Rare Invasive Yeast Infections in Greek Neonates and Children, a Retrospective 12-Year Study

Abstract

Although Candida species remain the leading cause of invasive fungal infections (IFI), the list of other isolated fungal pathogens is increasing. The aim of the study was to report cases of IFI caused by rare yeasts in the largest tertiary Greek pediatric hospital. A retrospective study was performed from 6/2008–6/2020 regarding IFI caused by rare species. Identification of isolates was attained by conventional, molecular, and MALDI TOF MS methods, and susceptibility testing was performed according to the Clinical and Laboratory Standards (CLSI) methodology. During a 12-year period, 14 different rare fungal species in 33 neonates and children with IFI hospitalized in intensive care and oncology units were isolated from blood, central catheters, peritoneal, pleural, or pericardial fluid specimens. It is the first time for IFI caused by Wickerhamomyces anomalus (Candida pelliculosa), Pichia fermentans (Candida lambica), Yarrowia (Candida) lipolytica, Pichia (Hansenula) kluyveri, Rhodotorula mucilaginosa, Wickerhamiella (Candida) pararugosa and Cyberlindnera (Candida) fabianii in Greek neonates and children to be reported. For most of these rare fungal species isolated in the present study, no official antifungal breakpoints have been defined, and there are no guidelines for their treatment. Clinical laboratories should be aware of uncommon and emerging yeast pathogens and be able to detect them with molecular and proteomic methods.

Invasive Trichosporonosis in Neonates and Pediatric Patients with Malignancies or Hematologic Disorders

“…The female/ male ratio was 1.14/1. Several occasional outbreaks of trichosporonemia from different NICUs involving single or a small number of patients were reported [29][30][31][32][33][34][35][36][37][38][39][40]. Two outbreaks in NICU in India contributed 11/24 cases [41,42].…”

“…The most common underlying disorder was acute lymphoblastic leukemia (ALL) (13/32; 41%) followed by acute myeloid leukemia (AML) (8/32 cases; 25%). The remaining 34% of the reported cases included 3 cases with aplastic anemia, 2 cases with mixed ALL and one case with Blackfan-Diamond, myelodysplastic syndrome, Langerhans cell histiocytosis, Wilms tumor, Ewing sarcoma and yolk sac tumor, respectively [40,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61]. The male/female ratio was 1/1.…”

Invasive Trichosporonosis in Neonates and Pediatric Patients with Malignancies or Hematologic Disorders

“…The female/male ratio was 1.14/1. Several occasional outbreaks of trichosporonemia from different Neonatal Intensive Care Units (NICUs) were reported [28][29][30][31][32][33][34][35][36][37][38]. Two outbreaks in a single NICU in India contributed to 11/24 (46%) cases [39,40].…”

“…The most common underlying disorder was acute lymphoblastic leukemia (ALL) (13/32; 41%) followed by acute myeloid leukemia (AML) (8/32 cases; 25%). The remaining 34% of the reported cases included three cases with aplastic anemia, two cases with mixed ALL and one case with Blackfan-Diamond, myelodysplastic syndrome (MDS), Langerhans cell histiocytosis, Wilms tumor, Ewing sarcoma and yolk sac tumor, respectively [38,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. The male/female ratio was 1/1.…”

The Flo Adhesin Family

“…It shows a wide spectrum antimicrobial activity, being active against a variety of microorganisms including other yeasts, filamentous fungi and bacteria [316]. W. anomalus is a very rare pathogen causing blood stream infections in neonates [275,[322][323][324][325]. It has been shown that W. anomalus can form biofilms on abiotic surfaces of a brewery plant [326] as well as on polystyrene and steel surfaces in vitro [166].…”