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Semin Thromb Hemost
DOI: 10.1055/a-2564-7613
Review Article

Hemostatic Manifestations of Invasive Fungal Infections: A Comprehensive Review of Pathophysiological Mechanisms in Sepsis-Induced Hemostatic Disturbances, with a Focus on the Neonatal Population

Alexandra Lianou 
1   Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece
,
Andreas G. Tsantes 
2   Microbiology Department, “Saint Savvas” Oncology Hospital, Athens, Greece
3   Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Daniele Piovani
4   Department of Biomedical Sciences, Humanitas University, Milan, Italy
5   IRCCS Humanitas Research Hospital, Milan, Italy
,
Stefanos Bonovas 
4   Department of Biomedical Sciences, Humanitas University, Milan, Italy
5   IRCCS Humanitas Research Hospital, Milan, Italy
,
Irma MD Lapaj
6   Salus Hospital, Tirane, Albania
,
Eleni A. Gounari
7   Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
,
Argirios E. Tsantes
3   Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Nicoletta Iacovidou
7   Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
,
Rozeta Sokou 
7   Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
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Abstract

Sepsis is a life-threatening condition that has challenged many clinicians over the years. The immune and hemostatic systems are the primary pillars of sepsis pathogenesis. Dysregulation of these intricate mechanisms significantly worsens the prognosis. Coagulopathy is a critical aspect of sepsis, with the degree of hemostatic impairment being a key determinant of poor outcomes. Although the concept of sepsis caused by bacteria has been well investigated, the fungal impact in the complexity of sepsis-related hemostatic derangement is not yet fully unraveled. In addition, sepsis occurs in patients across all age groups, with a particular concern for neonates, whose immature and vulnerable systems amplify the challenges. Notably, despite the high incidence of fungal septicemia in neonatal intensive care units (NICUs), along with its significant morbidity, mortality, and adverse neonatal outcomes, the impact of fungal sepsis on the neonatal hemostatic system—an essential determinant of prognosis—remains largely unexplored. The present review delves into the pathophysiologic mechanisms of sepsis-induced coagulopathy attributed to fungal infection, the mechanisms of fungal involvement in the hemostatic derangement, and attempts to contextualize this knowledge within the unique neonatal population. Finally, it aims to raise awareness of the critical need for a deep understanding of this hazardous condition to guide the development of optimal therapeutic strategies.

Keywords

hemostasis - fungal infections - platelets - sepsis-induced coagulopathy - neonates


Publication History

Received: 29 December 2024

Accepted: 21 March 2025

Accepted Manuscript online:
24 March 2025

Article published online:
17 April 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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