Candidiasis caused by Candida kefyr in a neonate: Case report

BMC Infectious Diseases

Tobias Tenenbaum¹  Horst Schroten¹  Anna Kristina Kilian³  Annebärbel Dietz⁴  Gernot Geginat⁴  Katrin Zahn⁵  Konrad Reinshagen⁵  Stefan Weichert² 

[1] Pediatric Infectious Diseases, University Children's Hospital Mannheim of Heidelberg University, Mannheim, Germany;Pediatric Infectious Diseases, University Children's Hospital Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;Department of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim of Heidelberg University, Mannheim, Germany;Institute for Medical Microbiology and Hygiene, University Hospital Mannheim of Heidelberg University, Mannheim, Germany;Department of Pediatric Surgery, University Hospital Mannheim of Heidelberg University, Mannheim, Germany

关键词: Urinary tract infection;    Non-albicans Candida species;    Candidiasis;    Children;   

Others  :  1175429
DOI  :  10.1186/1471-2334-12-61

 received in 2011-09-04, accepted in 2012-03-18,  发布年份 2012

【 摘 要 】

Background

Systemic Candidia infections are of major concern in neonates, especially in those with risk factors such as longer use of broad spectrum antibiotics. Recent studies showed that also term babies with underlying gastrointestinal or urinary tract abnormalities are much more prone to systemic Candida infection. We report a very rare case of candidiasis caused by Candida kefyr in a term neonate.

Case Presentation

Renal agenesis on the left side was diagnosed antenatally and anal atresia postnatally. Moreover, a vesico-ureteral-reflux (VUR) grade V was detected by cystography. The first surgical procedure, creating a protective colostoma, was uneventful. Afterwards our patient developed urosepsis caused by Enterococcus faecalis and was treated with piperacillin. The child improved initially, but deteriorated again. A further urine analysis revealed Candida kefyr in a significant number. As antibiotic resistance data about this non-albicans Candida species are limited, we started liposomal amphotericin B (AMB), but later changed to fluconazole after receiving the antibiogram. Candiduria persisted and abdominal imaging showed a Candida pyelonephritis. Since high grade reflux was prevalent we instilled AMB into the child's bladder as a therapeutic approach. While undergoing surgery (creating a neo-rectum) a recto-vesical fistula could be shown and subsequently was resected. The child recovered completely under systemic fluconazole therapy over 3 months.

Conclusions

Candidiasis is still of major concern in neonates with accompanying risk factors. As clinicians are confronted with an increasing number of non-albicans Candida species, knowledge about these pathogens and their sensitivities is of major importance.

