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Emerging fungal infection: Candida blankii fungaemia in NICU

April 20 2020

Neonatal sepsis due to fungi is usually caused by Candida albicans or Candida parapsilosis, but rare cases of Candida blankii have been reported in NICUs that are tricky to identify and resistant to fluconazole.

Dr Al-Haqqan and colleagues from Kuwait described the first case caused by Candida blankii in 2018 in the blood of a 27-week preterm neonate. Identification was challenging as MALDI-ToF (VITEK 2) misidentified the isolate as Stephanoascus ciferrii, and and studied the isolate’s morphology and taxonomy.

Dr Anuradha Chowdhary and colleagues in Delhi describe a series of 9 premature babies with Candida blankii fungaemia. Infection was early after birth at 2-3 postnatal days. All neonates were treated with fluconazole and four of the nine neonates died, resulting in a case fatality rate of 45%.

In Delhi, C. blankii was misidentified or not identified by automated identification systems. Its closest relatives are distant from most common human pathogenic Candida spp. It was fluconazole resistant (MICs all 8 mg/L) and also anidulafungin MICs were high (2 mg/L). All the strains were genetically indistinguishable with a genome size of 13.65 Mb. The C. blankii genome showed several larger deletions in the echinocandin target FKS1 gene, with an altered predicted protein sequence, as well as sequence alterations in the beta-D-glucan synthase enzyme.