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The management of fungal obstructive uropathy in neonates and infants
1Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Abstract:
Obstructive uropathy caused by upper urinary tract fungal ball formation is an uncommon but well recognized clinical entity. The clinical course and management of an infant with unilateral fungal ball obstruction is described. Ultrasound and Tc-diaminotetraethylpentacetic acid (DTPA) renal scan contributed significantly to the diagnosis and management of this patient. Complete resolution of the obstruction was achieved by treatment with intravenous amphotericin B and oral 5-fluorocytosine. The clinical course and management of 35 patients described in the literature indicate that prematurity, use of broad spectrum antibiotics, prolonged hospital stay and the use of intravascular catheters are predisposing factors. The mortality rate is 34%. Young age, small size, the presence of candidaemia and withholding antifungal therapy are poor prognostic factors. A rational plan of treatment, extrapolated from the literature, is presented which may help to reduce the mortality rate in this condition.
Insights
Infants can develop urinary tract obstruction from fungal balls. Prompt diagnosis with imaging and treatment with antifungal medications like amphotericin B can lead to complete resolution.
Area of Science:
- Pediatric Nephrology
- Mycology
- Infectious Diseases
Background:
- Fungal balls can cause obstructive uropathy, a rare but recognized condition.
- This case report details the management of an infant with unilateral fungal ball obstruction.
Observation:
- Ultrasound and Technetium-99m diethylenetriaminepentaacetic acid (DTPA) renal scans were crucial for diagnosis and management.
- The infant's obstruction resolved completely with intravenous amphotericin B and oral 5-fluorocytosine.
Findings:
- Literature review of 35 cases identified prematurity, broad-spectrum antibiotics, prolonged hospitalization, and intravascular catheters as predisposing factors.
- Mortality rate is 34%, with young age, small size, candidemia, and delayed antifungal therapy being poor prognostic indicators.
Implications:
- A structured treatment plan, derived from existing literature, is proposed to potentially decrease mortality.
- Early diagnosis and appropriate antifungal therapy are critical for favorable outcomes in pediatric fungal ball obstruction.