Candida spp bloodstream infections in a Latin American Pediatric Oncology Reference Center: Epidemiology and associated factors

Abstract

Summary Background Invasive fungal disease is a significant cause of morbidity and mortality in immunosuppressed children. The recognition of patients at risk for candidaemia is paramount to a better prognosis. Objectives To characterize Candida spp bloodstream infections (BSI) in a reference centre for paediatric oncology and to describe the most prevalent risk factors associated with candida infections. Patients/Methods This is a retrospective cohort study carried out with paediatric patients followed up with at the Institute of Pediatric Oncology, Brazil, who presented positive blood culture for Candida spp from January 2004 to December 2016. Results Ninety episodes of candidaemia were analysed; patients had a median age of 4.5 years, and 57.8% were males, with a diagnosis of solid tumours in 54.5% of cases. The most common Candida species were C albicans (35.6%), C parapsilosis (30.0%) and C tropicalis (16.7%). C tropicalis BSI was associated with neutropenia and skin lesions. Therapy was successful in 67.1% of the episodes. Older age and thrombocytopenia were associated with therapeutic failure. Death within 30 days occurred in 24.4% of patients; predictive factors were older age and admission to an ICU C parapsilosis candidaemia was a protective factor for death when compared to C albicans. Conclusion The main species isolated were C albicans, C parapsilosis and C tropicalis. C tropicalis BSI was associated with neutropenia and skin lesions. The death rate was significant, and a worse prognosis was associated with older age, thrombocytopenia and admission to an ICU C parapsilosis infection proved to be a protective factor against mortality.

Molecular diagnosis, phylogenetic analysis, and antifungal susceptibility profiles of Candida species isolated from neutropenic oncological patients

“…We found that the median neutrophil count differed statistically between Candida -positive (405 [200–700] cells/µl) and Candida -negative (990 [220–989] cells/µl) patients ( p value: 0.00). There are several studies that support our findings [ 40 , 41 , 43 , 45 , 53 , 55 – 59 ].…”

Microbiological Contamination of Mobile Phones and Mobile Phone Hygiene of Final-Year Medical Students in Uganda: A Need for Educational Intervention

“…However, it should be noted that fungi are potential pathogens on mobile phones that can be transmitted to especially immunocompromised patients in whom they cause significant morbidity and mortality. 42 Generally, while final-year medical students were aware of the basic IPC topics, our findings showed that the students had overall poor IPC practical skills regarding mobile phone use and hygiene irrespective of the ward of rotation. This is similar to what other studies have found, 23,43,44 and shows the gaps in the medical curriculum, which does not assess the practical skills to the same extent it does knowledge and awareness.…”

Overview of invasive fungal infections in children in South America – the threat of resistant Candida species and the role of climate change in the new geographic distribution of endemic systemic mycosis

“…Children and adolescents receiving intensive myelosuppressive chemotherapy and pediatric HSCT recipients are at higher risk for IFI caused by yeasts and molds [29] with mortality rates between 10% and 25%. Table 1 shows studies in cancer pediatric patients [7] and transplant patients [18].…”

“…Invasive fungal infection (IFI) is a major complication in immunocompromised adults [1][2][3] and children, including critically ill neonates [4 && ,5] and children with haematologic diseases and recipients of allogeneic hematopoietic stem-cell transplantation (HSCT) [6,7]. Endemic mycosis (EM) used to be present in specific areas of known endemicity but there have been increasing reports of EM in areas previously considered nonendemic [8].…”