Characterisation of CandidaColonisation in Neonates

Introduction: The occurrence of invasive fungal infections has increased significantly worldwide, premature infants in Neonatal Intensive Care Unit (NICU) along with other risk factors are at particular risk of these invasive fungal infections which lead to fungal septicaemia in newborns. Candidaemia is the most common form of invasive candidiasis associated with an unacceptably high mortality rates. Candida colonisation in neonates is considered the first step towards developing neonatal sepsis. Aim: To determine the prevalence of Candida colonisation and its characterisation among neonates admitted in NICU. Materials and Methods: The present study was a prospective cross-sectional study with 150 neonates included in the study. Swabs were taken from four different sites of each neonate and inoculated on Chocolate agar and Sabouraud’s Dextrose Agar (SDA) and incubated at 37°C for seven days. Candida species isolated were confirmed by gram stain, germ tube test, growth on Chromogenic (CHROM) agar and cornmeal agar. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 11.0. Results: A total of 32 (21.3%) neonates had Candida colonisation. Twenty two (68.7%) were low birth weight and 24 (75%) were born premature. Perineum was the most common (56%) site of colonisation. Among Candida isolates, Candida tropicalis(63%) was the commonest followed by Candida parapsilosis(25%) and Candida glabrata and Candida albicans (6%). The risk factors identified were low birth weight, premature birth, use of antibiotics. Conclusion: Colonisation of preterm and low birth weight neonates by Candida species is a major risk factor and needs attention to avoid dissemination and life threatening infection.

Preconceptional screening of sexually transmitted infections/diseases

Hungarian Preconceptional Care includes the preconceptional screening of sexually transmitted infections/disorders (STD) and vaginal candidosis of potential mothers and pyospermia of potential fathers. The aim of this study was to evaluate the effect of this screening and treatment for the rate of preterm births. Clinical and subclinical vaginal candidiasis (asymptomatic candida colonisation), combination of STD and vaginal candidiasis, STD without vaginal candidiasis, finally women without STD and vaginal candidiasis as references were evaluated in 4,672 pregnant women. The association of STD in pregnant women with higher risk of preterm birth was confirmed. However, an association was also found between clinically diagnosed vaginal candidiasis, asymptomatic candida colonisation, and a higher risk for preterm births. This risk was reduced with clotrimazole treatment. However, pregnant women without recognized STD and/or vaginal candidiasis had a higher risk for preterm birth than pregnant women with STD or vaginal candidiasis after appropriate treatment. Thus the conclusion of the study is that the preconceptional screening of STD and vaginal candidiasis followed by appropriate treatment is important to prevent a certain part of preterm birth but it is necessary to improve the efficacy of the previously used methods for this screening.

Honey as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck cancer

Aim:To evaluate the efficacy of pure natural honey as prophylaxis against radiochemotherapy-induced mucositis, through clinical scoring of oral and oropharyngeal mucositis, and culturing of pathogenic oral and oropharyngeal microbes.Patients and methods:The study was done in Assiut University Hospital, Egypt, between January 2005 and July 2006. Forty patients diagnosed with head and neck cancer were entered into the trial. Enrolled patients were randomised to either the treatment group, receiving concomitant chemotherapy and radiotherapy (with a significant area of directly visible oral and/or oropharyngeal mucosa included in the radiation fields) plus prior topical application of pure natural honey, or the control group, receiving concomitant chemotherapy and radiotherapy without honey. Patients were evaluated clinically every week to assess development of radiation mucositis. Aerobic cultures and candida colonisation assessment were undertaken, via oral and oropharyngeal swabs, prior to and at the completion of irradiation, and when infection was evident.Results:In the treatment group, no patients developed grade four mucositis and only three patients (15 per cent) developed grade three mucositis. In the control group, 13 patients (65 per cent) developed grade three or four mucositis (p < 0.05). Candida colonisation was found in 15 per cent of the treatment group and 60 per cent of the control group, either during or after radiotherapy (p = 0.003). Positive cultures for aerobic pathogenic bacteria were observed in 15 per cent of the treatment group and 65 per cent of the control group, during or after radiotherapy (p = 0.007).Conclusion:This study shows that prophylactic use of pure natural honey was effective in reducing mucositis resulting from radiochemotherapy in patients with head and neck cancer.