, Maceió, AL, Brasil
| | - I F Moreira
- Universidade Federal de Alagoas - UFAL, Campus A. C. Simões, Maceió, AL, Brasil
| | - M S C Melhem
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina, Programa de Pós Graduação em Doenças Infecciosas, Campo Grande, MS, Brasil
| | - R T F Moreira
- Universidade Federal de Alagoas - UFAL, Campus A. C. Simões, Maceió, AL, Brasil
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina, Programa de Pós Graduação em Doenças Infecciosas, Campo Grande, MS, Brasil
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Han T, Qiu M, Niu X, Wang S, Wang F, Cao J, Tang S, Cheng L, Mei Y, Liang H, Feng Z, Chen G, Li Q. End-organ damage from neonatal invasive fungal infection: a 14-year retrospective study from a tertiary center in China. BMC Infect Dis 2024; 24:521. [PMID: 38783182 PMCID: PMC11119303 DOI: 10.1186/s12879-024-09360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Invasive fungal infection (IFI) has become an increasing problem in NICU neonates, and end-organ damage (EOD) from IFI is one of the leading causes of morbidity and mortality in neonates. This study was conducted to summarize clinical data on epidemiology, risk factors, causative pathogens, and clinical outcomes of IFI-associated EOD among neonates in a center in China for the sake of providing references for prevention and treatment of fungal infections in neonates in future. METHODS The clinical data of IFI neonates who received treatment in a tertiary NICU of China from January 2009 to December 2022 were retrospectively analyzed, including causative pathogens and the incidence of EOD. The neonates were divided into EOD group and non-EOD (NEOD) group. The general characteristics, risk factors and clinical outcomes of the two groups were compared. RESULTS Included in this study were 223 IFI neonates (137 male and 86 female) with a median gestational age (GA) of 30.71 (29,35) weeks and a median birth weight (BW) of 1470 (1120,2150) g. Of them, 79.4% were preterm infants and 50.2% were born at a GA of ≥ 28, <32 weeks, and 37.7% with BW of 1000-1499 g. Candida albicans (C. albicans) was the most common Candida spp. in these neonates, accounting for 41.3% of all cases, followed by C. parapsilosis (30.5%) and C. glabrata (7.2%). EOD occurred in 40 (17.9%) of the 223 cases. Fungal meningitis was the most common EOD, accounting for 13.5% of the 40 EOD cases. There was no significant difference in the premature birth rate, delivery mode, GA and BW between EOD and NEOD groups, but the proportion of male infants with EOD was higher than that without. There was no significant difference in antenatal corticosteroid use, endotracheal intubation, invasive procedures, use of antibiotics, total parenteral nutrition, blood transfusion, postnatal corticosteroid use, fungal prophylaxis and the incidence of necrotizing enterocolitis between the two groups, but the proportion of C. albicans infection cases in EOD group was higher than that in NEOD group (57.5% vs. 37.7%). Compared with NEOD group, the proportion of cured or improved infants in EOD group was significantly lower (P < 0.05), and the number of infants who died or withdrew from treatment was larger (P < 0.05). CONCLUSIONS Our retrospective study showed that preterm infants were prone to fungal infection, especially very preterm infants. C. albicans was the most common Candida spp. for IFI, and was a high-risk factor for EOD. EOD can occur in both full-term and premature infants, so the possibility of EOD should be considered in all infants with IFI.
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Affiliation(s)
- Tao Han
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Meng Qiu
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Xinxin Niu
- Department of Organ Transplantation, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shumei Wang
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Feng Wang
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Jingke Cao
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shanghong Tang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liping Cheng
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Yabo Mei
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Huayu Liang
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Zhichun Feng
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China.
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China.
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China.
| | - Geyu Chen
- Department of clinical medicine, Nan Fang Hospital affiliated to Southern Medical University, 1838 North Guangzhou Avenue, Baiyun District, Guangzhou, 510515, China.
| | - Qiuping Li
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China.
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China.
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China.
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de Kroon RR, Frerichs NM, Struys EA, de Boer NK, de Meij TGJ, Niemarkt HJ. The Potential of Fecal Volatile Organic Compound Analysis for the Early Diagnosis of Late-Onset Sepsis in Preterm Infants: A Narrative Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:3162. [PMID: 38794014 PMCID: PMC11124895 DOI: 10.3390/s24103162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
Early diagnosis and treatment of late-onset sepsis (LOS) is crucial for survival, but challenging. Intestinal microbiota and metabolome alterations precede the clinical onset of LOS, and the preterm gut is considered an important source of bacterial pathogens. Fecal volatile organic compounds (VOCs), formed by physiologic and pathophysiologic metabolic processes in the preterm gut, reflect a complex interplay between the human host, the environment, and microbiota. Disease-associated fecal VOCs can be detected with an array of devices with various potential for the development of a point-of-care test (POCT) for preclinical LOS detection. While characteristic VOCs for common LOS pathogens have been described, their VOC profiles often overlap with other pathogens due to similarities in metabolic pathways, hampering the construction of species-specific profiles. Clinical studies have, however, successfully discriminated LOS patients from healthy individuals using fecal VOC analysis with the highest predictive value for Gram-negative pathogens. This review discusses the current advancements in the development of a non-invasive fecal VOC-based POCT for early diagnosis of LOS, which may potentially provide opportunities for early intervention and targeted treatment and could improve clinical neonatal outcomes. Identification of confounding variables impacting VOC synthesis, selection of an optimal detection device, and development of standardized sampling protocols will allow for the development of a novel POCT in the near future.
