OBJECTIVETo investigate the clinical features of invasive candidiasis in children and the risk factors for Candida bloodstream infection.

METHODSA retrospective study was performed on 134 children with invasive candidiasis and hospitalized in 5 tertiary hospitals in Urumqi, China, between January 2010 and December 2015. The Candida species distribution was investigated. The clinical data were compared between the patients with and without Candida bloodstream infection. The risk factors for Candida bloodstream infection were investigated using multivariate logistic regression analysis.

RESULTSA total of 134 Candida strains were isolated from 134 children with invasive candidiasis, and non-albicans Candida (NAC) accounted for 53.0%. The incidence of invasive candidiasis in the PICU and other pediatric wards were 41.8% and 48.5% respectively. Sixty-eight patients (50.7%) had Candida bloodstream infection, and 45 patients (33.6%) had Candida urinary tract infection. There were significant differences in age, rate of use of broad-spectrum antibiotics, and incidence rates of chronic renal insufficiency, heart failure, urinary catheterization, and NAC infection between the patients with and without Candida bloodstream infection (P<0.05). The multivariate logistic regression analysis showed that younger age (1-24 months) (OR=6.027) and NAC infection (OR=1.020) were the independent risk factors for Candida bloodstream infection.

CONCLUSIONSThe incidence of invasive candidiasis is similar between the PICU and other pediatric wards. NAC is the most common species of invasive candidiasis. Candida bloodstream infection is the most common invasive infection. Younger age (1-24 months) and NAC infection are the risk factors for Candida bloodstream infection.

Adolescent ; Age Factors ; Candidiasis ; drug therapy ; microbiology ; Child ; Child, Preschool ; Female ; Fungemia ; etiology ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Male ; Retrospective Studies ; Risk Factors

Rhodotorula species are round to oval-shaped, multilateral budding, encapsulated yeasts that produce urease and do not ferment carbohydrates. Rhodotorula species form characteristic salmon-pink colored colonies owing to carotenoid pigment production. These yeasts form a part of the normal flora of moist skin and are found in the environment. Rhodotorula was traditionally considered a contaminant but is now progressively recognized as a human pathogen, especially in immunocompromised patients with central venous catheters. However, isolation of Rhodotorula species from blood has been very rarely reported in Korea. We report a case of sepsis due to Rhodotorula mucilaginosa infection in a patient who had received chemotherapy and supportive care for non-small cell lung cancer.
Carbohydrates ; Carcinoma, Non-Small-Cell Lung* ; Central Venous Catheters ; Drug Therapy ; Fungemia ; Humans ; Immunocompromised Host ; Korea ; Rhodotorula* ; Sepsis* ; Skin ; Urease ; Yeasts

BACKGROUND/AIMS: The increasing incidence of Candida glabrata and Candida krusei infections is a significant problem because they are generally more resistant to fluconazole. We compared the risk factors associated with C. glabrata and C. krusei fungemia with Candida albicans fungemia and examined the clinical manifestations and prognostic factors associated with candidemia. METHODS: We retrospectively reviewed demographic data, risk factors, clinical manifestations, and outcomes associated with C. glabrata and C. krusei fungemia at a tertiary-care teaching hospital during a 10-years period from 1997 to 2006. RESULTS: During the study period, there were 497 fungemia episodes. C. glabrata fungemia accounted for 23 episodes and C. krusei fungemia accounted for 8. Complete medical records were available for 27 of these episodes and form the basis of this study. Compared to 54 episodes of C. albicans fungemia, renal insufficiency and prior fluconazole prophylaxis were associated with development of C. glabrata or C. krusei fungemia. The overall mortality was 67%. The fungemia-related mortality of C. glabrata and C. krusei was higher than that of C. albicans (52 vs. 26%, p=0.021). Empirical antifungal therapy did not decrease the crude mortality. Multiple logistic regression analysis showed that high APACHE II scores, catheter maintenance, and shock were independently associated with an increased risk of death. CONCLUSIONS: Renal insufficiency and prior fluconazole prophylaxis were associated with the development of C. glabrata or C. krusei fungemia. Fungemia-related mortality of C. glabrata or C. krusei was higher than that of C. albicans. Outcomes appeared to be related to catheter removal, APACHE II scores, and shock.
APACHE ; Adult ; Aged ; *Candida glabrata ; Candidiasis/drug therapy/epidemiology/*etiology ; Female ; Fluconazole/therapeutic use ; Fungemia/drug therapy/epidemiology/*etiology ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

INTRODUCTIONFungaemia carries with it high mortality rates and appropriate as well as timely antifungal therapy has been shown to be life saving.

