Ophthalmologic, Visceral, and Cardiac Involvement in Neonates with Candidemia

Abstract

A retrospective review of 86 neonates with candidemia hospitalized from January 1989 through June 1999 was conducted to determine the frequency of ophthalmologic, visceral, or cardiac involvement. Retinal abnormalities were observed in 4 (6%) of the 67 infants in whom indirect ophthalmoscopy examination was performed. Abdominal ultrasound abnormalities were detected in 5 (7.7%) of 65 infants. Echocardiogram revealed thrombi or vegetations in 11 (15.2%) of 72 infants. Age at onset, presence of central venous catheters, and species of Candida were not predictors for involvement at these sites. Infants with candidemia that lasted > or =5 days were more likely to demonstrate ophthalmologic, renal, or cardiac abnormalities than those with a shorter duration. Infants with involvement of these organs received larger cumulative doses of amphotericin B than those without detectable abnormalities. Because complication of disseminated candidiasis by eye, renal, or cardiac involvement has therapeutic implications, and because risk factors for candidemia inadequately predict these complications, evaluations are indicated for all neonates with candidemia.

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

“…98 Neonatal practices that may reduce the risks of invasive candidiasis include limited use of broad-spectrum antimicrobials in hosts with documented resistant pathogens, use of an aminoglycoside instead of a cephalosporin for empiric therapy when meningitis or antimicrobial resistance is not suspected, limitation of postnatal steroid use in VLBW infants, early enteral feeding, and the establishment of the neonatal gut microbiome with human milk feeding. 24,99 Infection prevention practices in the NICU, including the utilization of trained teams with standardized practices for the insertion and care of CVCs, have been shown to reduce the incidence of catheter-related infections. 100,101 Active surveillance of organisms associated with infection, antifungal resistance, and outcomes is important to optimize management.…”

Candidiasis invasoras en recién nacidos: diagnóstico, tratamiento y prevención

“…Se han encontrado alteraciones en la ecografía renal (bolas fúngicas o infiltración del parénquima renal) en 5% de los casos de candidemia. Un estudio ultrasonográfico inicial normal no descarta la aparición de bolas fúngicas en estudios posteriores, por lo que se recomienda seguir a estos pacientes hasta la resolución del cuadro clínico 59 . El tratamiento de las bolas fúngicas debe considerar un plazo mínimo de terapia antifúngica de cuatro semanas y mantener hasta la completa resolución de las imágenes renales o evidenciar su calcificación.…”

Management of a Case ofCandidaEndogenous Endophthalmitis in a Neonate

“…1 The incidence of endogenous candidal endophthalmitis in cases with candidemia varies from 6 to 50% but in neonates it is always the primary cause of endogenous endophthalmitis. 2,3 There is a paucity of clear-cut guidelines available for the management of neonatal candidal endophthalmitis.…”