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Affiliation(s)
- Rimke R. de Kroon
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nina M. Frerichs
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Eduard A. Struys
- Department of Laboratory Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nanne K. de Boer
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Tim G. J. de Meij
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Hendrik J. Niemarkt
- Department of Neonatology, Maxima Medisch Centrum, De Run 4600, 5504 DB Veldhoven, The Netherlands
- Department of Electrical Engineering, TU Eindhoven, Eindhoven University of Technology, Postbus 513, 5600 MB Eindhoven, The Netherlands
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Evren AE, Karaduman AB, Sağlik BN, Özkay Y, Yurttaş L. Investigation of Novel Quinoline-Thiazole Derivatives as Antimicrobial Agents: In Vitro and In Silico Approaches. ACS OMEGA 2023; 8:1410-1429. [PMID: 36643421 PMCID: PMC9835529 DOI: 10.1021/acsomega.2c06871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Infectious diseases are a major concern around the world. Today, it is an urgent need for new chemotherapeutics for infectious diseases. Because of that, our group designed, synthesized, and analyzed 14 new quinoline derivatives endowed with the pharmacophore moiety of fluoroquinolones primarily for their antimicrobial effects. Their cytotoxicity effects were tested against six bacterial and four fungal strains and NIH/3T3 cell line. Additionally, their action mechanisms were evaluated against DNA gyrase and lanosterol 14α-demethylase (LMD). Furthermore, to eliminate the potential side effects, the active compounds were evaluated against the aromatase enzyme. The experimental enzymatic results were evaluated for active compounds' binding modes using molecular docking and molecular dynamics simulation studies. The results were utilized to clarify the structure-activity relationship (SAR). Finally, compound 4m was the most potent compound for its antifungal activity with low cytotoxicity against healthy cells and fewer possible side effects, while compounds 4j and 4l can be used alone for special patients who are suffering from fungal infections in addition to the primer disease.
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Affiliation(s)
- Asaf Evrim Evren
- Department
of Pharmacy Services, Vocational School of Health Services, Bilecik Şeyh Edebali University, Bilecik 11000, Turkey
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
| | - Abdullah Burak Karaduman
- Department
of Pharmaceutical Toxicology, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
| | - Begüm Nurpelin Sağlik
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
- Central
Research Laboratory, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
| | - Yusuf Özkay
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
- Central
Research Laboratory, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
| | - Leyla Yurttaş
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
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Virulence Factors of Candida spp. and Host Immune Response Important in the Pathogenesis of Vulvovaginal Candidiasis. Int J Mol Sci 2022; 23:ijms23115895. [PMID: 35682581 PMCID: PMC9179972 DOI: 10.3390/ijms23115895] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 12/28/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) is one of the most common types of vaginal infections in women around the world and is often underestimated by both patients and doctors. Research on the pathogenesis of fungal vaginal infections over the last 20 years has resulted in a closer understanding of the virulence factors involved in Candida epithelial invasion and their mechanisms of action. Recently, attention was drawn to the enormous complexity of the interaction between yeast-like fungi and host cells, as well as the level of complexity of the host's response to infection and their impact on the course and treatment of VVC. Our work provides a broad description of already known and some new reports on Candida virulence factors (such as phenotypic switching or biofilm formation capacity) and their importance for tissue invasion in VVC. At the same time, we also focus on interactions with host cells and local innate immune mechanisms involved in the response to vaginal fungal invasion that are now considered equally important in this case. The presented review describes the most important aspects of the still unknown pathogenicity of Candida associated with vaginal infections.
