Congenital Cutaneous Candidiasis: Clinical Presentation, Pathogenesis, and Management Guidelines

Abstract

We describe a term infant with congenital cutaneous candidiasis (CCC), and review all cases in the English literature that reported birth weight and outcome. Presence of an intrauterine foreign body was a predisposing factor for development of CCC and subsequent preterm birth. The most common presentation of CCC in neonates weighing >1000 g was a generalized eruption of erythematous macules, papules, and/or pustules that sometimes evolved to include vesicles and bullae. Extremely low birth weight, premature neonates weighing <1000 g most often presented with a widespread desquamating and/or erosive dermatitis (10 of 15 [67%]), and were at greater risk for systemic infection with Candida spp (10 of 15 [67%]) and death (6 of 15 [40%] than those weighing >1000 g (5 of 48 [10%]; 4 of 48 [8%], respectively). Systemic antifungal therapy is recommended for neonates with burn-like dermatitis attributable to Candida spp, or positive blood, urine, and/or cerebrospinal fluid cultures. Systemic treatment also should be considered for all infants with CCC who have respiratory distress in the immediate neonatal period and/or laboratory signs of sepsis such as an elevated leukocyte count with an increase in immature forms or persistent hyperglycemia and glycosuria.

Fluconazole treatment of intrauterine Candida albicans infection in fetal sheep

“…Intra-amniotic Candida spp. infection can cause fetal death or fetal candidiasis with impaired neurodevelopmental outcomes (10,11). Again, although vaginal Candida spp.…”

Congenital cutaneous candidiasis and candidemia in a preterm infant: A case report

“…albicans is a common vaginal pathogen found in up to 30% of pregnant women, however Candida is recovered by culture from less than 1% of placentas. [2,4,5] Known risk factors for CCC are intrauterine devices (IUD) during early pregnancy and cervical cerclage later in pregnancy. [2] Ascending infection may occur either with rupture of membranes or through intact membranes resulting in whitish plaques on membranes and umbilical cord along with skin lesions.…”

“…[2,4,5] Known risk factors for CCC are intrauterine devices (IUD) during early pregnancy and cervical cerclage later in pregnancy. [2] Ascending infection may occur either with rupture of membranes or through intact membranes resulting in whitish plaques on membranes and umbilical cord along with skin lesions. [6] Due to immaturity of the immune system and of the mucocutaneous barrier, ELBW infants are at substantially higher risk for systemic involvement than term infants.…”

“…A progression to systemic candida infection occurs in up to 50% of CCC cases in extremely low birth weight (ELBW) infants. [2] We report a case of candidemia in an ELBW infant with congential cutaneous candidiasis. It is pointed out why a high level of suspicion concerning candida sepsis can be lifesaving when a preterm infant presents with lesions suggestive of CCC at birth and how antifungal treatment should be done.…”

Candidiasis cutánea generalizada en recién nacido a término

“…Por consiguiente, para prevenir futuros casos, sería pertinente un diagnóstico precoz (11) en el momento del parto, mediante el examen y el cultivo de los anexos fetales y del líquido amniótico para descartar una corioamnionitis y una funisitis candidiásicas (14), y el tratamiento de vulvovaginitis por C. albicans si la hubiere (16). Si la candidiasis cutánea congénita fue la consecuencia de la exposición al cuadro subclínico de la madre o si, además, una infección subyacente por S. aureus favoreció su aparición, es un dato relevante que se debe tener en cuenta, dados los antecedentes revisados en la bibliografía (13,16).…”