IJMST 2017 Volume 7 Issue 2

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Title:

Fungal infection in blood culture negative neonates, in NICU

Authors & Affiliation:

Mona Mohiy Eldeen, MD; Amal mohamed Sayed, MD; and Dalia Kadry Ismaiel, MD

Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, EGYPT

imaging70@gmail.com, mmohiedden@yahoo.com, hoelwan@gmail.com

Abstract:

Candida has been become an increasingly important in neonates hospitalized in neonatal intensive care unites(NICUs). Candida species are recognized as leading pathogens in the neonatal intensive care unit (NICU) for infections occurring after the third day of life This was a prospective study included 79 out of 1742 (4.5%) Septicemic neonates admitted to Neonatal Intensive Care Unit - Cairo university specialized pediatric hospital (CUSPH), during the period from August 2009 to August 2010 and having an evidence of sepsis. In this approach we performed amplification of a sequence of Candida most commonly involved in human infection, by employing universal fungal primers, followed by species specific primer for C.albicans being the most clinically important species, and we compared our method with the conventional diagnostic and identification methods for early detection of candidemia. They participant were broadly divided into two groups.

(i) Candidemic patients (n _ 73): They had at least two positive Candida blood cultures. (ii) Patients with suspected candidemia, (n _ 6); they were admitted to the neonatal intensive care unit for more than 1 week., all patients of this group were tested two to three times by blood culture and were always negative, they were treated with broad spectrum antibiotics for a minimum of 1 week and developed fever inspite of prolonged antibiotic therapy suggesting Candida infection.

In addition, 10 apparently healthy individuals with no complaints of Candida infection were included as controls.

The comparative results of blood culture and the PCR for the detection of candida spp. showed that among the 79 blood broth specimens; 73 cases (92%) were blood culture positive for candida, while 75 (95%) were positive by PCR using blood broth specimens, with two more cases positive for candida despite being repeatedly culture negative. Among 79 blood broth specimens, 9 cases(11%) were positive by Germ-tube test versus 43 cases (54%) positive by PCR for C.albicans.

Among 27 whole EDTA blood specimens 6cases(22%) were positive by Germ-tube test versus 19 cases (70%) were positive by PCR using C.albicans specific primers . Amplification of the product of the PCR with species-specific primers corresponding to the ITS2 sequences from

C. albicans resulted in specific amplification of single DNA products of the expected sizes .

Key words: NICU, Vertical transmission, Candida, Antifungal, PCR, candidemia, EDTA-blood specimens