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Intracardiac fungal masses in high-risk neonates: clinical observations
A S Daftary1, S K Patole, J S Whitehall
1Department of Neonatology, Kirwan Hospital for Women, Thuringowa, Queensland, Australia.
Abstract:
Four cases of intracardiac fungal masses occurred over 2 y amongst 7 cases of systemic candidiasis in a neonatal referral unit. The gestations and birthweights were 25, 23, 24 and 30 wk and 805, 605, 640 and 1395 g, respectively. The pedunculated, solitary right atrial masses were detected 2-17 d after diagnosing candidemia in 3 cases, whereas it was the presenting feature in the 4th. All had indwelling right atrial catheters and received multiple courses of broad-spectrum antibiotics. The masses were removed successfully in two cases fit for surgery. None survived despite antifungal therapy, including liposomal amphotericin B at 6 mg/kg/d. Early introduction of enteral feeds, minimization of prolonged exposure to broad-spectrum antibiotics and judicious use of central catheters may reduce the incidence of systemic candidiasis in high-risk neonates. Surveillance echocardiography and timely surgical intervention may reduce the mortality and/or morbidity related to intracardiac fungal masses.
Insights
Systemic candidiasis in neonates can lead to dangerous intracardiac fungal masses. Despite treatment, mortality remains high, highlighting the need for preventative strategies and early interventions.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Cardiology
Background:
- Systemic candidiasis is a serious concern in neonatal intensive care units.
- Intracardiac fungal masses are a rare but severe complication of candidemia.
Observation:
- Four cases of intracardiac fungal masses were observed in neonates over two years.
- These masses were associated with indwelling central venous catheters and broad-spectrum antibiotic use.
- Masses were typically located in the right atrium and detected days after candidemia diagnosis.
Findings:
- Despite antifungal therapy and surgical removal in some cases, all neonates with intracardiac fungal masses in this series died.
- Risk factors included prematurity, low birthweight, and prolonged use of central catheters and antibiotics.
Implications:
- Preventative measures such as judicious catheter use and minimizing broad-spectrum antibiotics are crucial.
- Early detection through surveillance echocardiography and prompt surgical intervention may improve outcomes for neonatal intracardiac fungal masses.