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Verma J, Sankar MJ, Atmakuri K, Agarwal R, Das B. Gut microbiome dysbiosis in neonatal sepsis. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2022; 192:125-147. [DOI: 10.1016/bs.pmbts.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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9
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Invasive fungal infections in neonates: a review. Pediatr Res 2022; 91:404-412. [PMID: 34880444 DOI: 10.1038/s41390-021-01842-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/16/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022]
Abstract
Invasive fungal infections remain the leading causes of morbidity and mortality in neonates, especially preterm and very low birth weight infants. Most invasive fungal infections are due to Candida or Aspergillus species, and other fungi are increasingly reported and described. Appropriate identification and treatment are required to augment activity and reduce the toxicity of antifungal drugs. Successful use of antifungals in the vulnerable neonatal population is important for both prevention and treatment of infection. Strategies for prevention, including prophylactic antifungal therapy as well as reducing exposure to modifiable risk factors, like limiting antibiotic exposure, discontinuation of central catheters, and hand hygiene are key techniques to prevent and decrease rates of invasive fungal infections. In conclusion, this is a review of the most common causes, prevention strategies, prophylaxis, and treatment of invasive fungal infections in neonates.
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Menezes RP, Melo SGO, Oliveira MB, Silva FF, Alves PGV, Bessa MAS, Silva NBS, Araújo LB, Penatti MPA, Pedroso RS, Abdallah VOS, Röder DVDB. Healthcare-associated infections in high-risk neonates: Temporal trends in a national surveillance system. Early Hum Dev 2021; 158:105394. [PMID: 34051584 DOI: 10.1016/j.earlhumdev.2021.105394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 04/13/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increased survival of preterm neonates who require hospitalization at the Neonatal Intensive Care Unit has led to an increase in infections. This study aims to describe the temporal trend, risk factors, and outcome of healthcare-associated infections in a NICU of a high complexity hospital, with emphasis on the differences of incidence between bacterial and fungal infections. METHODS The study was carried out from January 2013 to December 2016, with daily follow-up of the newborns by the National Healthcare Safety Network. RESULTS The study included 881 newborns, of whom 214 had a bacterial infection, 19 had fungi infection, and 12 bacterial and fungal infections associated. The hospital infection rate was 12/1000 patient-days. SNAPPE>24, days of hospitalization and PICC days were independent risk factors for the development of fungal and bacterial infection, respectively, with statistical significance for bacterial and fungal infections. The mortality rate was 2.6 times higher in those who had fungal infection than in those who had a bacterial infection. The occurrence of invasive infections was higher in the years 2015 and 2016 and Gram-negative bacteria and yeasts were more frequent, impacting morbidity and mortality. CONCLUSIONS The use of invasive devices is a risk factor for the occurrence of HAI caused by bacteria and fungi. The frequency of deaths was higher in the group of neonates with fungal infection. These results point to the importance of constant epidemiological surveillance and measures of effective control of infections in NICU.
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Affiliation(s)
- Ralciane P Menezes
- Healthcare Technical School- ESTES, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil.
| | - Sávia G O Melo
- Undergraduate Nursing, Faculty of Medicine - FAMED, UFU, Uberlandia, MG, Brazil
| | - Murilo B Oliveira
- Undergraduate Public Health - Geography Institute, UFU, Uberlandia, MG, Brazil
| | - Felipe F Silva
- Health Sciences Post-graduate Program, FAMED, UFU, Uberlandia, MG, Brazil
| | - Priscila G V Alves
- Health Sciences Post-graduate Program, FAMED, UFU, Uberlandia, MG, Brazil
| | - Meliza A S Bessa
- Immunology and Parasitology Post-graduate Program, Biomedical Sciences Institute- ICBIM, UFU, Uberlandia, MG, Brazil
| | - Nágela B S Silva
- Immunology and Parasitology Post-graduate Program, Biomedical Sciences Institute- ICBIM, UFU, Uberlandia, MG, Brazil
| | - Lúcio B Araújo
- Mathematics Faculty - FAMAT, UFU, Uberlandia, MG, Brazil
| | - Mário P A Penatti
- Healthcare Technical School- ESTES, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil
| | - Reginaldo S Pedroso
- Healthcare Technical School- ESTES, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil; Health Sciences Post-graduate Program, FAMED, UFU, Uberlandia, MG, Brazil
| | - Vânia O S Abdallah
- Health Sciences Post-graduate Program, FAMED, UFU, Uberlandia, MG, Brazil
| | - Denise V D B Röder
- Health Sciences Post-graduate Program, FAMED, UFU, Uberlandia, MG, Brazil; Biomedical Sciences Institute- ICBIM, UFU, Uberlandia, MG, Brazil
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11
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Zhu Y, Gong X, Li Z, Wang D, Yan C. Clinical Analysis of Intravenous and Oral Sequential Treatment With Voriconazole for Candida Central Nervous System Infection in Six Premature Infants. Front Pharmacol 2021; 12:631293. [PMID: 34248616 PMCID: PMC8263898 DOI: 10.3389/fphar.2021.631293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/02/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: The aim of the study was to observe the clinical efficacy and safety of intravenous and oral sequential treatment with voriconazole for Candida central nervous system (CNS) infection in premature infants. Methods: The study included retrospective analysis of the clinical data of six premature infants with Candida CNS infection admitted to the neonatology department in Shanghai Children’s Hospital between November 2016 and November 2019. By reviewing the characteristics of voriconazole based on the literature, it showed that infants without gastrointestinal dysfunction could be effectively treated by intravenous and