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Prematurity as a secondary immunodeficiency disorder with increased risk of infections: A mini-review

*1Ibraheem, R. M., and 2Issa, A.

1Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital, PMB 1515, Ilorin, Nigeria

2Department of Paediatrics, Children Specialist Hospital, Ilorin, Nigeria

*Correspondence to: ibraheem.rm@unilorin.edu.ng;

rasheedahbidmus@yahoo.com +2348033704168; ORCID: 0000-0002-3960-9740

Abstract:
Prematurity significantly increases neonatal mortality in sub-Saharan Africa. Underdeveloped immune systems and prolonged hospitalization elevate the risk of secondary immunodeficiency leading to heightened vulnerability to healthcare-associated infections, including neonatal sepsis from various sources like intrauterine, intrapartum, and postnatal agents. This review explores the impact of prematurity on infection susceptibility and the role of immature immunity. A literature search using PubMed and Google Scholar identified relevant articles published between January 1980 and December 2022, focusing on terms such as “preterm,” “prematurity,” “neonatal sepsis,” and “secondary immunodeficiency.” Despite neonatal susceptibility to sepsis, accurate incidence estimates are lacking in many countries, and preterm infants face higher morbidity and mortality risks compared to full-term babies. Early-onset infections usually manifest within the first 72 hours post-delivery, while late-onset neonatal sepsis occurs after this period. Immaturity affects various immune system components, with gestational age influencing functionality. The compromised innate immune response in preterm infants involves factors such as fragile skin, reduced tear/mucus production, and low antimicrobial peptide levels. Complement deficiencies and impaired neutrophil function increase susceptibility to infections. Macrophages, dendritic cells, and natural killer cells exhibit reduced activity, impacting viral clearance. Preterm infants also have lower immunoglobulin (Ig) G levels, contributing to a weakened adaptive immune response. Hypogammaglobulinaemia heightens susceptibility to infections relying on antibody-mediated protection, while low secretory IgA production and delayed antibody response predispose to gastrointestinal and respiratory infections. The combined effect of immature immunity and medical interventions heightens preterm infants’ susceptibility to pathogens. Recommendations for mitigating infection risks include antimicrobial stewardship, prompt initiation of exclusive breastfeeding, and timely administration of routine vaccinations. Continue reading “Prematurity as a secondary immunodeficiency disorder with increased risk of infections: A mini-review”

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Fungal neonatal and infantile sepsis in Egypt: risk factors and identification of fungal isolates

1*Ahmed, S. H., 2Mokhtar, E. M., 3El-Kholy, I. M., 4El Essawy, A. K., 1El-Din, A. A., and 1Shetaia, Y. M.
1Microbiology Department, Faculty of Science, Ain Shams University, Cairo, Egypt 2Microbiology Department, Abou Al-azayem Hospital, Cairo, Egypt 3Clinical Pathology Department, Ain Shams University Specialized Hospital, Ain Shams University, Cairo, Egypt 4Microbiology Department, Ain Shams University Specialized Hospital, Ain Shams University Cairo, Egypt, *Correspondence to: sara_saifelnasr@hotmail.com; 00971563993304

Abstract:

Background: Invasive fungal diseases (IFDs) are opportunistic infections associated with significant mortality in paediatric patients, especially in those with compromised immune system and neonates with very low birth weight (VLBW). The objectives of this study are to determine the prevalence, clinical features and fungi isolates of neonatal sepsis in three hospitals in Egypt. Methodology: The study is a cross sectional survey of 176 neonates with clinical sepsis admitted to the neonatal intensive care units (NICU) of the three hospitals over a period of one year (February 2015 to January 2016). A minimum of two blood samples (collected within 24 hours) from each neonate were cultured for bacteria in automated BacT/AlerT and conventional culture bottles, while Saboraud-Brain Heart Infusion broth was inoculated for fungi culture. Positive growths from the broth were sub-cultured on Sabouraud Dextrose Agar (SDA) plates for aerobic incubation at 25oC and 37oC for 2 weeks. Identification of fungi colonies on SDA was by conventional morphology and confirmation on chromogenic agar media. Phylogenetic analysis of representative fungi isolates was done by partial nucleotide sequencing of D1-D2 domain of the large subunit rRNA gene.
Results: Of the 176 neonates, blood culture was positive for pathogens in 55 (31.3 %) samples and fungi were isolated in 26 (14.8 %); yeast (25) and mould (1). The commonly isolated yeasts were Candida albicans, Candida tropicalis, and Candida krusei representing 34.6%, 30.8% and 23.1%, respectively of the total fungi isolated. The phylogenetic analysis in comparison to Genbank data showed defined clades for Candida tropicalis, Candida parapsilosis, Candida albicans and Pichia kudriavzevii
Conclusion: This current study highlights the changing pattern of neonatal infections in Egypt caused by Candida, with increasing incidence of infections caused by non-albicans Candida species.

