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Pichia fabianii blood infection in a premature infant in China: case report
1Department of Hospital Acquired Infection Control and Prevention, National, Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China.
Background:
Invasive fungal infections caused by uncommon fungi have increased in recent years. Hospitalized low-birth-weight infants are at high risk for neonatal fungal infections. Pichia fabianii is a rare pathogen causing blood infection, which has reportedly caused only 4 cases of fungemia and 1 case of endocarditis worldwide. Here, we describe the first case of a P. fabianii blood infection in a premature infant in China.
Case Presentation:
On July 28th, a low-birth-weight (LBW, 1760 g) female infant born at 33+4 weeks of gestation was admitted to the pediatric intensive care unit with mild neonatal asphyxia. Until August 2nd, a mechanical respirator was used to assist respiration under the Continuous Positive Airway Pressure (CPAP) model. The baby had an increased body temperature and a fever. To prevent infection, Ceftriaxone Sodium (CS) was administered intravenously for three days, after which Cefepime was administered until August 13th. Chest X-rays showed suspected plaque-like shadows in the right lung. Blood cultures twice tested positive for fungal infection caused by Candida pelliculosa (recognized as Pichia fabianii later), which is first mis-identified by commercial kit. Hence, intravenous fluconazole was administered. However, cultures of other body fluids (e.g., urine, feces and sputum) tested negative for fungal infection. Routine tests and biochemistry of cerebrospinal fluid (CSF) were normal. Latex agglutination of Cryptococcus neoformans and fungi cultures in the CSF were also negative. After 14 days of intravenous fluconazole, blood was re-cultured, the result of which was negative. On August 30th, intravenous fluconazole was suspended. On Sep 3rd, the infant left the hospital in good health.
Conclusions:
This is the first case of a blood infection caused by P. fabianii in a LBW premature female infant in China. Risk factors for fungal infection include premature birth, as well as mechanical invasive operation and antibacterial drug usage. Whether such risk factors necessitate prophylactic use of antifungal drugs is an important question that has yet to be fully addressed. Additionally, the pathogen P. fabianii collected in this study was resistant to amphotericin B (AMB) and itraconazole (ITR). With the exception of the azole-resistant endocarditis case, all other cases have not demonstrated such a resistance. Finally, commercial biochemical methods used in routine practice are limited in their ability to identify P. fabianii. Molecular genetic based methods are imperative for identification of uncommon fungal species from disseminated infections.
Insights
This study reports the first case of Pichia fabianii blood infection in a premature infant in China. The rare fungal pathogen P. fabianii showed resistance to common antifungals, highlighting diagnostic challenges.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Neonatal Care
Background:
- Invasive fungal infections (IFIs) are increasing, particularly in vulnerable hospitalized low-birth-weight (LBW) infants.
- Pichia fabianii is a rare fungal pathogen, with limited documented cases of fungemia and endocarditis globally.
- This case represents the first documented P. fabianii bloodstream infection in a premature infant in China.
Observation:
- A LBW premature infant (33+4 weeks gestation) developed a bloodstream infection initially misidentified by a commercial kit.
- The infant received broad-spectrum antibiotics and respiratory support via mechanical ventilation (Continuous Positive Airway Pressure model).
- Blood cultures confirmed Pichia fabianii infection, with negative results in other bodily fluids and cerebrospinal fluid.
Findings:
- Pichia fabianii was identified as the causative agent of fungemia in this premature infant.
- The isolated P. fabianii strain exhibited resistance to amphotericin B and itraconazole.
- Standard commercial identification methods were insufficient for accurate P. fabianii diagnosis.
Implications:
- Premature birth, invasive procedures, and antibiotic use are significant risk factors for IFIs in neonates.
- The need for prophylactic antifungal treatment in high-risk neonates warrants further investigation.
- Advanced molecular methods are crucial for accurate identification of uncommon fungal pathogens like P. fabianii in clinical settings.
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