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Intra-amniotic Candida albicans Infection Treated With Liposomal Amphotericin B With a Successful Neonatal Outcome

Norma Urbano Gutiérrez1, María José Vergara López1, Camila Álvarez Bustos1

  • 1Departamento de Obstetricia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Open Forum Infectious Diseases
|February 19, 2024
PubMed

Insights

Intra-amniotic Candida infection is rare and dangerous. High-dose liposomal amphotericin B successfully treated a case, prolonging pregnancy and resulting in a healthy newborn despite persistent fungal presence.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Infectious Diseases

Background:

  • Intra-amniotic infection (IAI) by Candida species presents a severe obstetric complication with significant fetal risks.
  • Current management strategies for Candida IAI lack established clinical guidelines, posing therapeutic challenges.

Observation:

  • A case of Candida albicans IAI was diagnosed in a 25-week pregnant patient.
  • Treatment involved high-dose liposomal amphotericin B, leading to pregnancy prolongation to 30 weeks.

Findings:

  • Despite persistently positive amniotic fluid cultures for Candida, a healthy neonate was delivered without systemic infection.
  • Maternal and cord blood amphotericin B concentrations were significantly higher (over 30-fold) than amniotic fluid levels at delivery.

Implications:

  • High-dose liposomal amphotericin B may offer clinical protection in Candida IAI, even with incomplete fungal clearance from amniotic fluid.
  • Therapeutic drug monitoring and understanding drug distribution are crucial for managing invasive fungal infections during pregnancy.
Keywords:
Candida albicanscervical insufficiencychorioamnionitisfungal chorioamnionitisintra-amniotic infectionliposomal amphotericin B

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