oral sequential therapy with voriconazole (both 7 mg/kg/dose, every 12 h). Clinical manifestations, the time required for the cerebrospinal fluid (CSF), blood culture, nonspecific infection markers such as platelets and C-reactive protein (CRP) to turn normal, and drug-related side effects were observed and recorded in the process of treatment. All data were statistically analyzed by T test and Mann–Whitney U test. Results: A total of six premature infants were diagnosed with Candida CNS infection, two cases were diagnosed by a positive CSF culture and four cases were clinically diagnosed. Blood culture was positive for Candida in five cases. Among the 6 patients, 4 cases were Candida albicans and 2 cases were Candida parapsilosis. All the six cases were cured. After 3–5 days of treatment, symptoms such as lethargy, apnea, and feeding intolerance were improved and disappeared; a repeated blood culture turned negative in 3–7 days; CSF returned to normal in 15 ± 9 days on an average. Brain abscess, meningeal inflammation, and other infectious lesions were cleared on cranial magnetic resonance imaging (MRI) after treatment. The average total course of voriconazole was 61 ± 29 days, and the average oral treatment was 28 ± 15 days. No Candida recurrence was found during the treatment, and no drug-related side effects such as skin rash, liver and kidney function impairment, or visual abnormalities were found. The white blood cells, CSF glucose/plasma glucose ratio, and protein in CSF were significantly improved after the treatment (p < 0.05). No statistically significant difference was identified in the liver and kidney function indexes (p > 0.05). Conclusion: Voriconazole is a relatively safe and effective alternative treatment for Candida CNS infection in preterm infants. No severe drug-related side effects were detected.
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Affiliation(s)
- Yingying Zhu
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiling Li
- Department of Pharmacology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Danni Wang
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chongbing Yan
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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12
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Robati Anaraki M, Nouri-Vaskeh M, Abdoli Oskoei S. Fluconazole prophylaxis against invasive candidiasis in very low and extremely low birth weight preterm neonates: a systematic review and meta-analysis. Clin Exp Pediatr 2021; 64:172-179. [PMID: 32683818 PMCID: PMC8024115 DOI: 10.3345/cep.2019.01431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/29/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Evidence shows that fluconazole prophylaxis is an effective treatment against invasive fungal infections in preterm neonates, however, the most efficient schedule of fluconazole prophylaxis for the colonization and mortality of invasive candidiasis (IC) is unknown. PURPOSE This systematic review and meta-analysis aimed to assess the efficiency of different prophylactic fluconazole schedules in controlling IC colonization, infection, and mortality in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants in neonatal intensive care units. METHODS We searched the PubMed, Scopus, Embase, and Cochrane databases using the keywords "candida," "invasive candidiasis," "IC," "fluconazole prophylaxis," "preterm infants," "very low birth weight infants," "VLBW," "extremely low birth weight," and "ELBW." RESULTS Mortality was significantly decreased in a metaanalysis of studies using different fluconazole prophylaxis regimens. The meta-analysis also indicated a significant decrease in the incidence of IC-associated mortality in ELBW infants using the same fluconazole prophylaxis schedules. CONCLUSION Future studies should explore the effectiveness of other different fluconazole prophylaxis schedules on IC colonization, infection, and mortality.
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Affiliation(s)
- Mahmoud Robati Anaraki
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Prosthodontics, Dental School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Nouri-Vaskeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahram Abdoli Oskoei
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Wang Y, Chen W, Wu W, Yu D, Yan H, Ye X. Severe extensive community acquired aspergillus infection in a full-term infant accompanied with increases in white blood cell counts and C-reactive protein: a case report. BMC Pediatr 2021; 21:118. [PMID: 33750330 PMCID: PMC7941996 DOI: 10.1186/s12887-021-02588-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/02/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Aspergillus infection is more common among premature infants in neonatal intensive care units, who have decreased qualitative immune defenses and need various invasive treatment procedures. It is rare in normal full-term neonates, especially in newborn babies from the community. Moreover, the white blood cell (WBC) count and C-reactive protein (CRP) level may be normal or slightly changed in fungal infections, but the neonate reported in this study had significant increases in WBC and CRP. To the best of our knowledge, this is the first report on a full-term neonate from the community with aspergillus infection accompanied by significant increases in WBC and CRP levels. CASE PRESENTATION A 28-day-old infant, who received empirical antibiotic treatment for 10 days because of neonatal pneumonia, was referred to our neonatal department from the local hospital. The infant had persistent infection and multiple organ failure syndromes. Bronchoscopy and deep sputum smear were performed to identify the pathogen, which confirmed aspergillus infection in the sputum. Fluconazole was immediately administered, but the baby died after three days. Thereafter, an autopsy was performed with parental consent. There were multiple necrotic areas in the lungs and liver, and pathological examination revealed aspergillus. CONCLUSIONS The present case emphasized that community-sourced aspergillus infection can exist in full-term neonates, with significantly increased WBC count and CRP level. Advanced antibiotics were not effective in this case, and fungal infections should have been considered earlier.
