Baltogianni Maria, Giapros Vasileios, Dermitzaki Niki
Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45500 Ioannina, Greece.
Children (Basel). 2024 Sep 30;11(10):1207. doi: 10.3390/children11101207.
Invasive infections represent a significant cause of morbidity and mortality in the neonatal intensive care unit (NICU), particularly among preterm and low birth weight neonates. The nonspecific clinical presentation of invasive candidiasis, resembling that of bacterial sepsis with multiorgan involvement, makes the diagnosis challenging. Given the atypical clinical presentation and the potential detrimental effects of delayed treatment, empirical treatment is often initiated in cases with high clinical suspicion. This underscores the need to develop alternative laboratory methods other than cultures, which are known to have low sensitivity and a prolonged detection time, to optimize therapeutic strategies. Serum biomarkers, including mannan antigen/anti-mannan antibody and 1,3-β-D-glucan (BDG), both components of the yeast cell wall, a nano-diagnostic method utilizing T2 magnetic resonance, and DNA detection by PCR-based techniques have been investigated as adjuncts to body fluid cultures and have shown promising results in improving diagnostic efficacy and shortening detection time in neonatal populations. This review aims to provide an overview of the diagnostic tools and the current management strategies for invasive candidiasis in neonates. Timely and accurate diagnosis followed by targeted antifungal treatment can significantly improve the survival and outcome of neonates affected by species.
侵袭性感染是新生儿重症监护病房（NICU）发病和死亡的重要原因，尤其是在早产儿和低出生体重儿中。侵袭性念珠菌病的临床表现不具特异性，与伴有多器官受累的细菌性败血症相似，这使得诊断具有挑战性。鉴于其非典型临床表现以及延迟治疗的潜在有害影响，对于临床高度怀疑的病例，通常会开始经验性治疗。这凸显了开发除培养法之外的其他实验室方法的必要性，因为已知培养法敏感性低且检测时间长，以优化治疗策略。血清生物标志物，包括甘露聚糖抗原/抗甘露聚糖抗体和1,3-β-D-葡聚糖（BDG），二者均为酵母细胞壁的成分，一种利用T2磁共振的纳米诊断方法，以及基于PCR技术的DNA检测，已作为体液培养的辅助手段进行了研究，并在提高新生儿侵袭性念珠菌病诊断效率和缩短检测时间方面显示出有前景的结果。本综述旨在概述新生儿侵袭性念珠菌病的诊断工具和当前管理策略。及时、准确的诊断并随后进行针对性抗真菌治疗可显著提高受念珠菌属感染新生儿的生存率和预后。
