Pulmonary candidiasis in infants: clinical, radiologic, and pathologic features

Area of Science:

• Medical Mycology
• Pediatric Pathology
• Infectious Diseases

Background:

• Systemic candidiasis is common in hospitalized patients, but invasive pulmonary candidiasis is rare.
• Pulmonary Candida infections are often secondary and overlooked at autopsy.
• Infants with systemic candidiasis are at risk for pulmonary involvement.

Purpose of the Study:

• To investigate the incidence and patterns of invasive pulmonary candidiasis in infants.
• To characterize the histologic findings and clinical presentation of pulmonary candidiasis in neonates.
• To evaluate the diagnostic accuracy of radiologic findings in pulmonary candidiasis.

Main Methods:

• Retrospective review of autopsy records over a 12-year period.
• Identification of infants with systemic candidiasis as a primary or major cause of death.
• Histologic examination of lung tissue to determine patterns of Candida invasion.

Main Results:

• Fifteen infants had systemic candidiasis as a primary or major cause of death, with 14 showing significant pulmonary involvement.
• Three histologic patterns were identified: embolic (arterial-invasive), disseminated (capillary-invasive), and bronchopulmonary (air space-invasive).
• Vascular catheters or infected wounds were the portal of entry in embolic cases; infections were rarely diagnosed antemortem.

Conclusions:

• Invasive pulmonary candidiasis in infants presents with distinct histologic patterns.
• Diagnosis during life is challenging, with poor correlation between radiologic and pathologic findings.
• Pulmonary candidiasis should be considered in critically ill infants with risk factors, despite diagnostic limitations.