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Affiliation(s)
- Yanli Wang
- Guangdong Women and Children Hospital, No. 13, Guangyuan West Road, Yuexiu District, 510000, Guangzhou, China
| | - Wenjing Chen
- Guangdong Women and Children Hospital, No. 13, Guangyuan West Road, Yuexiu District, 510000, Guangzhou, China
| | - Wenshen Wu
- Dongguan Children's Hospital, Guangdong Medical University, 523000, Dongguan, China
| | - Dongling Yu
- Guangdong Women and Children Hospital, No. 13, Guangyuan West Road, Yuexiu District, 510000, Guangzhou, China
| | - Huiheng Yan
- Guangdong Women and Children Hospital, No. 13, Guangyuan West Road, Yuexiu District, 510000, Guangzhou, China
| | - Xiuzhen Ye
- Guangdong Women and Children Hospital, No. 13, Guangyuan West Road, Yuexiu District, 510000, Guangzhou, China.
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Vigezzi C, Riera FO, Rodriguez E, Icely PA, Miró MS, Figueredo CM, Caeiro JP, Sotomayor CE. [Invasive candidiasis: A view to central nervous system infection]. Rev Argent Microbiol 2020; 53:171-178. [PMID: 32768262 DOI: 10.1016/j.ram.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/24/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022] Open
Abstract
Candidemia is the most frequent invasive mycosis in hospitalized patients worldwide. Fungal infection in central nervous system is a life-threatening complication which aggravates patients' prognosis. This article summarizes relevant aspects on the clinical characteristics of this pathology, mechanisms of fungus invasion, local immune response to Candida albicans and the impact of genetic defects on innate immune receptors that increase susceptibility to the acquisition of this form of mycosis.
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Affiliation(s)
- Cecilia Vigezzi
- Laboratorio de Inmunidad Innata a Patógenos Fúngicos, Departamento de Bioquímica Clínica, Córdoba, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología, CIBICI-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina; Servicio de Infectología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Research Group of Immunology and Mycology, Córdoba, Argentina
| | - Fernando Oscar Riera
- Servicio de Infectología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Research Group of Immunology and Mycology, Córdoba, Argentina; Servicio de Infectología, Sanatorio Allende, Córdoba, Argentina
| | - Emilse Rodriguez
- Laboratorio de Inmunidad Innata a Patógenos Fúngicos, Departamento de Bioquímica Clínica, Córdoba, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología, CIBICI-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina; Servicio de Infectología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Research Group of Immunology and Mycology, Córdoba, Argentina
| | - Paula Alejandra Icely
- Laboratorio de Inmunidad Innata a Patógenos Fúngicos, Departamento de Bioquímica Clínica, Córdoba, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología, CIBICI-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina; Servicio de Infectología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Research Group of Immunology and Mycology, Córdoba, Argentina
| | - María Soledad Miró
- Laboratorio de Inmunidad Innata a Patógenos Fúngicos, Departamento de Bioquímica Clínica, Córdoba, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología, CIBICI-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina; Servicio de Infectología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Research Group of Immunology and Mycology, Córdoba, Argentina
| | - Carlos Mauricio Figueredo
- Laboratorio de Inmunidad Innata a Patógenos Fúngicos, Departamento de Bioquímica Clínica, Córdoba, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología, CIBICI-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina; Servicio de Infectología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Juan Pablo Caeiro
- Servicio de Infectología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Servicio de Infectología, Sanatorio Allende, Córdoba, Argentina
| | - Claudia Elena Sotomayor
- Laboratorio de Inmunidad Innata a Patógenos Fúngicos, Departamento de Bioquímica Clínica, Córdoba, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología, CIBICI-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina; Servicio de Infectología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Research Group of Immunology and Mycology, Córdoba, Argentina.
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15
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Bersani I, Piersigilli F, Goffredo BM, Santisi A, Cairoli S, Ronchetti MP, Auriti C. Antifungal Drugs for Invasive Candida Infections (ICI) in Neonates: Future Perspectives. Front Pediatr 2019; 7:375. [PMID: 31616647 PMCID: PMC6764087 DOI: 10.3389/fped.2019.00375] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/02/2019] [Indexed: 12/26/2022] Open
Abstract
Fungal infections may complicate the neonatal clinical course, and the spectrum of therapies for their treatment in the perinatal period is limited. Polyenes, Azoles and Echinocandins represent the three classes of antifungal drugs commonly used in the neonatal period. The present review provides an overview about the most recent therapeutic strategies for the treatment of fungal infections in neonates.
