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Candidiasis in Pediatrics; Identification and In vitro Antifungal Susceptibility of the Clinical Isolates
1;
Background:
Candida species are normal microflora of oral cavity, vagina, and gastrointestinal tract. They are the third most prevalent cause of pediatric health care-associated bloodstream fungal infection. This study aimed to provide an epidemiological feature of candidiasis and also presents an antifungal susceptibility profile of clinical Candida isolates among children.
Materials And Methods:
During July 2013 to February 2015, 105 patients from different hospitals of Isfahan, Iran, were examined for candidiasis by phenotypic tests. Samples were obtained from nail clippings, blood, thrush, BAL, urine, oropharynx, skin, and eye discharge. The age range of patients was between 18 days to 16 years. Genomic DNA of isolates was extracted and ITS1-5.8SrDNA-ITS2 region was amplified by ITS1 and ITS2 primers. The PCR products were digested using the restriction enzyme MspI. Minimum inhibitory concentration (MICs) was determined using microdilution broth method according to the clinical and laboratory standards institute (CLSI) M27-A3 and M27-S4 documents.
Results:
Forty-three patients (40.9%) had Candida infection.The most clinical strains were isolated from nail infections (39.5%), and candidemia (13.9%). Candida albicans was the most prevalent species (46.5%). MICs ranges for amphotericin B, fluconazole, and itraconazole were (0.025-0.75 µg/ml), (0.125-16 µg/ml), and (0.094-2 µg/ml), respectively.
Conclusion:
Due to high incidence of Candida infections among children, increasing of fatal infection like candidemia, and emersion of antifungal resistance Candida isolates, early and precise identification of the Candida species and determination of antifungal susceptibility patterns of clinical isolates may lead to better management of the infection.
Insights
This study investigated pediatric candidiasis in Iran, finding Candida infections in 40.9% of children. Early identification and antifungal susceptibility testing are crucial for managing these common fungal infections.
Area of Science:
- Medical Mycology
- Pediatric Infectious Diseases
- Clinical Microbiology
Background:
- Candida species are common microflora but can cause serious infections in children.
- Pediatric candidiasis, including candidemia, is a significant healthcare-associated fungal infection.
- Antifungal resistance in Candida isolates is an emerging concern.
Purpose of the Study:
- To determine the epidemiological features of candidiasis in children.
- To profile the antifungal susceptibility of clinical Candida isolates from pediatric patients.
- To inform early and precise diagnosis and management strategies.
Main Methods:
- Phenotypic testing and molecular identification (ITS region sequencing) of Candida isolates from various sample types.
- Analysis of 105 pediatric patients (18 days to 16 years) from July 2013 to February 2015.
- Minimum Inhibitory Concentration (MIC) determination for amphotericin B, fluconazole, and itraconazole using CLSI guidelines.
Main Results:
- Candida infection was identified in 40.9% of pediatric patients.
- The most common clinical isolates were from nail infections (39.5%) and candidemia (13.9%).
- Candida albicans was the predominant species (46.5%), with observed MIC ranges for key antifungals.
Conclusions:
- High incidence of pediatric candidiasis necessitates prompt diagnosis.
- Candidemia and emerging antifungal resistance highlight the need for susceptibility testing.
- Accurate species identification and antifungal susceptibility data are vital for effective treatment of pediatric candidiasis.
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