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Systemic candidiasis and pneumonia in preterm infants
H L Loke1, I Verber, W Szymonowicz
1Department of Paediatrics, Monash Medical Centre, Clayton, Victoria, Australia.
Insights
Systemic candidiasis affects preterm infants, particularly those with very low birthweight. Early diagnosis and antifungal treatment lead to favorable outcomes, despite potential complications.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pediatric Critical Care
Background:
- Systemic candidiasis is a serious fungal infection in preterm infants.
- Very low birthweight infants are particularly vulnerable to invasive fungal infections.
- Understanding the clinical presentation and outcomes is crucial for timely intervention.
Purpose of the Study:
- To report on the clinical characteristics, diagnosis, and outcomes of systemic candidiasis in preterm infants.
- To evaluate the effectiveness and safety of antifungal therapy in this population.
- To emphasize the importance of early detection and management.
Main Methods:
- Retrospective case series of 22 preterm infants with systemic candidiasis.
- Analysis of clinical features, diagnostic methods, treatment strategies, and patient outcomes.
- Comparison of laboratory findings with bacterial infections.
Main Results:
- Fifteen infants had positive blood, CSF, or urine cultures; seven had Candida pneumonia.
- Clinical signs included instability, respiratory decline, and necrotizing enterocolitis-like symptoms.
- Mortality was 18%, with an 18% impairment rate among survivors; treatment delays were noted.
Conclusions:
- Systemic candidiasis requires a high index of suspicion in very low birthweight preterm infants.
- Early recognition and prompt antifungal therapy (amphotericin B, 5-flucytosine) are associated with favorable short- and long-term outcomes.
- Effective and safe antifungal treatment is possible, with manageable complications.
Abstract:
Twenty-two preterm infants with systemic candidiasis are reported, of which seven cases were presumed to be antenatally acquired and 15 postnatally acquired. All except one were of very low birthweight. Fifteen infants had positive cultures of blood, cerebrospinal fluid or urine and seven had candida pneumonia only. Clinical features included general instability, respiratory deterioration and a necrotizing enterocolitis-like presentation. The incidence of leukocytosis, shift to the left, eosinophilia and thrombocytopenia were not different from those with bacterial infection. The diagnosis was made after death in two infants. In the remaining 20 infants, treatment was initiated between 5 and 97 days of age, with a median delay of 4 days after the first positive cultures were taken. Complications of amphotericin and 5-flucytosine therapy which developed in five infants resolved on cessation of treatment. The mortality rate was 18% and impairment rate among the 17 very low birthweight survivors was 18%. A high index of suspicion is required for systemic candidiasis, especially in infants of less than 1000 g birthweight. If recognized early, effective and safe antifungal therapy is possible with favourable short- and long-term outcome.