Disseminated Congenital Candidiasis in a Premature Infant

Congenital Systemic Fungus Infection in Twin Prematurity—A Case Report and Literature Review

“…The fetal swallowing movement leads to colonization of the gastrointestinal (GI) tract, and the occasional deep breathing may cause aspiration of the infected amniotic fluid into the lungs. 12 Though the severity of illness varies, Candida infection of the placenta, amniotic fluid, maternal bloodstream infected, and infant skin involvement (congenital cutaneous candidiasis), in addition to infant blood, urine, or CSF involvement, should prompt treatment of both twins (or other multiples). Risk of systemic involvement increases in prematurity and low BBW infants, whose inadequate skin barrier and impaired cellular immunity may be the causes.…”

“… 7 The mortality of untreated systemic candidiasis ranges from 39 to 94%. 12 Therefore, early diagnosis and early treatment are crucial.…”

“…Once there were symptoms and signs, the clinical course was so fulminant that in-time antifungal treatment was always impossible. 1 2 12 13 14 The time to initiate of antifungal treatment is crucial for the outcome. In our review, only two cases survived from congenital candidiasis.…”

Congenital cutaneous candidiasis from an asymptomatic mother

“…This is due to incompletely developed epidermal barrier and immature immune system. [6,7] Skin lesions develop at or within 72 h of life and presents as erythematous macules which progresses to papules, vesicles and pustules on an erythematous base. The eruption usually involves trunk, extremities, diaper area, skin folds, palms and soles.…”

Picture of the Month—Diagnosis

“…10 In these pa-tients, topical antifungal agents are indicated (nystatin or azole formulations), although spontaneous resolution has also been described. 2,6 Amphotericin B (0.5-1 mg/kg/d) is the recommended antifungal agent for the treatment of candidemia and any form of invasive candidiasis in the neonate, [6][7][8][9]11,12 although lipid-associated amphotericin B preparations (3-5 mg/kg/d) are preferred in those cases with invasive candidiasis and severe preexisting renal insufficiency. Fluconazole (6-12 mg/kg/d) can be used as alternative therapy to amphotericin B, if the Candida species is identified and the susceptibility is shown.…”