Case report of three Candida albicans infections detected at delivery

We report three similar cases of Candida albicans infections in neonates, at delivery. A retrospective study of the isolates was conducted to define the diversity of infective strains and their susceptibility to amphotericin B and fluconazole. Three neonates with fever, 'not doing well' at delivery had positive cultures for C. albicans. Samples were then taken from the mothers who did not exhibit any clinical symptoms of infection. Candida albicans strains isolated from both neonates and mothers were cultured, six colonies of each were typed by multilocus enzyme electrophoresis. The E-test method was used to determine the susceptibility of each colony to the two antifungals commonly used in this unit: amphotericin B and fluconazole. The initial isolates were composed of different types of strains. In the three cases, one of the mother types was found in the neonate isolates, leading us to suggest a vertical transmission of strains. All of the other types were distinct. All of the types were susceptible to amphotericin B, although three of them, one type isolated from a neonate and two types isolated from the mother, were resistant to fluconazole. The diversity of infective strains remains alarming and encourages the consideration of several colonies per isolate or several isolates, when it is possible, per infection case. This study also points out the need to survey the susceptibility of infective strains, since some of them appear soon to be resistant to fluconazole.