Candida Septicemia and Right Atrial Mass Secondary to Umbilical Vein Catheterization

Abstract

tract. Infants with suspected congen¬ ital candidiasis should be considered as candidates for systemic antifungal therapy in the following situations that either indicate the presence or increase the risk of disseminated dis¬ ease: (1) evidence of respiratory dis¬ tress or other laboratory or clinical signs of sepsis in the immediate neo¬ natal period; (2) birth weight less than 1,500 g; (3) treatment with broad-spec¬ trum antibiotics; (4) extensive instru¬ mentation during delivery or invasive procedures in the neonatal period, which would allow systemic invasion of organisms, eg, indwelling vascular catheters; (5) positive systemic (blood, CSF, or urine) cultures; and (6) evi¬ dence of an altered immune response.Systemic therapy, if initiated, should include both amphotericin and flucytosine, pending the determi¬ nation of the sensitivities of the orga¬ nisms to the latter drug. Administra¬ tion of amphotericin is often asso¬ ciated with severe toxic reactions in older children and adults, but reac¬ tions in infancy are less common if the drug is instituted at a low dosage, 0.1 mg/kg/day, and increased gradually to final levels of 0.5 to 1.0 mg/kg/ day.2325 No specific side effects of flucytosine have been noted in infan¬ cy at dosages ranging from 50 to 200 mg/kg/day.25 Blood levels of both drugs should be monitored during therapy.The appropriate care of these infants requires consideration of a number of factors. With appropriate integration of the maternal history, symptomatology, physical examina¬ tion, laboratory results, and risk fac¬ tors, appropriate decisions regarding therapy and care can be made.

Intravascular Catheter Complications in the Neonatal Intensive Care Unit

“…UVC catheters also can be the source of bacteremia and sepsis. These infections are similar to those of other catheters, although UVCs are associated with an increased risk of localized infections of the liver [51] and heart [52,53].…”

An unusual right atrial mass in a two-month old infant

“…According to one study, lesions were observed on the tricuspid valve by cross-sectional echocardiography in 5 neonates, 4 of whom presented with fetal distress 6 . Other reports noted that candida septicaemia, and right atrial masses, may emerge secondary to umbilical venous catheterization 4 , 7 , 8 . These reports, taken together, indicating that all such factors should be considered as the predisposing factors of Candida endocarditis.…”

Infections of the Newborn

“…Abdominal masses may indicate focal Candida abscesses as well. 224 Antifungal Therapy. Having performed the above examinations, it is wise to begin amphotericin B therapy.…”