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Affiliation(s)
- Iliana Bersani
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Fiammetta Piersigilli
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Bianca Maria Goffredo
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandra Santisi
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sara Cairoli
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Paola Ronchetti
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
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Verma P, Laforce-Nesbitt SS, Tucker R, Mao Q, De Paepe ME, Bliss JM. Galectin-3 expression and effect of supplementation in neonatal mice with disseminated Candida albicans infection. Pediatr Res 2019; 85:527-532. [PMID: 30679793 PMCID: PMC6397689 DOI: 10.1038/s41390-019-0279-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/04/2018] [Accepted: 12/31/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Invasive candidiasis is an important cause of fungal infections in immunocompromised patients, including premature infants. The S-type lectin, galectin-3 (gal3), is increasingly recognized for its role in antifungal host defense. This study tested the hypothesis that tissue gal3 expression is affected by disseminated infection with Candida albicans and that supplementation with gal3 will provide a benefit in this setting. METHODS To determine the expression of gal3 at the tissue level in response to disseminated infection with C. albicans, adult and neonatal mice were infected using previously established models. End points were chosen that reflected substantive tissue fungal burden but before mortality. RESULTS No differences in gal3 were detected in tissues of adult animals relative to uninfected controls. In neonatal animals, gal3 concentration was lower in the spleen of infected animals compared to uninfected. Pretreatment of neonatal mice with recombinant gal3 was associated with reduced mortality and reduced fungal burden in the kidney, spleen, and lung at 24 h following infection. CONCLUSION These findings suggest that gal3 has an active role in host defense against candidiasis and that neonatal animals can benefit from supplementation with this lectin in the setting of disseminated candidiasis.
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Affiliation(s)
- Prasoon Verma
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Sonia S. Laforce-Nesbitt
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Richard Tucker
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Quanfu Mao
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Monique E. De Paepe
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Joseph M. Bliss
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI,Corresponding Author: Dept. of Pediatrics, Women & Infants Hospital of Rhode Island, 101 Dudley St., Providence, RI 02905, Phone: (401)274-1100, Fax: (401) 453-7571,
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17
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Hemedez C, Trail-Burns E, Mao Q, Chu S, Shaw SK, Bliss JM, De Paepe ME. Pathology of Neonatal Non- albicans Candidiasis: Autopsy Study and Literature Review. Pediatr Dev Pathol 2019; 22:98-105. [PMID: 30193562 PMCID: PMC9620501 DOI: 10.1177/1093526618798773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION/OBJECTIVES Non- albicans Candida species such as Candida parapsilosis and Candida glabrata have emerged as prevalent pathogens in premature infants. The aim of this study was to systematically delineate the histopathologic findings in neonatal non- albicans candidiasis. METHODS We performed a retrospective clinicopathologic analysis of extremely premature (23-28 weeks' gestation) infants diagnosed with invasive candidiasis. Archival autopsy tissues were subjected to periodic acid-Schiff, methenamine-silver and anti- Candida (immuno)histochemical stains, as well as dual anti- Candida and anti-cytokeratin or anti-CD31 immunofluorescence assays. In addition, we studied the prevalence of intestinal Candida colonization in a consecutive autopsy series of extremely premature infants. RESULTS Based on positive postmortem blood and/or lung cultures, invasive candidiasis (3 non- albicans and 11 Candida albicans) was diagnosed in 14 of the 187 extremely premature infants examined between 1995 and 2017. In contrast to the well-known inflammatory and tissue-destructive phenotype of congenital C. albicans infection, invasive non- albicans candidiasis/candidemia caused by C. parapsilosis and C. glabrata was inconspicuous by routine hematoxylin-eosin-based histopathologic analysis despite a heavy fungal presence detected in intestines, lungs, and blood by targeted (immuno)histochemical assays. Intestinal colonization by Candida species was identified in 16 of the 26 (61%) extremely premature neonates who had lived for at least 1 week, as assessed by anti- Candida immunostaining. CONCLUSION Invasive neonatal non- albicans candidiasis/candidemia appears to have no distinct histopathologic signature. Based on the notoriously low sensitivity of fungal blood cultures and the observed high frequency of Candida intestinal colonization (>50%), it is likely that non- albicans candidiasis/candidemia may be underdiagnosed in (deceased) preterm infants. Routine inclusion of targeted (immuno)histochemical fungal detection strategies in the perinatal autopsy may lead to deeper insight into the prevalence and clinical relevance of neonatal non- albicans candidiasis.
