Candidemia due to Candida guilliermondii in an immuno-compromised infant: a case report and review of literature

Abstract

Background and Purpose: Candidemia is a life-threatening fungal infection with significant mortality and morbidity in neutropenic individuals, immunosuppressive chemotherapy recipients, and broad-spectrum antibiotics consumers. The epidemiology and antifungal susceptibility testing of non-albicans Candida species have been poorly studied. These species are characterized by low susceptibility to azoles and echinocandins. Herein, we report the first pediatric case of candidemia due to C. guilliermondii in Iran and review the literature on fungemia caused by C. guilliermondii.Case report: We presented the first candidemia case due to C. guilliermondii in a 4-month-old male infant with neuroblastoma in Iran. This study also involves a comprehensive literature review on fungemia caused by C. guilliermondii during a period of 18 years (i.e., 2000-2018) to discuss the epidemiology, clinical features, and treatment of this disease. The literature review resulted in the identification of 501 cases of candidemia caused by C. guilliermondii. Most of the patients were adults and had multiple risk factors. However, the main risk factors were significantly related to cancer chemotherapy, followed by central venous catheter use and Intensive Care Unit admission. Mortality rate due to this disease had a range of 3.4-66.6%, in this regard, the patients with cancer had the highest mortality rate.Conclusion: Given the high mortality of candidemia, the early diagnosis of this infection and timely initiation of antifungal therapy significantly improve the patients’ survival rate and result in better outcomes. Consequently, it is highly recommended to monitor the local epidemiology of this life-threatening infection and raise awareness in this regard.

Epidemiological features of nosocomial candidaemia in neonates, infants and children: A multicentre study in Iran

“…Candida tropicalis appears to be more virulent than C. albicans and is more prone to causing invasive candidiasis with a high rate of mortality than the latter. Although C. tropicalis strains are generally susceptible to azoles, 85% are reported to be resistant to fluconazole and 100% are resistant to posaconazole in some studies . Missense mutations in the ERG11 gene; overexpression of ERG11 , CDR1 and MDR1 ; and reduced expression of CYTb all contribute to the azole resistance of C. tropicalis .…”

“…This indicates that healthcare-associated risk factors are a good predictor of positive blood culture. 6,14,[19][20][21][22][23][24][25] Strikingly, invasive candidiasis caused by non-albicans Candida species has only been reported in the past two decades. 22 Nonalbicans Candida species have emerged as agents of candidaemia, with an overall decreased incidence rate of C. albicans from 70% to 50% in developed countries.…”

“…Although C. tropicalis strains are generally susceptible to azoles, 85% are reported to be resistant to fluconazole and 100% are resistant to posaconazole in some studies. 14,23,24 Missense mutations in the ERG11 gene; overexpression of ERG11, CDR1 and MDR1; and reduced expression of CYTb all contribute to the azole resistance of C. tropicalis. 25 Considering that this highly resistant species was identified in the current study, molecular investigation of the mechanism(s) of resistance is warranted in future studies.…”

“…Although, C. guilliermondii is reported as the most common species isolated from candidaemia patients in some countries and the majority of C. guilliermondii fungaemia cases are described in adults with cancer, this yeast has been a rare cause of candidaemia in adult and paediatric patients in Iran to date . In line with the findings of the current study, that is high susceptibility of C. guilliermondii to amphotericin B (0.125‐0.25 μg/mL) and high fluconazole MIC (1‐4 μg/mL), numerous studies have demonstrated a high azole MIC for this yeast …”

Nanopartículas lipídicas sólidas contendo óleo essencial de Melaleuca alternifolia Cheel como plataforma inovadora no tratamento da candidíase orofaríngea

“…Se não tratada adequadamente, tem potencial para se estender ao esôfago ou evoluir para uma infecção sistêmica (candidemia) (BENSADOUN et al, 2011;MATSUURA et al, 2015). A candidemia é uma condição de difícil diagnóstico e tratamento (MATSUURA et al, 2015;VECCHIARELLI et al, 2012;WILLE et al, 2013), constituindo uma importante causa de morbi-mortalidade em pacientes hospitalizados em todo o mundo (AHANGARKANI et al, 2019;KURAOKA et al, 2018;MOTTA et al, 2010;WILLE et al, 2013), além de gerar grandes custos para o sistema de saúde (FELIPE et al, 2018;WILLE et al, 2013).…”