Key words: fungal infection, neonatal, risk factors, PCR, yeast

Received July 4, 2019; Revised September 16, 2019; Accepted September 18, 2019
Copyright 2020 AJCEM Open Access. This article is licensed and distributed under the terms of the Creative Commons Attrition 4.0 International License (//creativecommmons.org/licenses/by/4.0), which permits unrestricted use, distribution and reproduction in any medium, provided credit is given to the original author(s) and the source.

Infection fongique néonatale et infantile en Égypte: facteurs de risque et identification des isolats fongiques

1*Ahmed, S. H., 2Mokhtar, E. M., 3El-Kholy, I. M., 4El Essawy, A. K., 1El-Din, A. A., et 1Shetaia, Y. M.
1Département de microbiologie, Faculté des sciences, Université Ain Shams, Le Caire, Égypte
2Département de microbiologie, Hôpital Abou Al-Azayem, Le Caire, Égypte
3Département de pathologie clinique, Hôpital spécialisé de l’Université Ain Shams, Université Ain Shams,
Le Caire, Égypte
4Département de microbiologie, Université de Ain Shams, Spécialisé Hôpital, Université Ain Shams,
Le Caire, Égypte
*Correspondance à: sara_saifelnasr@hotmail.com; 00971563993304

Abstrait:

Contexte: Les maladies fongiques invasives (IFD) sont des infections opportunistes associées à une mortalité significative chez les patients pédiatriques, en particulier ceux dont le système immunitaire est compromis et les nouveau-nés de très faible poids à la naissance (VLBW). Les objectifs de cette étude sont de déterminer la prévalence, les caractéristiques cliniques et les isolements fongiques de la sepsie néonatale dans trois hôpitaux en Égypte.
Méthodologie: L’étude est une enquête transversale menée auprès de 176 nouveau-nés présentant une septicémie clinique et admis dans les unités de soins intensifs néonatals des trois hôpitaux sur une période d’un an (de février 2015 à janvier 2016). Un minimum de deux échantillons de sang (recueillis dans les 24 heures) de chaque nouveau-né ont été cultivés pour la bactérie dans des flacons de culture automatisés BacT/AlerT et conventionnels, tandis que le bouillon Saboraud-Brain Heart Infusion a été inoculé pour la culture de champignons. Les croissances positives du bouillon ont été sous-cultivées sur des plaques de gélose Sabouraud Dextrose Agar (SDA) pour une incubation aérobie à 25°C et à 37°C pendant 2 semaines. L’identification des colonies de champignons sur la SDA a été réalisée par la morphologie conventionnelle et confirmée sur un milieu chromogène en gélose. L’analyse phylogénétique d’isolats de champignons représentatifs a été réalisée par séquençage partiel de nucléotides du domaine D1-D2 du gène de l’ARNr de grande sous-unité.
Résultats: Sur les 176 nouveau-nés, la culture de sang était positive pour les agents pathogènes dans 55 échantillons (31,3%) et les champignons ont été isolés dans 26 (14,8%); levure (25) et moisissure (1). Les levures communément isolées étaient Candida albicans, Candida tropicalis et Candida krusei, représentant respectivement 34,6%, 30,8% et 23,1% du total des champignons isolés. L’analyse phylogénétique comparée aux données de Genbank a montré des clades définis pour Candida tropicalis, Candida parapsilosis, Candida albicans et Pichia kudriavzevii
Conclusion: La présente étude met en évidence l’évolution du schéma des infections néonatales causées par Candida en Égypte, avec une incidence croissante des infections causées par des espèces de Candida non albicans.

Afr. J. Clin. Exper. Microbiol. Fungal neonatal and infantile sepsis 2020; 21 (1): 14 – 20

Mots-clés: infection fongique, néonatale, facteurs de risque, PCR, levure

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Fungal neonatal and infantile sepsis in Egypt: risk factors and identification of fungal isolates