Characterizing neonatal community-acquired invasive fungal infections: Clinical profiles, pathogens, and underlying conditions.

OBJECTIVE

To characterize the clinical presentation and diagnostic indicators of neonatal community-acquired invasive fungal infections and establish a systematic approach for early identification and management.

METHODS

This study retrospectively reviewed the medical records of neonates discharged from the neonatal department between 1/1/2019 and 1/12/2023. Cases were identified based on the primary or first diagnosis using the International Classification of Diseases, 9th Revision codes. A total of 6 patients were included and comprehensive clinical data were analyzed. A systematic literature review (PubMed/Embase, 2000-2023) was conducted to contextualize findings.

RESULTS

6 neonates, including 5 boys, weighed 2700 to 4480 g, hospitalized at the age of 15 to 26 days. Key findings included: Patients had nonspecific respiratory symptoms, such as cough, tachypnea, and fever; the auxiliary examination showed positive β-ᴅ-glucan (cases 1, 4, 5) and galactomannan test (cases 2, 3, 4), and all cases had elevated CD4+/CD8 + ratio; multifocal consolidations (cases 2, 3) with halo sign evolution on serial imaging; pathogen spectrum were: Aspergillus flavus (3/6), Candida spp. (2/6), Lichtheimia corymbifera (1/6); antifungal treatments achieved clinical resolution in all cases (median duration 24 days), with sustained remission at 3-month follow-up; underlying immunometabolic disorders identified post-diagnosis in 83% (5/6) cases, including chronic granulomatous disease, lupus syndrome, and methylmalonic acidemia.

CONCLUSION

Neonatal community-acquired invasive fungal infections represents a critical diagnostic challenge requiring for its low incidence and nonspecific clinical features. Diagnosis mainly based on the fungi-culture. Appropriate use of antifungi medication can lead to a better outcome. Moreover, suspicion of the latent diseases which can cause immune and metabolic dysfunction would be benefit for improving prognosis.