Two different clones of Candida pelliculosa bloodstream infection in a tertiary neonatal intensive care unit

Abstract

Introduction: Fungemia in preterm infants results in high mortality and morbidity. The genotypes, drug susceptibilities of Candida pelliculosa strains, and clinical features of two outbreaks of neonatal candidemia caused by C. pelliculosa were analyzed, in order to provide evidence for the outbreaks and characteristics of C. pelliculosa neonatal candidemia.
 Methodology: The strains were genotyped by pulsed-field gel electrophoresis to investigate their genetic relatedness. The broth microdilution method was used to determine in vitro susceptibility of the isolates to antifungal drugs. Clinical features of the infected patients were collected to analyze the risks for C. pelliculosa infection.
 Results: Fourteen neonates, hospitalized in the neonatal intensive care unit from November 2012 to October 2013, were infected by C. pelliculosa. All 14 patients were cured after treatment with fluconazole and discharged without any complications. The C. pelliculosa isolates from the 14 patients were clustered into two groups, indicating that the outbreaks were caused by two types of strains. Eight of nine strains isolated from the 2013 outbreak were clustered into the same group, while one isolate was grouped together with five isolates from the 2012 outbreak. In vitro experiments demonstrated high antifungal activity of fluconazole, voriconazole, amphotericin B, and 5-fluorocytosine to C. pelliculosa. The common symptoms of C. pelliculosa candidaemia were fever, cyanosis, polypnea, hypoactivity, and apnea.
 Conclusions: The current study revealed high in vitro susceptibility of C. pelliculosa to antifungals. As C. pelliculosa candidaemia cannot be characterized by clinical symptoms and routine blood testing alone, monitoring unusual strains isolated from immunodeficient hosts is very important to prevent possible outbreaks.

Investigation of the Emerging Nosocomial Wickerhamomyces anomalus Infections at a Chinese Tertiary Teaching Hospital and a Systemic Review: Clinical Manifestations, Risk Factors, Treatment, Outcomes, and Anti-fungal Susceptibility

“…New lines of studies, however, have revealed its clinical importance and have implicated this species in a wide range of fungal infections, such as keratitis, meningitis, and candidemia, in immunocompromised and neonatal patients (Neumeister et al, 1992;Park et al, 2008;Ratcliffe et al, 2011). Moreover, this species has been associated with a relatively high mortality rate (41.2%) (Pasqualotto et al, 2005), and numerous studies have found this species as a cause of outbreaks (Kalenic et al, 2001;Kalkanci et al, 2010;Jung et al, 2018), especially among neonates (da Silva et al, 2013;Lin et al, 2013;Yang et al, 2021). While molecular tools failed to be identified from the hands of healthcare workers, they have revealed that W. anomalus isolates obtained from the outbreaks are genetically related, and importantly, the application of strict infection control and hand hygiene practices has resulted in eradication of such infections in hospitals with ongoing outbreaks due to W. anomalus (Pasqualotto et al, 2005).…”

Fungemia by Wickerhamomyces anomalus—A Narrative Review

“…A total of 243 articles from PubMed and Scopus were screened. Finally, 36 met the present study’s inclusion criteria [ 19 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. These 36 studies involved 170 patients in total.…”

“…However, an increasing number of reports of human infections by W. anomalus have emerged, suggesting that this microorganism is an emerging pathogen. For example, there are reports of clonal outbreaks of invasive fungal disease, more commonly fungemia [ 26 , 27 ].…”

Fungemia With Wickerhamomyces anomalus: A Case Report and Literature Review

“…Among the 211 cases, 154 cases (73%) were pediatrics, mostly including neonates. Twelve articles reported on nosocomial infections causing outbreaks [ 2 , 8 , 12 , 23 , 25 , 26 , 30 , 43 , 46 , 48 , 49 , 51 ]. Fungemia was reported in 199 cases (94%), and four cases were eye involvement such as endophthalmitis [ 11 , 47 ] or keratitis [ 18 , 21 ].…”