MATERIALS AND METHODSWe studied the invitro activities of antifungal agents using the Etest method, against 100 Candida isolates from blood cultures, 10 Cryptococcus isolates from blood or cerebrospinal fluid and 50 mould isolates from various clinically significant sites of patients in Singapore General Hospital, from June 2004 to December 2006.

RESULTSOverall, the yeasts appeared to have low minimum inhibitory concentrations (MICs) for all the 5 antifungal drugs tested except for fluconazole. The overall high MIC90 values of the moulds against the azoles were largely attributed to the non-Aspergillus moulds. Posaconazole, itraconazole, voriconazole and caspofungin appear effective against local strains of Aspergillus species, although there are no interpretive breakpoints.

CONCLUSIONSThe results show that the local fungal strains studied appear to be susceptible to the usual antifungal drugs recommended in the literature.

Antifungal Agents ; pharmacology ; therapeutic use ; Candida ; drug effects ; isolation & purification ; Candidiasis ; microbiology ; Cryptococcosis ; microbiology ; Cryptococcus ; drug effects ; isolation & purification ; Fungemia ; drug therapy ; microbiology ; Fungi ; drug effects ; Hospitals, Public ; Humans ; Microbial Sensitivity Tests ; methods ; Reproducibility of Results ; Singapore ; Yeasts ; drug effects

INTRODUCTIONWorldwide, Candida albicans is the most common Candida species implicated in bloodstream infections. However, the proportion of non-albicans bloodstream infections is increasing. Fluconazole resistance is known to be more common in non-albicans species, but is also reported in C. albicans. This retrospective study was performed to determine the species epidemiology of Candida bloodstream infections in Singapore hospitals, and to perform susceptibility testing to a range of antifungal drugs.

MATERIALS AND METHODSCandida spp. isolated from bloodstream infections from October 2004 to December 2006 were collected from 3 participating hospitals: a tertiary referral hospital (Singapore General Hospital), a secondary referral hospital (Changi General Hospital) and an obstetrics/paediatric hospital [KK Women's and Children's Hospital (KKWCH)]. Isolate collection was also retrospectively extended to January 2000 for KKWCH because of the limited number of cases from this hospital. Isolates were identified by a common protocol, and antifungal susceptibility testing was performed by microbroth dilution (Sensititre One, Trek Diagnostics, United Kingdom).

RESULTSThe most common isolates were C. albicans (37%), C. tropicalis (27%) and C. glabrata (16%). There were differences in species distribution between institutions, with C. parapsilosis and C. albicans predominant in KKWCH, and C. albicans and C. tropicalis predominant in the other 2 institutions. Fluconazole resistance was detected in 3.2% of all Candida spp., and 85.3% were classified as susceptible. All C. albicans and C. parapsilosis were susceptible to fluconazole and voriconazole, while susceptibility to fluconazole was much more variable for C. glabrata and C. krusei.

CONCLUSIONThis study shows that C. albicans remains the predominant Candida species isolated from bloodstream infections in the 3 participating hospitals. However, non-albicans species accounted for nearly two-thirds of all cases of candidaemia. Resistance to fluconazole was uncommon, and was generally confined to C. krusei and C. glabrata.

Antifungal Agents ; pharmacology ; Candida ; classification ; drug effects ; isolation & purification ; Candidiasis ; drug therapy ; epidemiology ; microbiology ; Cross Infection ; epidemiology ; microbiology ; Drug Resistance, Fungal ; drug effects ; Female ; Fungemia ; epidemiology ; microbiology ; Hospitals, University ; Humans ; Microbial Sensitivity Tests ; Retrospective Studies ; Singapore ; epidemiology

Scedosporium prolificans is a saprophytic fungus widespread in the environment. It has become an emerging pathogen in recent years causing disseminated infections, especially in profoundly neutropenic immunocompromised patients. We report a case of fatal Scedosporium fungemia in a 45 year old female with acute myeloid leukemia in relapse. She received salvage chemotherapy and antibiotic treatment, and was neutropenic with relapsing fever. S. prolificans was isolated repeatedly from the aerobic bottles on the second day of two successive blood cultures. Amphotercin B was started; however, the patient expired the next day.
Drug Therapy ; Female ; Fungemia* ; Fungi ; Humans ; Immunocompromised Host ; Leukemia, Myeloid, Acute* ; Middle Aged ; Recurrence ; Relapsing Fever ; Scedosporium*