【 授权许可】

   
2012 Weichert et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Zaoutis TE, Greves HM, Lautenbach E, Bilker WB, Coffin SE: Risk factors for disseminated candidiasis in children with candidemia. Pediatr Infect Dis J 2004, 23:635-641.
• [2]Manzoni P, Stolfi I, Pugni L, Decembrino L, Magnani C, Vetrano G, Tridapalli E, Corona G, Giovannozzi C, Farina D, Arisio R, Merletti F, Maule M, Mosca F, Pedicino R, Stronati M, Mostert M, Gomirato G: A multicenter, randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med 2007, 356:2483-2495.
• [3]Neu N, Malik M, Lunding A, Whittier S, Alba L, Kubin C, Saiman L: Epidemiology of candidemia at a Children's hospital, 2002 to 2006. Pediatr Infect Dis J 2009, 28:806-809.
• [4]Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Ellis D, Tullio V, Rodloff A, Fu W, Ling TA: Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-year analysis of susceptibilities of Candida Species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion. J Clin Microbiol 2010, 48:1366-1377.
• [5]White TJ, Bruns T, Lee S, Taylor JW: Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics. In PCR Protocols: A Guide to Methods and Applications. Edited by Innis MA, Gelfand DH, Sninsky JJ, White TJ. New York: Academic; 1990:315-322.
• [6]Tortorano AM, Peman J, Bernhardt H, Klingspor L, Kibbler CC, Faure O, Biraghi E, Canton E, Zimmermann K, Seaton S, Grillot R: Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microbiol Infect Dis 2004, 23:317-322.
• [7]Gomez-Lopez A, Pan D, Cuesta I, Alastruey-Izquierdo A, Rodriguez-Tudela JL, Cuenca-Estrella M: Molecular identification and susceptibility profile in vitro of the emerging pathogen Candida kefyr. Diagn Microbiol Infect Dis 2010, 66:116-119.
• [8]Pfaller MA, Diekema DJ, Messer SA, Boyken L, Hollis RJ, Jones RN: In vitro activities of voriconazole, posaconazole, and four licensed systemic antifungal agents against Candida species infrequently isolated from blood. J Clin Microbiol 2003, 41:78-83.
• [9]Borg-von Zepelin M, Kunz L, Rüchel R, Reichard U, Weig M, Gross U: Epidemiology and antifungal susceptibilities of Candida spp. to six antifungal agents: results from a surveillance study on fungaemia in Germany from July 2004 to August 2005. J Antimicrob Chemother 2007, 60:424-428.
• [10]Mirdha BR, Sethi S, Banerjee U: Prevalence of fungal species in patients with candiduria. Indian J Med Res 1998, 107:90-93.
• [11]Ostrosky-Zeichner L, Pappas PG: Invasive candidiasis in the intensive care unit. Crit Care Med 2006, 34:857-863.
• [12]Robinson JL, Davies HD, Barton M, O'Brien K, Simpson K, Asztalos E, Synnes A, Rubin E, Le Saux N, Hui C, Langley JM, Sauve R, de Repentigny L, Kovacs L, Tan B, Richardson SE: Characteristics and outcome of infants with candiduria in neonatal intensive care - a Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study. BMC Infect Dis 2009, 9:183. BioMed Central Full Text
• [13]Lundstrom T, Sobel J: Nosocomial candiduria: a review. Clin Infect Dis 2001, 32:1602-1607.
• [14]Olaechea PM, Palomar M, Leon-Gil C, Alvarez-Lerma F, Jordá R, Nolla-Salas J, León-Regidor MA, EPCAN Study Group: Economic impact of candida colonization and candida infection in the critically ill patient. Eur J Clin Microbiol Infect Dis 2004, 23:323-330.
• [15]Altuncu E, Bilgen H, Cerikçioğlu N, Ilki A, Ulger N, Bakır M, Akman I, Ozek E: Neonatal Candida infections and the antifungal susceptibilities of the related Candida species. Mikrobiyol Bul 2010, 44:593-603.
• [16]Rani R, Mohapatra NP, Mehta G, Randhawa VS: Changing trends of Candida species in neonatal septicaemia in a tertiary North Indian hospital. Indian J Med Microbiol 2002, 20:42-44.
• [17]Reuter CW, Morgan MA, Bange FC, Gunzer F, Eder M, Hertenstein B, Ganser A: Candida kefyr as an emerging pathogen causing nosocomial bloodstream infections in neutropenic leukemia patients. Clin Infect Dis 2005, 41:1365-1366.
• [18]Chopra T, Bhargava A, Kumar S, Chopra A, Dhar S, Afonso L, Sobel JD: Candida kefyr endocarditis in a patient with hypertrophic obstructive cardiomyopathy. Am J Med Sci 2010, 339:188-189.
• [19]Direkze S, Mansour M, Rodriguez-Justo M, Kibbler C, Gant V, Peggs KS: Candida kefyr fungal enteritis following autologous BMT. Bone Marrow Transplantation 2011. doi:10.1038/bmt.2011.112
• [20]Sendid B, Lacroix C, Bougnoux ME: Is Candida kefyr an emerging pathogen in patients with oncohematological diseases? Clin Infect Dis 2006, 43:666-667.
• [21]Valderrama MJ, de Silóniz MI, Gonzalo P, Peinado JM: A differential medium for the isolation of Kluyveromyces marxianus and Kluyveromyces lactis from dairy products. J Food Prot 1999, 62:189-193.