Candidemia-induced pediatric sepsis and its association with free radicals, nitric oxide, and cytokine level in host.

Candida species has become the seventh most frequent causal microorganisms of nosocomial sepsis. Prematurity and low birth weights are strongly associated with the development of neonatal nosocomial bloodstream infections. Candida albicans has been the species most often associated with neonatal infections, but recently, there has been a changing pattern in the isolates recovered from neonates with invasive candidiasis, which poses resistance to the existing class of azoles such as fluconazole antifungals along with cross resistance to newer triazoles, which results in a therapeutic challenge in invasive fungal infections causing high incidence of mortality. Candida species was isolated from blood of neonates and children younger than 15 years admitted to hospital and susceptible for Candida-induced sepsis. Polymerase chain reaction-based identification and confirmation of individual Candida species were done using DNA sequencing. Antibiotic susceptibility assay and resistance pattern for fluconazole, voriconazole, and amphotericin were done for all the isolates. Furthermore, the change in free radical, cytokine release, and nitric oxide synthase expression and nitric oxide release from polymorphonuclear leukocytes isolated from control and pediatric sepsis cases were also performed. The present study probably for the first time reports the change in increasing incidence of nonalbicans Candida-induced sepsis in neonates and children admitted to the intensive care unit of hospital, and current antibiotics load posing resistance for antifungal treatment strategy and provide serious threats in future treatment. The increase in free radicals in polymorphonuclear leukocytes and increase in expression of nitric oxide synthase expression and nitric oxide release in Candida-infected pediatric sepsis cases underlie the role of host factor in dissemination and invasiveness of infection from exogenous sources and pathogenesis of systemic inflammation during sepsis.