Fungal neonatal and infantile sepsis in Egypt: Risk factors and identification of fungal isolates

Background: Invasive fungal diseases (IFDs) are opportunistic infections associated with significant mortality in paediatric patients, especially in those with compromised immune system and neonates with very low birth weight (VLBW). The objectives of this study are to determine the prevalence, clinical features and fungi isolates of neonatal sepsis in three hospitals in Egypt. Methodology: The study is a cross sectional survey of 176 neonates with clinical sepsis admitted to the neonatal intensive care units (NICU) of the three hospitals over a period of one year (February 2015 to January 2016). A minimum of two blood samples (collected within 24 hours) from each neonate were cultured for bacteria in automated BacT/AlerT and conventional culture bottles, while Saboraud-Brain Heart Infusion broth was inoculated for fungi culture. Positive growths from the broth were sub-cultured on Sabouraud Dextrose Agar (SDA) plates for aerobic incubation at 25oC and 37oC for 2 weeks. Identification of fungi colonies on SDA was by conventional morphology and confirmation on chromogenic agar media. Phylogenetic analysis of representative fungi isolates was done by partial nucleotide sequencing of D1-D2 domain of the large subunit rRNA gene. Results: Of the 176 neonates, blood culture was positive for pathogens in 55 (31.3 %) samples and fungi were isolated in 26 (14.8 %); yeast (25) and mould (1). The commonly isolated yeasts were Candida albicans, Candida tropicalis, and Candida krusei representing 34.6%, 30.8% and 23.1%, respectively of the total fungi isolated. The phylogenetic analysis in comparison to Genbank data showed defined clades for Candida tropicalis, Candida parapsilosis, Candida albicans and Pichia kudriavzevii Conclusion: This current study highlights the changing pattern of neonatal infections in Egypt caused by Candida, with increasing incidence of infections caused by non-albicans Candida species. Key words: fungal infection, neonatal, risk factors, PCR, yeas