Study on mucocutaneous candidiasis in infants: the clinical characteristics and in vitro susceptibility of pathogenic yeasts

Abstract

Abstract:

Objective To analyze and investigate the clinical characteristics of mucocutaneous candidiasis in infants, and to determine in vitro antifungal susceptibility of pathogenic yeasts. Method 105 patients with clinical and mycological diagnosis of mucocutaneous candidiasis, aged from 0~3 years old, were enrolled. Meanwhile, the questionnaires of related data from patients were collected and analyzed. The strains were identified by CHROMagar medium and API20AU test card. Antifungal susceptibility testing was performed according to CLSI documents M27-A3, using 5 drugs including miconazole, econazole, ketoconazole, bifonazole and terbinafine. Results The subjects were between 0.4 and 36 months old (average age, 10.67 months old), and most of them were within one year old (75%). Skin lesions were mainly found in the diaper area, followed by neck and armpit. 189 strains were isolated from those patients; 81.5% were C.albicans, 10.6% were C.parapsilosis, 3.2% were C.glabrata. Miconazole and ketoconazole showed the lowest MIC₉₀ (0.25 μg/mL) against C.albicans. The MIC₉₀ of Ketoconazole and econazole among all strains including non-albicans Candida were 0.25 μg/mL and 2 μg/mL respectively. Bifonazole and terbinafine showed the highest MIC₉₀ (16 μg/mL) against C.albicans, and the MIC₉₀ among non-albicans Candida were 8 μg/mL and 16 μg/mL respectively. Conclusion Mucocutaneous candidiasis was more frequent in infants within one year old. The lesions mainly located in the warm and humid areas such as the diaper area, neck and armpit. C.albicans was still the predominant species of mucocutaneous candidiasis in infants, while C.parapsilosis was the main species in non-albicans Candida. Miconazole and ketoconazole, especially ketoconazole, were better external drug s for the treatment of mucocutaneous candidiasis in infants.

Key words: infants, mucocutaneous candidiasis, clinical characteristics, in vitro susceptibility test, antifungal drugs

CLC Number:

R519.3

KAN Si-yue, CAI Qing, JING Yun, CHEN Wei, HU Su-quan, YANG Lian-juan, LIU Wei-da. Study on mucocutaneous candidiasis in infants: the clinical characteristics and in vitro susceptibility of pathogenic yeasts[J]. Chinese Journal of Mycology, 2020, 15(2): 97-100.

References

[1] 赵辩. 中国临床皮肤病学[M].第4版.南京:江苏科学技术出版社,2010:575.
[2] CLSI. Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard; CLSI document M27-A3[S]. 2008.
[3] 董兴军.婴幼儿皮肤念珠菌病254例临床研究[J].中国麻风皮肤病杂志,2016,32(9):558-559.
[4] Nikolovski J, Stamatas GN, Kollias N, et al. Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life[J]. J Invest Dermatol, 2008, 128(7):1728-1736.
[5] Kalia YN, Nonato LB, Lund CH, et al. Development of skin barrier function in premature infants[J]. J Invest Dermatol, 1998, 111(2):320-326.
[6] Bhai N,Tendolkar U, Baradkar V, et al. Paediatric oropharyngeal and cutaneous candidiasis with special reference to Candida dubliniensis[J]. J Med Microbiol, 2014, 63(Pt4):518-521.
[7] Honig PJ, Gribetz B, Leyden JJ, et al. Amoxicillin and diaper dermatitis[J]. J Am Acad Dermatol, 1988, 19(2):275-279.
[8] Swanson JR, Gurka MJ, Kaufman DA. Risk factors for invasive fungal infection in premature infants:enhancing a targeted prevention approach[J]. J Pediatric Infect Dis Soc, 2014, 3(1):49-56.
[9] 马黎民,周平.1298例儿童皮肤念珠菌病的临床分析[J].中国真菌学杂志, 2009, 4(1):31-32.
[10] Bendel CM. Colonization and epithelial adhesion in the pathogenesis of neonatal candidiasis[J]. Semin Perinatol, 2003, 27(5):357-364.
[11] Arsenault AB, Bliss JM. Neonatal candidiasis:new insights into an old problem at a unique host-pathogen interface[J]. Curr Fungal Infect Rep, 2015, 9(4):246.
[12] Rangel-Frausto MS, Wiblin T, Blumberg HM, et al. National epidemiology of mycoses survey (NEMIS):Variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units[J]. Clin Infect Dis, 1999, 29(2):253-258.
[13] Abastabar M, Shokohi T, Kord RR, et al. In vitro activity of econazole in comparison with three common antifungal agents against clinical Candida strains isolated from superficial infections[J]. Curr Med Mycol, 2015, 1(4):7-12.
[14] Koga H, Tsuji Y, Inoue K, et al. In vitro antifungal activity of luliconazole against clinical isolates from patients with dermatomycoses[J]. J Infect Chemother, 2006, 12(3):163-165.
[15] Yenisehirli G, Bulut N, Yenisehirli A, et al. In Vitro susceptibilities of Candida albicans isolates to antifungal agents in Tokat, Turkey[J]. Jundishapur J Microbiol, 2015, 8(9):156-158.