A 63-year-old female with candidemia following necrotizing pancreatitis developed clinical signs of chorioretinitis and underwent the systemic administration of voriconazole, after which anterior chamber inflammation and multiple, white, fluffy, chorioretinal lesions, under 1mm in diameter, were gradually resolved and visual acuity improved. We report the first Korean case of candida chorioretinitis successfully treated with the systemic administration of voriconazole.
Antifungal Agents/*therapeutic use ; Candidiasis/*drug therapy/microbiology ; Chorioretinitis/*drug therapy/microbiology ; Eye Infections, Fungal/*drug therapy/microbiology ; Female ; Fungemia/drug therapy ; Humans ; Middle Aged ; Pyrimidines/*therapeutic use ; Triazoles/*therapeutic use

Trichosporon beigelii is a causative agent of white piedra, an superficial hair shaft infection in immunocompetent individuals, and rarely of disseminated trichosporonosis in immunocompromised patients especially in neutropenic patients with leukemia. Trichosporon infections in immunocompromised patients are frequently fatal despite therapy with amphotericin B. We describe an acute myelogenous leukemia patient with T. beigelii fungemia after remission induction chemotherapy who was successfully treated with amphotericin B and fluconazole.
Amphotericin B* ; Drug Therapy ; Fluconazole* ; Fungemia* ; Hair ; Humans ; Immunocompromised Host ; Leukemia ; Leukemia, Myeloid, Acute* ; Neutropenia ; Piedra ; Remission Induction ; Trichosporon* ; Trichosporonosis

A particular strain of Saccharomyces cerevisiae, Hansen CBS 5926 (syn. S. boulardii), is commonly used as biotherapeutic agent for the prevention and treatment of antibiotic associated diarrhea. Recently, cases of fungemia with S. cerevisiae have increased especially in immunosuppressed or critically ill patients treated with S. boulardii. And S. boulardii administered can simply pass into stool and be isolated as S. cerevisiae. In cases of S. cerevisiae isolated from clinical specimens, it should be required to confirm the relatedness with administration of biotherapeutic agent composed of S. boulardii. A 61-year-old woman who had persistent urinary tract infection by C. tropicalis, developed absolute neutopenia, fever and watery diarrhea and treated with Bioflor composed of S. boulardii, amikacin, ceftriaxone, metronidazole and fluconazole during 3rd chemotherapy against bladder cancer with liver metastasis. On KOH smear of stool specimen, yeasts were observed and the yeasts were identified as S. cerevisiae. She was diagnosed as fungal enterocolitis and sepsis and treated with amphotericin B, but considering her clinical course, S. cerevisiae was presumed not to be a pathogen, but to be a simple passage of S. boulardii administered from intestine. We report a case of S. cerevisiae isolated from stool specimen of a patient administered Bioflor with literatures review.
Amikacin ; Amphotericin B ; Ceftriaxone ; Critical Illness ; Diarrhea ; Drug Therapy ; Enterocolitis ; Female ; Fever ; Fluconazole ; Fungemia ; Humans ; Intestines ; Liver ; Metronidazole ; Middle Aged ; Neoplasm Metastasis ; Saccharomyces cerevisiae* ; Saccharomyces* ; Sepsis ; Urinary Bladder Neoplasms ; Urinary Tract Infections ; Yeasts*

Pichia ohmeri is an yeast-like fungus used in the food industry for fermentation. This organism has been implicated in human disease only in a few case reports. We describe herewith two cases of Pichia ohmeri fungemia in immunocompromised pediatric patients with central venous catheters. A 7-year-old patient with Burkitt's lymphoma undergoing chemotherapy and a newborn with low birth weight developed fungemia during hospitalizations. Both patients were receiving parenteral nutrition through central venous catheters. Both patients succumbed despite empiric treatment with amphotericin B in Case 1. A brief review of the literature ensues with the case reports.
Amphotericin B ; Burkitt Lymphoma ; Central Venous Catheters ; Child ; Drug Therapy ; Fermentation ; Food Industry ; Fungemia* ; Fungi ; Hospitalization ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Parenteral Nutrition ; Pichia*