Background: Advances in neonatal management have led to considerable improvement in new-born survival. The objective of this study was to determine the predominant organisms, antifungal sensitivity patterns and clinical risk factors in neonatal fungal blood stream infection cases (BSI) admitted to our hospital.Methods: This is a retrospective study of all neonatal fungal BSI cases between January 2015 to December 2015.Results: Fungal sepsis was found in 50/360 (13.6%) of cases. Non Albicans candida (NAC)species were responsible for 88% of cases with Candida. glabrata (54%)as the most predominant species. Other species isolated were C. tropicalis 9 (18%). C. albicans 6 (12%). C. paraspinolosis 5 (10%), C. Krusei 2 (4%) and C. Kodo1 (2%). Antifungal sensitivity results revealed that most of the NAC isolates especially candida glabrata,candida paraspinolosis were resistant to flucanazole, than Candida albicans. Amphoterician B had greater sensitivity than FLK over NAC species Among the risk factor observed for candidemia were low birth weight (62%), prematurity (60%,), broad spectrum antibiotic use (60%), ventilater support (56%) and total parentral nutrition (50%).Conclusions: The increase in neonatal fungal BSI and resistant organisms highlights the need to review use of strict infection control strategies, appropriate preventive and therapeutic measures such as prophylactic antifungal use and a restrictive policy of antibiotic use.
A seven-month old male infant presented to the emergency department with progressive distension of abdomen noticed by his parents since the age of 4 months. A disproportionate increase in size was noticed in the past 3 days. There were multiple episodes of non-projectile vomiting in the previous 2 days. There was no haematemesis or rash over the body. His weight was 7 kg and length was 66cm.On examination, he was afebrile and had massive hepatomegaly; the spleen was not palpable and there was no lymphadenopathy. Routine haemogram showed moderate anemia (7.2 g/dl) and high ESR (46 mm/1st hour). Serum aspartate transaminase was 78 IU/ml, total bilirubin 1.6 mg/dl and indirect bilirubin 1.03 while Alpha Fetoprotein (AFP) was high (302ng/ml). Abdominal CT scan showed a large mass measuring 72 x 68 mm involving almost the entire liver [Table/ Fig-1].Considering the age, clinical symptoms and radiological findings, a provisional clinical diagnosis of hepatoblastoma was made. Consent for open liver biopsy could not be obtained however needle biopsy was performed using Menghini needle and under the cover of diluted intravenous ketamine. Biopsy was immediately fixed in 10% formalin and sent for histopathological examination.Gross examination: Liver biopsy was received in two bits together measuring 10x4x4mm.
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