{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T21:39:46Z","timestamp":1772487586581,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:00:00Z","timestamp":1683244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Limited studies on candidemia in malignancy in the paediatric population from developing countries show a high incidence, high morbidity and a unique epidemiology as compared to developed nations. Our prospective observational study aimed to explore the prevalence of invasive candidiasis, especially candidemia, in febrile paediatric patients with lymphoreticular malignancy. A sample size of 49 children, with 100 recorded febrile episodes was studied. The relevance of candida colonization and mannan antigen detection as indicators of impending candidemia was evaluated. Genotypic identification of the yeast isolates was followed by sequence analysis using the NCBI-BLAST program, and the generation of the phylogenetic tree using MEGA 6.0 software. We observed a 5% prevalence of candidemia among febrile paediatric patients with lymphoreticular malignancy, predominantly caused by non-albicans candida. Colonization at multiple anatomical sites decreased from day 1 to day 8 of febrile episodes. Significant candida colonization (colonization index \u22650.5) was seen in a larger proportion of candidemia patients on day 1 and day 4 (p &lt; 0.001) displaying a definite association between the two. The receiver operator characteristic (ROC) curve analysis for mannan antigen level revealed a cut-off of \u2265104.667 pg\/mL, suitable for predicting candidemia with a sensitivity of 100%, specificity of 92% and area under ROC value of 0.958 (95% CI: 0.915\u20131; p &lt; 0.001). A phylogenetic tree with three population groups, clade 1, 2 and 3, consisting of Candida auris (1), Candida tropicalis (2) and Candida parapsilosis (2), respectively, was generated. The diagnosis of candidemia based on mannan antigen detection gives early results and has high negative predictive values. It can be combined with other biomarkers to increase sensitivity, specificity and positive predictive value.<\/jats:p>","DOI":"10.3390\/diagnostics13091638","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T01:32:53Z","timestamp":1683509573000},"page":"1638","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of Candidemia during Febrile Episode in Lymphoreticular Malignancy Affecting Paediatric Population"],"prefix":"10.3390","volume":"13","author":[{"given":"Suchita","family":"Gautam","sequence":"first","affiliation":[{"name":"Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8117-2423","authenticated-orcid":false,"given":"Shukla","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2429-7913","authenticated-orcid":false,"given":"Praveen","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gargi","family":"Rai","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charu","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rumpa","family":"Saha","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Narendra","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Gomber","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raga","family":"Eltayeb","sequence":"additional","affiliation":[{"name":"Department of Pathology, College of Medicine, Jazan University, Jazan 45142, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2499-8701","authenticated-orcid":false,"given":"Sajad","family":"Dar","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India"},{"name":"Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.5152\/TurkPediatriArs.2016.2757","article-title":"Febrile neutropenia in children with acute lymphoblastic leukemia: Single center experience","volume":"51","author":"Yantri","year":"2016","journal-title":"Turk. Arch. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2030","DOI":"10.1002\/1097-0142(19891115)64:10<2030::AID-CNCR2820641011>3.0.CO;2-2","article-title":"Candida colonization and systemic infection in neutropenic patients. A retrospective study","volume":"64","author":"Martino","year":"1989","journal-title":"Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"218","DOI":"10.7883\/yoken.JJID.2005.218","article-title":"Candidosis in children with onco-hematological diseases in Chennai, south India","volume":"58","author":"Sundararajan","year":"2005","journal-title":"Jpn. J. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.jcrc.2019.02.005","article-title":"Epidemiology and clinical outcomes of invasive mould infections in Indian intensive care units (FISF study)","volume":"51","author":"Chakrabarti","year":"2019","journal-title":"J. Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1097\/00000658-199412000-00008","article-title":"Candida colonization and subsequent infections in critically ill surgical patients","volume":"220","author":"Pittet","year":"1994","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2731","DOI":"10.1093\/molbev\/msr121","article-title":"MEGA5: Molecular evolutionary genetics analysis using maximum likelihood, evolutionary distance, and maximum parsimony methods","volume":"28","author":"Tamura","year":"2011","journal-title":"Mol. Biol. Evol."},{"key":"ref_7","first-page":"1068","article-title":"The epidemiology of fungal infections in patients with hematologic malignancies: The SEIFEM-2004 study","volume":"91","author":"Pagano","year":"2006","journal-title":"Haematologica"},{"key":"ref_8","first-page":"e41317","article-title":"Incidence of fungal infections in pediatric patients with hematologic neoplasms","volume":"5","author":"Badiee","year":"2017","journal-title":"Arch. Pediatr. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Pasqualotto, A.C., Rosa, D.D., Medeiros, L.R., and Severo, L.C. (2006). Candidaemia and cancer: Patients are not all the same. BMC Infect. Dis., 6.","DOI":"10.1186\/1471-2334-6-50"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"8883700","DOI":"10.1155\/2021\/8883700","article-title":"Bacterial Infection among Cancer Patients: Analysis of Isolates and Antibiotic Sensitivity Pattern","volume":"2021","author":"Bhat","year":"2021","journal-title":"Int. J. