Candidemia Masked by Multiple Comorbidities and Identified by MALDI-TOF: A Diagnostic Challenge

Case RepoRtmicturition for the past 2 months, high-grade fever (103C) and swelling in the left knee joint for 10 days, and 4-5 episodes of loose stools.The child was a preterm breech, delivered by lower segment cesarean section (LSCS), and had been in the neonatal ICU care for 6 days.He had undergone arthrotomy for septic arthritis in a private hospital at Prayagraj.The child was immunized to date.Laboratory investigations showed leukocytosis (total leukocyte count of 64.200/L, polymorphs (86%), anemia (hemoglobin of 9.3 gm/dL), and a positive C-reactive protein.Renal function was evaluated, and blood urea (76 mg/dL) and serum creatinine (1.46 mg/dL) were both elevated.He was tested for COVID-19 since IntroductIonCandida auris, an opportunistic yeast infection, was first detected in a patient's ear discharge in Japan in 2009. 1 Since the onset of the COVID-19 pandemic, there has been an increase in its prevalence, with cases reported in 47 countries spanning six continents. 2 Currently, the prevalence of C. auris is 5-30% among patients with candidemia. 3In India, of all Candida spp.isolates in intensive care unit (ICU) settings as skin or urinary tract colonization, it is estimated to be 5.2%. 4 C. auris is an emerging, dangerous threat in the public health sectors due to the ease of nosocomial spread among patients, healthcare workers (HCW), from contaminated surroundings or equipment.This pathogen predominantly targets the bloodstream, but it can also affect wounds, pleural effusions, pericarditis, osteomyelitis, malignant otitis media, intra-abdominal infections, and vulvovaginitis.Additionally, risk factors for infection include central venous catheter use, recent surgery, diabetes, a weak immune system, and prolonged use of broad-spectrum antibiotics or antifungals.This species is often resistant to multiple drugs, including azoles, echinocandins, and Amphotericin B. Specialized laboratory techniques are necessary to rapidly and accurately identify C. auris to overcome challenges in its detection, outbreak management, and control. 5,6In the present study, we report a case of a child with kidney disease and multiple coexisting risk factors who recovered from septicemia due to early microbiological diagnosis and appropriate treatment. case descrIptIon