title: Candida infections in non-neutropenic children after the neonatal period.
abstract: There are a variety of diseases, from local mucous membrane infections to invasive systemic infections, that are caused by Candida species. As a causative agent, Candida albicans is the most common; however, the other Candida species can also cause the same clinical syndromes. Most invasive fungal infections in children occur in the hospital setting. Candidemia is a serious condition associated with high morbidity and mortality and increased healthcare costs in pediatric patients. Children at the highest risk are those with prolonged intensive care unit stays, reduced immune function, recent surgery, prior bacterial infection, prior use of antibiotics and/or corticosteroids and other immunosuppressive agents, as well as use of a central venous catheter, total parenteral nutrition, mechanical ventilation and dialysis. Positive blood culture is the gold standard of candidemia; it should not be accepted as contamination or colonization in children with an intravascular catheter. However, in oropharyngeal or vulvovaginal candidiasis, culture of lesions is rarely indicated unless the disease is recalcitrant or recurrent. Recovery of Candida from the sputum should usually be considered as colonization and should not be treated with antifungal therapy. Antigen and antibody detecting tests are evaluated in invasive Candida infections; however, there are no published results in children, and their roles in diagnosis are also unclear. For the therapy of invasive Candida infections in non-neutropenic patients, fluconazole or an echinocandin is usually recommended. Alternatively, amphotericin B deoxycholate or lipid formulations of amphotericin B can also be used. The recommended therapy of Candida meningitis is amphotericin B combined with flucytosine. The combination therapy for Candida infections is usually not indicated. Prophylaxis in non-neonatal, immunocompetent children is not recommended.
authors.affiliation: Uludag University Medical Faculty, Department of Pediatric and Pediatric Infectious Diseases, Gorukle, Bursa, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Hacimustafaoglu
authors.forename: Solmaz
authors.initials: S
authors.lastname: Celebi
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification / Q000502:physiology; D058387:Candidemia / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D055499:Catheter-Related Infections / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D002648:Child; D003428:Cross Infection / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D003840:Deoxycholic Acid / Q000008:administration & dosage* / Q000627:therapeutic use; D004338:Drug Combinations; D054714:Echinocandins / Q000008:administration & dosage* / Q000627:therapeutic use; D015725:Fluconazole / Q000008:administration & dosage* / Q000627:therapeutic use; D005437:Flucytosine / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units; D007958:Leukocyte Count; D016533:Mycological Typing Techniques; D009504:Neutrophils / Q000166:cytology; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; D054714:Echinocandins; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D015725:Fluconazole; D005437:Flucytosine