الفهرس 
Review of Literatureيوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Summary
-Nowadays opportunistic fungal infections are a common problem in neonatal intensive care units (NICUs). It appeared to have increased over the past few decades, because there has been an increase in children with primary or secondary immune deficiencies.
-Candida species are one of the most common causes of blood stream infections among neonates especially Candida albicans. Also, the study showed that non albicans Candida has emerged as a major cause of neonatal candidemia.
-In this study one hundred and seventy six clinical samples suspected of having neonatal bacterial and fungal infections were collected from NICU in Ain Shams Specialized Hospital, Wadi El Nile hospital, and Al Hussein University Hospital. Fifty five cases were positive in blood cultures and PCR, while one hundred and twenty one were negative. These negative cases were excluded from the tested group.
-Full clinical examination stressed on gestational age, birth, weight, mode of delivery, risk factors for sepsis, patients name, sex, , whether preterm or full term, clinical symptoms and diagnosis. Also the mother was asked about the pregnancy period, if she had fever, premature rupture of membranes or any other infections. The site of labor was also reported.
-Blood samples were collected in blood culture bottles and processed in automated blood culture device BACTEC beside the conventional method. Gram stained smear of plasma buffy coat layer obtained by centrifuging anticoagulant capillary blood were examined. Clinical specimen to be cultured for fungus was inoculated on sabouraud dextrose agar medium.
Identification of Candida isolates was carried out according to colony morphology on SDA, color production on chromogenic media, germ tube test, chamydospore formation and carbohydrate fermentation and assimilation tests.
-Molecular identification revealed the presence of;Candida tropicalis (isolates, 3 [MK686027] and isolate, 5 [MK686029]), Candida parapsilosis (isolate, 4 [MK686028]), Candida albicans (isolate, 2 [MK686026]) and Pichia kuriavzevii (isolate, 1 [MK686025]), Penicillium oxalicum (isolate, 6 [KT959294.1])
-Antifungal susceptibility test was carried out for all fungal isolates using disc diffusion method. Minimal inhibitory concentration (MIC), and minimum fungicidal concentration (MFC) were also detected.
-In this study, four species of Candida, Pichia kudriavzevii andPenicillium oxalicum were isolated from total clinical specimens. Systemic candidiasis occurred in 14.8% of tested group. 9 isolates of Candida albicans was isolated from 26 cases (5.11%). While other species of Candida and molds represented by 8 isolates of C.tropicalis (4.55%), 6 isolates of Candida krusei (3.41%), and isolate of C.parapsillosis (0.57%), 1 of Penicillium oxalicum (0.57%), and 1 of Pichia kudriavzevii (0.57%).
-The current study highlights the changing pattern of candidal species (in the last decade) in neonatal fungal sepsis. Also, it indicated the increasing prevalence of non albicans Candida species, that represented by 15 isolates out of total 24 isolates of Candida species.
-In this study, all fungal isolates (yeast& mold) were resistant to the antifungal AFG and were susceptible to CAS.
-According to MIC results, Fluconazole showed the highest sensitivity followed by micafungin then trebanafine, amphotrecien B, and itraconazole. While MFC showed the sensitivity of all fungal isolates (yeast &mold) towards AMB and ITC. C.parapsilosis and Penicillium oxalicum were the most sensitive isolates. Recently, the incidence of fungal sepsis in neonatal intensive care was increased, for this reason, it is crucial to promote the prevention, early detection and effective treatment in high risk neonates.
-Amphotrecien B was the preferred initial therapy in neonates with candidemia. Also alternate therapy includes fluconazole as monotherapy or in combination with amphotericin B.