title: Horizontal transmission of Candida parapsilosis candidemia in a neonatal intensive care unit.
abstract: This report describes the nosocomial acquisition of Candida parapsilosis candidemia by one of the six premature newborns housed in the same room of a neonatal intensive care unit at the Ospedale Santa Chiara, Pisa, Italy. The infant had progeria, a disorder characterized by retarded physical development and progressive senile degeneration. The infant, who was not found to harbor C. parapsilosis at the time of his admission to the intensive care unit, had exhibited symptomatic conjunctivitis before the onset of a severe bloodstream infection. In order to evaluate the source of infection and the route of transmission, two independent molecular typing methods were used to determine the genetic relatedness among the isolates recovered from the newborn, the inanimate hospital environment, hospital personnel, topically and intravenously administered medicaments, and indwelling catheters. Among the isolates collected, only those recovered from the hands of two nurses attending the newborns and from both the conjunctiva and the blood of the infected infant were genetically indistinguishable. Since C. parapsilosis was never recovered from indwelling catheters or from any of the drugs administered to the newborn, we concluded that (i) horizontal transmission of C. parapsilosis occurred through direct interaction between nurses and the newborn and (ii) the conjunctiva was the site through which C. parapsilosis entered the bloodstream. This finding highlights the possibility that a previous C. parapsilosis colonization and/or infection of other body sites may be a predisposing condition for subsequent C. parapsilosis hematogenous dissemination in severely ill newborns.
authors.affiliation: Dipartimento di Patologia Sperimentale, Biotecnologie Mediche, Infettivologia ed Epidemiologia, Università degli Studi di Pisa, Pisa, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Lupetti
authors.forename: Arianna
authors.initials: A
authors.lastname: Tavanti
authors.forename: Paola
authors.initials: P
authors.lastname: Davini
authors.forename: Emilia
authors.initials: E
authors.lastname: Ghelardi
authors.forename: Valerio
authors.initials: V
authors.lastname: Corsini
authors.forename: Ilaria
authors.initials: I
authors.lastname: Merusi
authors.forename: Antonio
authors.initials: A
authors.lastname: Boldrini
authors.forename: Mario
authors.initials: M
authors.lastname: Campa
authors.forename: Sonia
authors.initials: S
authors.lastname: Senesi
mesh_terms: D002175:Candida / Q000235:genetics / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications / Q000382:microbiology / Q000635:transmission*; D003228:Conjunctiva / Q000382:microbiology; D003428:Cross Infection / Q000150:complications / Q000382:microbiology / Q000635:transmission*; D016172:DNA Fingerprinting; D004271:DNA, Fungal / Q000235:genetics / Q000302:isolation & purification; D004783:Environmental Microbiology; D016469:Fungemia / Q000150:complications / Q000382:microbiology / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D017757:Infectious Disease Transmission, Professional-to-Patient; D007363:Intensive Care Units, Neonatal; D007558:Italy; D007621:Karyotyping; D008297:Male; D009741:Nursing Staff, Hospital; D011371:Progeria / Q000150:complications; D019105:Random Amplified Polymorphic DNA Technique; D012867:Skin / Q000382:microbiology
chemical_list: D004271:DNA, Fungal