A State of the Art Review on the Recalcitrant Candidiasis as a Clue of Inborn Errors of Immunity in Newborns.

Abstract

Defects in the development or function of the immune system are characteristic of inborn errors of immunity (IEI), a diverse group of inherited disorders. IEI can manifest in various ways during the neonatal stage, posing a challenge in their identification and treatment. The family who have a background of IEI, including a previous instance of an infant's death caused by infection, sepsis from bacteria in children requiring intravenous (IV) antibiotics, and failure to thrive, as well as newborns with fungus infection such as chronic recalcitrant candidiasis. This review sought to clarify the significance of recalcitrant candidiasis in identifying IEI in newborns. To enhance healthcare strategies, we make it a priority to keep data on managing difficult candidiasis up-to-date and consider the potential benefits of implementing these newborn screening programs for IEI. In this review, we highlight the state-of-the-art recalcitrant candidiasis-based diagnostic strategies of the IEI in newborns. The article is organized as follows: In Section 2, different clinical features of immunodeficiencies in newborns will be summarized, with emphasis different pathogens are associated in different types of immunodeficiencies. Also, different types of candidiasis which are related to each type of IEI will be presented in Section 3. The challenges diagnostic tests to identify of IEI (screening and definite diagnosis) and the type of diagnostic tests for confirmation of recalcitrant candidiasis from bench to bedside will be covered in Sections 4-6. The concept of a patient's treatment who has recalcitrant candidiasis will be addressed along with this paper in Section 7. Implication for practice will be discussed in Section 8. The most previous study shows antifungal treatment failure, caused by resistant or tolerant activity toward commonly used antifungal medications, is a probable cause for the presence of recalcitrant candidiasis in newborns. It is important for clinicians to consider the possibility of underlying conditions and order specific tests to identify the type of Candida and determine the best treatment for newborns with persistent candidiasis. To sum up, remember to consider immunodeficiency when deciphering abnormal treatment response for candidiasis. Resistant or dose-dependent candidiasis lab results in a neonate may signal a potential immunodeficiency, leading to more medical and lab examinations to confirm or rule it out. It can be said that the recalcitrant candidiasis may be considered as a clue about the nature of the underlying immune deficiency. A comprehensive knowledge of recalcitrant candidiasis is imperative in identifying IEI, underscoring the crucial role of well-trained local pediatricians in early detection. The importance of implementing an early detection program for IEI couldn't be overstated, as it has been proven to significantly enhance quality of life and life expectancy by allowing for timely medical interventions in cases of IEI and significantly reduces medical expenses.