Successful Management of an Extremely Premature Infant with Congenital Candidiasis

Abstract

Congenital candidiasis, which presents with a variety of clinical symptoms, is very rare in both term and preterm infants, and less than 100 neonatal cases have been reported in the medical literature. We describe the case of an extremely premature infant with congenital candidiasis, who was successfully treated and survived without major sequelae. A male infant was born at 25 weeks' gestation (weight, 834 g). He exhibited diffuse erythematous papules. Samples of his skin, pharyngeal mucus, gastric fluid, and tracheal aspirate were found to be Candida albicans—positive while blood cultures were negative. Further histopathological examinations revealed that Candida albicans mycelia had invaded the umbilical cord. After prompt antifungal therapy, the patient's skin lesions improved markedly, and he was discharged from hospital without any major complications. This report highlights the importance of characteristic skin lesions for the early diagnosis of Candida infections, especially in extremely premature infants.

Keywords

congenital candidiasis - candida albicans - chorioamnionitis - erythematous papule - extremely premature infant

• References

• 1 Van Winter JT, Ney JA, Ogburn Jr PL, Johnson RV. Preterm labor and congenital candidiasis. A case report. J Reprod Med 1994; 39 (12) 987-990
• 2 Darmstadt GL, Dinulos JG, Miller Z. Congenital cutaneous candidiasis: clinical presentation, pathogenesis, and management guidelines. Pediatrics 2000; 105 (2) 438-444
• 3 Johnson DE, Thompson TR, Ferrieri P. Congenital candidiasis. Am J Dis Child 1981; 135 (3) 273-275
• 4 Rode ME, Morgan MA, Ruchelli E, Forouzan I. Candida chorioamnionitis after serial therapeutic amniocenteses: a possible association. J Perinatol 2000; 20 (5) 335-337
• 5 Wolach B, Bogger-Goren S, Whyte R. Perinatal hematological profile of newborn infants with candida antenatal infections. Biol Neonate 1991; 59 (1) 5-12
• 6 Ozkiraz S, Tarcan A, Gokmen Z, Gürakan B, Bilezikci B, Ozbek N. Invasive Candida albicans infection mimicking leukemia in a neonate. J Matern Fetal Neonatal Med 2007; 20 (7) 555-557
• 7 Cotch MF, Hillier SL, Gibbs RS, Eschenbach DA ; Vaginal Infections and Prematurity Study Group. Epidemiology and outcomes associated with moderate to heavy Candida colonization during pregnancy. Am J Obstet Gynecol 1998; 178 (2) 374-380
• 8 Berry DL, Olson GL, Wen TS, Belfort MA, Moise Jr KJ. Candida chorioamnionitis: a report of two cases. J Matern Fetal Med 1997; 6 (3) 151-154
• 9 Ito F, Okubo T, Yasuo T , et al. Premature delivery due to intrauterine Candida infection that caused neonatal congenital cutaneous candidiasis: a case report. J Obstet Gynaecol Res 2013; 39 (1) 341-343
• 10 Manzoni P, Stolfi I, Pugni L , et al; Italian Task Force for the Study and Prevention of Neonatal Fungal Infections; Italian Society of Neonatology. A multicenter, randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med 2007; 356 (24) 2483-2495
• 11 Makhoul IR, Bental Y, Weisbrod M, Sujov P, Lusky A, Reichman B ; Israel Neonatal Network. Candidal versus bacterial late-onset sepsis in very low birthweight infants in Israel: a national survey. J Hosp Infect 2007; 65 (3) 237-243
• 12 Pinhat EC, Borba MG, Ferreira ML , et al. Fungal colonization in newborn babies of very low birth weight: a cohort study. J Pediatr (Rio J) 2012; 88 (3) 211-216