Clinical Significance of Candida tropicalis in Pediatric Patients with Invasive Candidiasis

To the Editors: We read with great interest the recent article by Said et al.1 on Candida infections in pediatric patients with hematologic malignancies. Given the increasing prevalence of non-albicans Candida (NAC) species and their associated poor prognosis, we would like to contribute additional insights based on our analysis of pediatric patients with invasive Candida infections. Our data highlight notable differences between infections caused by Candida albicans and Candida tropicalis in children. Among 75 patients with invasive Candida infections, C. tropicalis accounted for 13 cases (17.3%), while C. albicans was responsible for 62 cases (82.7%) (Fig 1). In contrast to the report by Said et. al1, most of our cases consist of patients with oncological malignancies (30.7%). Patients with C. tropicalis infection were more frequently exposed to broad-spectrum antibiotics (100% vs. 74.2%) and had a higher prevalence of central venous catheter use (92.3% vs. 83.9%). The catheter removal rate in C. tropicalis infections was 66.7%, comparable to the overall cohort.Fig 1.: Distribution of Candida albicans and Candida tropicalis among pediatric patients with invasive candidiasis.A key finding in our study was the strong association between early catheter removal and improved survival, reducing mortality risk by over 10-fold (OR = 10.48; P < 0.001). Given the link between Candida spp. infection and prolonged bloodstream infection, the role of catheter management in these patients warrants further discussion. Notably, C. tropicalis demonstrated a greater association with pediatric intensive care unit admission (46.2% vs. 38.7%) and overall mortality (38.5% vs. 29%), underscoring its potential for more severe disease progression. In a systematic review, all-cause mortality due to invasive C. tropicalis infections was 55%–60%.2 Interestingly, our findings regarding C. tropicalis-related mortality (38.5%) appear to be higher than the overall 12-week crude mortality rate (11.8%) reported in the study by Said et al.1 These discrepancies may be attributed to differences in patient populations, underlying risk factors, or the inclusion of more critically ill patients in our cohort. Additionally, while Said et al.1 highlighted C. glabrata as having a particularly poor prognosis, our data suggest that C. tropicalis also carries a significant mortality risk, reinforcing the need for close monitoring and aggressive management strategies. Like the findings of Said et al.1 candidemia was the most common manifestation in both groups, although C. tropicalis was associated with a higher frequency of pneumonia (7.7% vs. 4.8%) and a slightly longer treatment duration (median 20 days, IQR, 14–38 vs. 20 days, IQR 14–25). These findings align with previous studies suggesting C. tropicalis as a more invasive pathogen with a predilection for hematogenous dissemination.3 Regarding antifungal susceptibility, C. tropicalis demonstrated 100% susceptibility to echinocandins and 88.9% susceptibility to fluconazole and voriconazole in our cohort. Similarly, Said et al.1 reported an increasing trend in minimum inhibitory concentration levels for fluconazole and voriconazole. Previous studies have reported C. tropicalis resistance rates of up to 25%, highlighting the variability in antifungal susceptibility across different settings.4,5 These findings emphasize the importance of species–specific antifungal selection. The findings reported by Said et al.1 align with broader global trends observed in our study, underscoring the need for ongoing surveillance, species–specific therapeutic approaches, and early catheter management strategies to optimize clinical outcomes.