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Pediatric Candidemia in the Indian Subcontinent, and in Parts of the Middle East, Africa, and South America

Candidemia is defined as the isolation of Candida species from at least one blood culture with the presence of symptoms of sepsis. It is the main cause of fungal nosocomial bloodstream infections with its resultant mortality in children ranging from 5% to 71% and sometimes over 80%. A thorough search of the literature in Google, PubMed, Med Facts, using different sets of keywords, viz. candidemia, bloodstream Candida infections, neonates, children, and developing countries showed that candidemia in neonates and children is caused by a variety of species, viz. Candida albicans, C. auris, C. famata, C. glabrata, C. guilliermondii, C. krusei, C. ortholopsis, C. parapsilosis, and C. tropicalis. The predominant etiological agents vary in different countries. Risk factors in most of the reports included prematurity, mechanical ventilation, prolonged use of antibiotic and steroid urinary catheter, hH 2 blockers, neutropenia, leukemia, and malnourishment. The underlying diseases included sepsis, pyogenic meningitis, encephalitis, pneumonia, acute reparatory distress syndrome, chronic liver disease, and kidney disease, etc. A noteworthy observation in the literature is that several investigators employed MALD-TOFE, PCR, and molecular methods including DNA sequencing in addition to the study of phenotypic features for the characterization of Candida species. Antifungal therapy in most studies used liposomal amphotericin B, caspofungin, azoles, or combination therapies The epidemiology of pediatric candidemia varies in different countries. Surveillance of candidaemia in different regions is necessary, especially in neonates and children. Rapid and precise detection of Candida species isolated from the bloodstream by polymerase chain reaction, restriction fragment length polymorphism technique can help in better management of candidemia. The strategies for the prevention of candidemia include improved hand hygiene, optimal catheter placement and care, and prudent hygiene. Prophylactic antifungal therapy is recommended for patients who have not yet been diagnosed with candidemia but are at a high risk of acquiring Candida infections.