Peer-reviewed article
S6.1d First case report of pediatric blood stream infection by Candida magnoliae in a known case of B cell ALL post -induction chemotherapy in Central India
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Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a case report of a rare fungal infection (Candida magnoliae) found in the bloodstream of a 6-year-old child with acute lymphoid leukemia undergoing chemotherapy in India. The infection was discovered during routine pre-consolidation screening and was initially misidentified as a more common fungal species before confirmation at a reference laboratory. The child responded well to treatment and is doing well on follow-up. The report highlights the challenge of correctly identifying emerging fungal pathogens in immunosuppressed children and the risk of hospital-acquired infections in this vulnerable population.
Key points
- First documented case of Candida magnoliae bloodstream infection in a pediatric patient with acute lymphoid leukemia
- Fungal isolate initially phenotypically identified as C. glabrata but confirmed as C. magnoliae by reference center
- Isolate showed elevated resistance to fluconazole but remained susceptible to amphotericin B, voriconazole, and caspofungin
- Only four cases of C. magnoliae infection previously reported in literature: two in neonates from Brazil, one immunocompetent child from USA, and one terminal oncology patient from Italy
- Immunosuppression and repeated hospital admissions identified as risk factors for nosocomial fungal bloodstream infections
Limitations
This is a single case report with no comparative data or longitudinal outcomes beyond noting the child is 'doing well' on follow-up; it cannot establish the prevalence, typical outcomes, or optimal treatment approaches for this rare infection in pediatric populations.
Abstract
Abstract S6.1 Antifungal Prophylaxis in Children with Cancer and HSCT, September 22, 2022, 4:45 PM - 6:15 PM Objectives Documentation and dissemination of findings of a rare fungal isolate in an immunosuppressed child. Methods A case study with rare fungal isolate in correlation to age, clinical condition, sample, and comorbidity was done. A 6-year-old male child was admitted for routine management of B cell acute lymphoid leukemia. The patient completed induction chemotherapy in July 2021. The patient was planned for consolidation in the last week of July and to rule out any infection blood and urine samples were sent. Paired blood samples were received in pediatric automated BacT/Alert blood culture bottles. After 8 days both the blood culture bottles flashed positive. On gram stain, budding yeast cells oval to globose were seen. No pseudohyphae were seen. Nigrosin staining result was negative. It was processed further on HiCrome™ agar showing cream-colored colonies at 370 C, cornmeal agar with 1% tween 80 for Dalmau technique showed only oval to globose yeast cells with blastoconidia, enlarged cells appearing as chlamydoconidia without pseudohyphae or true hyphae were seen. Glucose and sucrose were fermented and trehalose was weakly fermented. Urease was negative. Isolate was identified as Candida glabrata/Candida auris. Antifungal susceptibility showed elevated MIC for fluconazole but susceptible to amphotericin B, voriconazole, and caspofungin. As part of routine collaboration with reference center PGIMER, bloodstream Candida isolates were sent for confirmation, and quality control. Results The isolate phenotypically suspected as C. glabrata causing fungemia was confirmed by the reference center as C. magnoliae. Currently, patient is on routine follow-up and doing well. On reviewing of available literature on C. magnoliae; bloodstream infections in two low birth weight neonates from Brazil, one immunocompetent child with tenosynovitis from the USA, and a terminal oncology patient from Italy were noted. In a Chinese study of 2007, phylogenetic analysis showed a close relationship of C. magnoliae to Candida krusei. Conclusion Immunosuppression with longstanding or repeated hospital admissions is a risk for nosocomial fungal infections, especially, bloodstream infections. Already confusing phenotypic identification among C. glabrata, C. auris, C. haemoulonii, and now the current isolate C. magnoliae further complicates and challenges diagnostic workflow impacting timely management of cases. Further studies and more documentation of such findings in literature are necessary for newer insights.