First case of a human Candida berthetii systemic infection in a preterm infant - a case report

Sep 29, 2026

Invasive human infection caused by Candida berthetii in a preterm infant is reported as the first documented case. A premature neonate with prolonged NICU hospitalization, intensive care support, multiple surgeries, and broad-spectrum antibiotics developed persistent candidemia despite antifungal therapy. Species identification used internal transcribed spacer sequencing, and EUCAST microbroth dilution susceptibility showed high MICs to fluconazole and anidulafungin with low MICs to amphotericin B. After switching to liposomal amphotericin B, the infant progressed to multiple organ dysfunction and died, attributed to severity and delayed adequate antifungal therapy.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Case Presentation

Initial NICU course

Complications and antimicrobial therapy

Surgical management and outcomes

Keywords

| Antimicrobial Chemotherapy | Case Report First case of a human Candida berthetii systemic infection in a preterm infant: a case report Elaine Cristina Francisco,1,2,3 Fatima M. V. Porfirio,4 Larissa M. Favarello,1 Elisa J. U. Kusano,5 Debora D. Krenke,5 Regina Matielo,4 Denise Vilarino Louzada,4 Lúcio Flávio Peixoto de Lima,4 Lígia C. Pierrotti,5 Arnaldo L. Colombo1,3 AUTHOR AFFILIATIONS See affiliation list on p. 4. ABSTRACT Background We report the first case of invasive human infection caused by Candida berthetii in a preterm infant. Case Summary A premature neonate who required prolonged hospitalization, intensive care support, multiple surgical interventions, and broad-spectrum antibiotics developed persistent candidemia due to C. berthetii. Species identification was confirmed through sequencing of the internal transcribed spacer region of ribosomal DNA. Antifungal susceptibility testing, performed using the the European Committee on Antimicrobial Susceptibility Testing (EUCAST) microbroth dilution method, revealed high minimal inhibitory concentrations (MICs) to fluconazole and anidulafungin but low MICs for amphotericin B. Despite switching to liposomal amphotericin B, the infant progressed to multiple organ dysfunction and died. The poor clinical outcome was attributed to both the severity of underlying conditions associated with candidemia and the delay in starting adequate antifungal therapy. Conclusion This case broadens the current understanding of rare yeast pathogens and highlights the critical need for improved diagnostic tools to accurately detect and identify uncommon Candida species. Clinicians should remain vigilant to the emergence of rare yeast pathogens causing fungemia, especially among immunosuppressed hosts undergoing invasive medical procedures and prolonged exposure to broad-spectrum antimicrobials. KEYWORDS Candida berthetii, rare yeast pathogens, invasive fungal infections, antifungal resistance, candidemia I nvasive fungal infections in neonates, particularly in premature infants with complex medical conditions, pose significant challenges in both diagnosis and treatment (1, 2) . Rare and emerging Candida species have been increasingly associated with these infections, but there remains a lack of detailed documentation regarding their clinical impact and antifungal susceptibility (3, 4) . Candida berthetii (Boidin, Pignal, Mermiér & Arpin), first described in 1963 from an isolate found in gum arabic from a forest tree, was later identified in the ambrosia beetle Xyleborus volvulus (5, 6) . Notably, this species has not been documented in wildlife animals or humans, highlighting challenges in understanding its ecological niche and its potential role in human infections. This study describes the first case of human systemic infection caused by C. berthetii in a premature neonate, who developed a persistent bloodstream infection despite antifungal therapy. Editor Ritu Banerjee, Vanderbilt University Medical Center, Nashville, Tennessee, USA Address correspondence to Arnaldo L. Colombo, [colomboal@terra.com.br](colomboal@terra.com.br). A. L. C. has received educational grants from Sandoz, Mundipharma, United Medical-Knight, Gilead, and IMMY. The other authors report no conflicts of interest. CASE PRESENTATION A preterm male neonate, the first of a twin pregnancy, was transferred to the neonatal intensive care unit (NICU) of a tertiary care center with 6 days of life for the surgical management of hypoplastic left heart syndrome (HLHS). The infant was born at 28 weeks via an emergency cesarean section due to preterm labor triggered by congenital heart disease, with a birth weight of 1,610 g and Apgar scores of 7 and 6 at 1 and 5 min, respectively. Intrauterine diagnosis of HLHS was established by fetal echocardiography. During the first 7 days of NICU admission, the infant remained intubated and received empirical broad-spectrum antibiotics to treat a putative clinica

FAQs

What was the key diagnosis in the reported case?

The preterm infant developed persistent candidemia due to Candida berthetii, confirmed by sequencing of the internal transcribed spacer region of ribosomal DNA.

How did antifungal susceptibility results influence therapy?

EUCAST microbroth dilution testing showed high MICs to fluconazole and anidulafungin but low MICs to amphotericin B, leading to a switch to liposomal amphotericin B.

Why was the clinical outcome poor?

The case describes death after progression to multiple organ dysfunction, attributed to the severity of underlying conditions associated with candidemia and delays in starting adequate antifungal therapy.

Sep 29, 2026

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