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Affiliation(s)
- Claire Hemedez
- Department of Pathology, Women and Infants Hospital, Providence, Rhode Island
- Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Quanfu Mao
- Department of Pathology, Women and Infants Hospital, Providence, Rhode Island
- Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sharon Chu
- Department of Pathology, Women and Infants Hospital, Providence, Rhode Island
| | - Sunil K Shaw
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joseph M Bliss
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Monique E De Paepe
- Department of Pathology, Women and Infants Hospital, Providence, Rhode Island
- Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
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Abstract
BACKGROUND Neonatal candidiasis causes significant morbidity and mortality in high risk infants. The micafungin dosage regimen of 10 mg/kg established for the treatment of neonatal candidiasis is based on a laboratory animal model of neonatal hematogenous Candida meningoencephalitis and pharmacokinetic (PK)-pharmacodynamic (PD) bridging studies. However, little is known about the how these PK-PD data translate clinically. METHODS Micafungin plasma concentrations from infants were used to construct a population PK model using Pmetrics software. Bayesian posterior estimates for infants with invasive candidiasis were used to evaluate the relationship between drug exposure and mycologic response using logistic regression. RESULTS Sixty-four infants 3-119 days of age were included, of which 29 (45%) infants had invasive candidiasis. A 2-compartment PK model fits the data well. Allometric scaling was applied to clearance and volume normalized to the mean population weight (kg). The mean (standard deviation) estimates for clearance and volume in the central compartment were 0.07 (0.05) L/h/1.8 kg and 0.61 (0.53) L/1.8 kg, respectively. No relationship between average daily area under concentration-time curve or average daily area under concentration-time curve:minimum inhibitory concentration ratio and mycologic response was demonstrated (P > 0.05). Although not statistically significant, mycologic response was numerically higher when area under concentration-time curves were at or above the PD target. CONCLUSIONS While a significant exposure-response relationship was not found, PK-PD experiments support higher exposures of micafungin in infants with invasive candidiasis. More patients would clarify this relationship; however, low incidence deters the feasibility of these studies.
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Kooshki P, Rezaei-Matehkolaei A, Mahmoudabadi AZ. The patterns of colonization and antifungal susceptibility of Candida, isolated from preterm neonates in Khorramabad, South West of Iran. J Mycol Med 2018. [PMID: 29530715 DOI: 10.1016/j.mycmed.2018.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Usually, 7-20% of preterm neonates colonized by Candida species present invasive candidiasis. Candida albicans, and several non-albicans species cause invasive infection with C. albicans being the most dominant agent. In the last two decades, infection due to non-albicans have been increased dramatically due to their low sensitivity to antifungal drugs such as fluconazole. The aim of present study was to evaluate Candida colonization pattern and antifungal susceptibility among preterm neonates from Khorramabad, South west of Iran. MATERIALS AND METHODS Samples were collected from 80 preterm neonates, cultured on CHROMagar Candida and incubated at 37°C. All recovered isolates were primarily screened based on classical methods and identified by PCR-RFLP targeting the ITS-rDNA regions. Antifungal susceptibility testing of all isolates was performed according to the CLSI method against amphotericin B, caspofungin, itraconazole, fluconazole and voriconazole. RESULTS Totally 23 isolates of Candida species were recovered from 20 patients (female: male, 50:50) including, C. albicans (18), C. parapsilosis (2) and C. glabrata (1). Furthermore, the blood cultures from two patients were yielded C. albicans and C. parapsilosis so that patient with C. albicans died after five days. Generally, in this study, 9 (39.1%) isolates were resistant to amphotericin B including; 7 (30.4%) C. albicans and 2 (8.7%) C. parapsilosis. In addition, 2 (8.7%) and 4 (17.4%) isolates were also resistant to itraconazole and caspofungin, respectively. CONCLUSION In conclusion, Candida colonization among preterm neonates is still an important issue in hospitals. In addition, in spite of a significant amphotericin B resistant Candida, voriconazole, fluconazole, and itraconazole are valuable antifungals, due to fully sensitivity to Candida.
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Affiliation(s)
- P Kooshki
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - A Rezaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - A Z Mahmoudabadi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Abstract
Considerable progress has been made in the prevention, diagnosis, and management of pediatric patients with invasive fungal disease (IFD). The reported decreasing trend in the incidence of invasive candidiasis (IC) over the past 15 years in both neonates and children has been encouraging. Nevertheless, due to the growing number of immunocompromised children at risk for IFD, this disease continues to be associated with significant morbidity and death and with increased financial burden to the health care system. Therefore, it is important to understand the contemporary epidemiology of IFD. Incidence rates of IFD in children are affected by geographical, population, and time variability. There is an ongoing effort to constantly document and update the incidence of IFD and species distribution among different pediatric populations as a means to direct preventative, diagnostic, and therapeutic resources to the most appropriate subset of patients. Children with a hematologic malignancy or a primary or secondary immunodeficiency, those undergoing solid organ or hematopoietic stem cell transplantation, and premature neonates are the major subsets of pediatric patients at risk of developing IFD. In this review, we focus on fungal disease epidemiology with a specific emphasis on the 2 most common pediatric IFDs, IC and invasive aspergillosis (IA).