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"442","DOI":"10.3855\/jidc.9725","article-title":"Bacterial profile and antibiogram of blood stream infections in febrile neutropenic patients with haematological malignancies","volume":"12","author":"Kokkayil","year":"2018","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1093\/cid\/cis697","article-title":"Changes in incidence and antifungal drug resistance in candidemia: Results from population-based laboratory surveillance in Atlanta and Baltimore, 2008\u20132011","volume":"55","author":"Cleveland","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.hemonc.2015.06.006","article-title":"Epidemiological and mycological characteristics of candidemia in patients with hematological malignancies attending a tertiary-care center in India","volume":"8","author":"Dewan","year":"2015","journal-title":"Hematol. Oncol. Stem Cell Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/BF02893420","article-title":"Significance of oral Candida infections in children with cancer","volume":"12","author":"Alberth","year":"2006","journal-title":"Pathol. Oncol. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s11046-005-3451-2","article-title":"Fecal fungal flora of pediatric healthy volunteers and immunosuppressed patients","volume":"159","year":"2005","journal-title":"Mycopathologia"},{"key":"ref_16","first-page":"e11858","article-title":"Yeast colonization and drug susceptibility pattern in the pediatric patients with neutropenia","volume":"7","author":"Haddadi","year":"2014","journal-title":"Jundishapur J. Microbiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1111\/j.1469-0691.2011.03528.x","article-title":"Colonization by Candida in children with cancer, children with cystic fibrosis, and healthy controls","volume":"17","author":"Gammelsrud","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Hamzavi, S.S., Amanati, A., Badiee, P., Kadivar, M.R., Jafarian, H., Ghasemi, F., Haghpanah, S., Dehghani, M., and Baghani, A.N. (2019). Changing face of Candida colonization pattern in pediatric patients with hematological malignancy during repeated hospitalizations, results of a prospective observational study (2016\u20132017) in shiraz, Iran. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4372-x"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1200\/JCO.1990.8.2.280","article-title":"Invasive fungal disease in pediatric acute leukemia patients with fever and neutropenia during induction chemotherapy: A multivariate analysis of risk factors","volume":"8","author":"Wiley","year":"1990","journal-title":"J. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1002\/1097-0142(19840201)53:3<411::AID-CNCR2820530308>3.0.CO;2-E","article-title":"Multivariate analysis of factors associated with invasive fungal disease during remission induction therapy for acute myelogenous leukemia","volume":"53","author":"Schwartz","year":"1984","journal-title":"Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1111\/myc.12792","article-title":"Candidemia in children: Epidemiology, prevention and management","volume":"61","author":"Mantadakis","year":"2018","journal-title":"Mycoses"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Fontecha, G., Montes, K., Ortiz, B., Galindo, C., and Braham, S. (2019). Identification of Cryptic Species of Four Candida Complexes in a Culture Collection. J. Fungi, 5.","DOI":"10.20944\/preprints201911.0293.v1"},{"key":"ref_23","unstructured":"Eggimann, P., and Pittet, D. (2006). Year Book of Intensive Care and Emergency Medicine, Springer."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1007\/s00134-014-3355-z","article-title":"Candida colonization index and subsequent infection in critically ill surgical patients: 20 years later","volume":"40","author":"Eggimann","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1089\/109629600750067200","article-title":"The diagnostic value of fungal surveillance cultures in critically ill patients","volume":"1","author":"Pelz","year":"2000","journal-title":"Surg. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.diagmicrobio.2006.03.013","article-title":"The association between anatomic site of Candida colonization, invasive candidiasis, and mortality in critically ill surgical patients","volume":"55","author":"Magill","year":"2006","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1093\/mmy\/myu018","article-title":"Characteristic and clinical relevance of Candida mannan test in the diagnosis of probable invasive candidiasis","volume":"52","author":"Chumpitazi","year":"2014","journal-title":"Med. Mycol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"R222","DOI":"10.1186\/cc9365","article-title":"The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: Recommendations from the Third European Conference on Infections in Leukemia","volume":"14","author":"Mikulska","year":"2010","journal-title":"Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.diagmicrobio.2004.08.015","article-title":"Early diagnosis of invasive candidiasis with mannan antigenemia and antimannan antibodies","volume":"51","author":"Prella","year":"2005","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4103\/2348-3334.172395","article-title":"Species distribution and antifungal susceptibility of candidemia at a multispecialty center in North India","volume":"3","author":"Thomas","year":"2016","journal-title":"CHRISMED J. Health Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3899","DOI":"10.18203\/2394-6040.ijcmph20193990","article-title":"An etiological and antifungal profile of candidemia in children","volume":"6","author":"Kaur","year":"2019","journal-title":"Int. J. Commun. Med. Public Health"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/9\/1638\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:30:02Z","timestamp":1760124602000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/9\/1638"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,5]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["diagnostics13091638"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13091638","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,5]]}}}