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Publications

Journal Article Systematic Review Ppublish

PubMed: 40550072 DOI: 10.1097/MD.0000000000042921

Characterizing neonatal community-acquired invasive fungal infections: Clinical profiles, pathogens, and underlying conditions.

Medicine (Baltimore) 104(25):e42921

Authors: Chunfang Gao, Li Wang, Lingkong Zeng, Xuwei Tao

Affiliations

  • Department of Neonatology, Wuhan Children's Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.

Abstract

OBJECTIVE

To characterize the clinical presentation and diagnostic indicators of neonatal community-acquired invasive fungal infections and establish a systematic approach for early identification and management.

METHODS

This study retrospectively reviewed the medical records of neonates discharged from the neonatal department between 1/1/2019 and 1/12/2023. Cases were identified based on the primary or first diagnosis using the International Classification of Diseases, 9th Revision codes. A total of 6 patients were included and comprehensive clinical data were analyzed. A systematic literature review (PubMed/Embase, 2000-2023) was conducted to contextualize findings.

RESULTS

6 neonates, including 5 boys, weighed 2700 to 4480 g, hospitalized at the age of 15 to 26 days. Key findings included: Patients had nonspecific respiratory symptoms, such as cough, tachypnea, and fever; the auxiliary examination showed positive β-ᴅ-glucan (cases 1, 4, 5) and galactomannan test (cases 2, 3, 4), and all cases had elevated CD4+/CD8 + ratio; multifocal consolidations (cases 2, 3) with halo sign evolution on serial imaging; pathogen spectrum were: Aspergillus flavus (3/6), Candida spp. (2/6), Lichtheimia corymbifera (1/6); antifungal treatments achieved clinical resolution in all cases (median duration 24 days), with sustained remission at 3-month follow-up; underlying immunometabolic disorders identified post-diagnosis in 83% (5/6) cases, including chronic granulomatous disease, lupus syndrome, and methylmalonic acidemia.

CONCLUSION

Neonatal community-acquired invasive fungal infections represents a critical diagnostic challenge requiring for its low incidence and nonspecific clinical features. Diagnosis mainly based on the fungi-culture. Appropriate use of antifungi medication can lead to a better outcome. Moreover, suspicion of the latent diseases which can cause immune and metabolic dysfunction would be benefit for improving prognosis.

MeSH

Infant, Newborn, Mycoses, Fungi, Diagnosis, Invasive Fungal Infections, Infections