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Affiliation(s)
- Zoi Dorothea Pana
- Hospital Epidemiology and Infection Control Department (HEIC), Division of Infectious Diseases, Johns Hopkins Hospital, Baltimore, Maryland
- Third Department of Paediatrics, Infectious Diseases Unit, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - Emmanuel Roilides
- Third Department of Paediatrics, Infectious Diseases Unit, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece
| | - Adilia Warris
- Aberdeen Fungal Group, MRC Centre for Medical Mycology, Institute of Medical Sciences and the Royal Aberdeen Children’s Hospital, University of Aberdeen, United Kingdom
| | - Andreas H Groll
- Center for Bone Marrow Transplantation and Department of Paediatric Hematology and Oncology, Infectious Disease Research Program, University Children’s Hospital, Muenster, Germany
| | - Theoklis Zaoutis
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness Research, Children’s Hospital of Philadelphia, Pennsylvania; and
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia
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21
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King J, Pana ZD, Lehrnbecher T, Steinbach WJ, Warris A. Recognition and Clinical Presentation of Invasive Fungal Disease in Neonates and Children. J Pediatric Infect Dis Soc 2017; 6:S12-S21. [PMID: 28927201 PMCID: PMC5907856 DOI: 10.1093/jpids/pix053] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Invasive fungal diseases (IFDs) are devastating opportunistic infections that result in significant morbidity and death in a broad range of pediatric patients, particularly those with a compromised immune system. Recognizing them can be difficult, because nonspecific clinical signs and symptoms or isolated fever are frequently the only presenting features. Therefore, a high index of clinical suspicion is necessary in patients at increased risk of IFD, which requires knowledge of the pediatric patient population at risk, additional predisposing factors within this population, and the clinical signs and symptoms of IFD. With this review, we aim to summarize current knowledge regarding the recognition and clinical presentation of IFD in neonates and children.
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Affiliation(s)
- Jill King
- Aberdeen Fungal Group, Medical Research Council Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, and the Royal Aberdeen Children’s Hospital, United Kingdom
| | - Zoi-Dorothea Pana
- Hospital Epidemiology and Infection Control, Division of Infectious Diseases, Johns Hopkins Hospital, Baltimore, Maryland
| | - Thomas Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; and
| | - William J Steinbach
- Division of Pediatric Infectious Diseases, Department of Pediatrics, and Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina
| | - Adilia Warris
- Aberdeen Fungal Group, Medical Research Council Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, and the Royal Aberdeen Children’s Hospital, United Kingdom
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Leonart LP, Tonin FS, Ferreira VL, Tavares da Silva Penteado S, de Araújo Motta F, Pontarolo R. Fluconazole Doses Used for Prophylaxis of Invasive Fungal Infection in Neonatal Intensive Care Units: A Network Meta-Analysis. J Pediatr 2017; 185:129-135.e6. [PMID: 28285752 DOI: 10.1016/j.jpeds.2017.02.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/30/2017] [Accepted: 02/14/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of different doses of fluconazole used for invasive prophylaxis of fungal infection in neonates. STUDY DESIGN A systematic search was conducted with PubMed, Scopus, and Web of Science. A manual search was performed as well. Only randomized controlled trials of neonates in a neonatal intensive care unit (NICU) who received fluconazole prophylaxis for invasive fungal infection, regardless of the dose or therapeutic regimen, were included in this review. Data on baseline characteristics, outcomes incidence of proven invasive Candida infection, overall mortality, and invasive Candida infection-related mortality were extracted. RESULTS Eleven studies were included in the review, with fluconazole doses of 3, 4, or 6?mg/kg. When the incidence of invasive Candida and invasive Candida-related mortality were considered as outcomes, the 3 and 6?mg/kg fluconazole doses were found to be statistically superior to placebo (OR, 5.48 [95% credible interval, 1.81-18.94] and 2.63 [1.18-7.02], respectively, and 15.32 [1.54-54.31] and 9.14 [1.26-142.7], respectively), but data for the 3 doses were not statistically significantly different. CONCLUSIONS Use of the lowest fluconazole dose (3?mg/kg) should be recommended for Candida prophylaxis in neonates, given that increasing the fluconazole dose is not associated with higher efficacy and has greater potential for toxicity and increased cost.
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Affiliation(s)
| | | | | | | | - Fábio de Araújo Motta
- Pelé Pequeno Príncipe Research Institute, Pequeno Príncipe Hospital, Curitiba, PR, Brazil
| | - Roberto Pontarolo
- Department of Pharmacy, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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