Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries

Abstract

Candidemia, the commonest invasive fungal infection, is associated with high morbidity and mortality in developing countries, though the exact prevalence is not known due to lack of systematic epidemiological data from those countries. The limited studies report a very high incidence of candidemia and unique epidemiology with a different spectrum of Candida species. The recent global emergence of multi-drug resistant Candida auris is looming large as an important threat in hospitalized patients of developing countries. While managing candidemia cases in those countries several challenges are faced, which include poor infrastructure; compromised healthcare and infection control practices; misuse and overuse of antibiotics and steroids; lack of awareness in fungal infections; non-availability of advance diagnostic tests and antifungal drugs in many areas; poor compliance to antifungal therapy and stewardship program. Considering the above limitations, innovative strategies are required to reduce mortality due to candidemia in adults and neonates. In the present review, we have unraveled the challenges of candidemia faced by low resource countries and propose a ten part strategy to reduce mortality due candidemia.

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

“…However, similar to other studies, we here observed that C. albicans was the predominant Candida species responsible for candidaemia, and the incidence of candidaemia associated with C albicans vs that associated with non-albicans Candida species was almost the same (49% vs 51%, respectively). 7,13,14,22 In the current study, we observed signifi- Candida tropicalis was the third most frequent causal agent of candidaemia, responsible for 18.18% mortality in patients examined in this study. 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.…”

“…However, several factors (e.g., patient characteristics like age, type of infecting Candida species, handling centre, antifungal resistance, and healthcare workers and facility) may also influence the clinical outcome. 12,13 Notwithstanding, the reported worldwide rate of candidaemia varies depending on where the study is conducted. Although half of the global candidaemia cases have been reported in Asia, followed by the Americas, Europe and Africa, 13 in developing countries such as Iran, the exact rate of candidaemia is underestimated.…”

“…12,13 Notwithstanding, the reported worldwide rate of candidaemia varies depending on where the study is conducted. Although half of the global candidaemia cases have been reported in Asia, followed by the Americas, Europe and Africa, 13 in developing countries such as Iran, the exact rate of candidaemia is underestimated. This might be because of the difficulty and delay in diagnosis, which leads to prolonged hospitalisation and financial burden on the healthcare system.…”

Mechanisms of Pathogenic Candida Species to Evade the Host Complement Attack

“…In Asian countries, higher mortality rates are associated with NAC species (Ma et al, 2013;Pinhati et al, 2016). In general, cases of candidemia increased nearly 5fold in the last 10 years, with the highest increase of 4-15-fold recorded in developing countries in which recurrent episodes were frequent (Kaur and Chakrabarti, 2017). Crude mortality rates among patients with invasive candidiasis or candidemia generally range between 40 to 60%, depending on the underlining conditions (Wu et al, 2017).…”

“…Crude mortality rates among patients with invasive candidiasis or candidemia generally range between 40 to 60%, depending on the underlining conditions (Wu et al, 2017). Increasing incidences of candidemia have occurred in pediatric ICUs, particularly in developing countries in which there are limited resources, a dearth of advanced diagnostics, high patient loads, and a potential limited awareness about fungal diseases (Kaur and Chakrabarti, 2017). Given that Candida infections contribute to a relatively high morbidity and mortality, especially among patients admitted to ICUs, much attention has been paid on understanding the basics of their pathobiology, virulence factors, predisposing conditions along with the immune responses of both healthy and immune compromised individuals.…”