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Progressive thrombocytopenia as the harbinger of occult invasive candidiasis in a moderate preterm infant
Dexiang Wang1, Yuehang Geng1, Li Li1
1Children's Medical Center, Peking University First Hospital, Beijing, China.
Abstract:
Invasive fungal infection is among the top causes of late-onset sepsis in preterm infants. Typical signs of infection are often absent, making the recognition of subtler signs critical for diagnosis. We report the case of a moderate preterm infant born to a mother with chorioamnionitis following prolonged preterm premature rupture of membranes and a prolonged course of antenatal antibiotics. On day 6, the infant exhibited recurrent non-specific symptoms which were often attributed to prematurity while the infant remained persistently afebrile. Profound progressive thrombocytopenia in the absence of overt fever prompted evaluation for fungal sepsis. Candida tropicalis was identified by blood culture and plasma targeted next-generation sequencing. A guideline-adherent antifungal regimen led to subsequent improvement.This case underscores that in moderate preterm infants presenting with non-specific symptoms and significant thrombocytopenia, even in the absence of fever, prompt evaluation for fungal sepsis is warranted. It also suggests that incorporating the duration of maternal antenatal antibiotic exposure into risk assessment could potentially help identify moderate preterm infants who might benefit from antifungal prophylaxis.
Insights
Invasive fungal infections in preterm infants can be subtle. Early detection of non-specific symptoms like thrombocytopenia, even without fever, is crucial for timely diagnosis and treatment of fungal sepsis.
Area of Science:
- Neonatology
- Infectious Diseases
- Medical Mycology
Background:
- Invasive fungal infections are a significant cause of late-onset sepsis in preterm infants.
- Subtle clinical signs often complicate early diagnosis, necessitating heightened clinical suspicion.
- Chorioamnionitis and prolonged maternal antenatal antibiotic exposure are potential risk factors.
Purpose of the Study:
- To highlight the importance of considering fungal sepsis in moderate preterm infants with non-specific symptoms and thrombocytopenia.
- To emphasize the diagnostic value of blood cultures and next-generation sequencing in identifying fungal pathogens.
- To suggest potential risk stratification strategies for antifungal prophylaxis.
Main Methods:
- Case report of a moderate preterm infant with suspected fungal sepsis.
- Utilized blood culture and plasma targeted next-generation sequencing for pathogen identification.
- Administered guideline-adherent antifungal therapy.
Main Results:
- Identified *Candida tropicalis* as the causative agent of fungal sepsis.
- Observed significant improvement following appropriate antifungal treatment.
- Demonstrated the utility of next-generation sequencing in diagnosing rare fungal infections.
Conclusions:
- Prompt evaluation for fungal sepsis is warranted in moderate preterm infants presenting with non-specific symptoms and profound thrombocytopenia, irrespective of fever.
- Maternal antenatal antibiotic exposure duration may inform risk assessment for fungal prophylaxis in preterm infants.
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