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Disseminated nosocomial candidiasis in a pediatric intensive care unit
M Hiranandani1, S C Singhi, I Kaur
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh.
Insights
Nosocomial disseminated candidiasis occurred in 3% of pediatric intensive care patients. Early oral itraconazole effectively treated this fungal infection in children, showing good tolerance.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Nosocomial disseminated candidiasis is a serious fungal infection in critically ill children.
- Predisposing factors include broad-spectrum antibiotics, indwelling devices, and invasive monitoring.
Purpose of the Study:
- To report the incidence, clinical presentation, and treatment outcomes of nosocomial disseminated candidiasis in a pediatric intensive care unit (PICU).
Main Methods:
- Retrospective analysis of 6 cases of disseminated candidiasis over 9 months in a PICU.
- Diagnosis involved KOH wet mount, Gram stain, and Candida species isolation from body sites and blood cultures.
- Treatment with oral itraconazole (10 mg/kg/day) was administered.
Main Results:
- The incidence was 3% (6/200 children).
- Diagnosis was delayed (average 14 days PICU stay) with symptoms mimicking bacterial sepsis.
- All patients achieved mycological cure and symptom resolution within 6-14 days of itraconazole therapy, which was well tolerated.
Conclusions:
- Disseminated candidiasis should be suspected in critically ill children with nosocomial infections, especially those with worsening clinical status.
- Oral itraconazole is an effective and well-tolerated treatment for pediatric disseminated candidiasis.
Abstract:
Nosocomial disseminated candidiasis was diagnosed in 6 out of 200 (3%) children receiving pediatric intensive care over a period of 9 months. The ages of patients ranged between 20 days to 3 years; 4 were < 2 months. Therapy with broad spectrum antibiotics (in all), indwelling cannula (in all), peritoneal dialysis (in 3), low birth weight (in 3) and invasive hemodynamic monitoring were recognizable predisposing factors. The diagnosis was suspected on an average after 14 days, PICU stay (range 8-20 days). All the patients showed a secondary worsening after evidence of improvement from the primary illness. It was characterized by lethargy, fever (in 3), weight loss (in 3), loose stools (in 2) and respiratory distress (in 3), and was indistinguishable from any bacterial sepsis. Presumptive diagnosis was made on basis of KOH wet mount and Gram stained smear findings of mycelia, and was confirmed later on isolation of candida species from one or more body sites and blood culture. All the patients showed disappearance of symptoms and mycological cure within 6-14 days of oral itraconazole therapy, (10 mg/ kg/day in 2 divided doses). The therapy was continued for upto 14 days after sterile fungal blood culture, and was well tolerated. Fungal superinfection especially with candida must be looked for in hospitalized patients suspected of nosocomial infection. Early oral itraconazole is effective in disseminated candidiasis and well tolerated by children.