Recovery From Disseminated Candidiasis in a Premature Neonate

Abstract

The management of candidemia in neonates is difficult since even transient episodes of fungal septicemia may lead to widespread tissue invasion and multiple secondary complications.1-8 The patient reported here was a premature neonate receiving parenteral hyperalimentation and broad spectrum antibiotic therapy when Candida septicemia developed. The septicemia was followed by Candida arthritis, osteomyelitis, meningitis, endophthalmitis and pyelonephritis. Initial treatment with 5-fluorocytosine rapidly resulted in the emergence of resistant organisms, but prolonged therapy with a combination of amphotericin B and 5-fluorocytosine brought about a satisfactory clinical response and reversed the destructive changes observed in the eyes, bones and joints. Four months after discontinuation of antifungal therapy, the patient had a recurrence of Candida ophthalmic infection which responded to another course of amphotericin B. CASE REPORT The patient was a 1,928-gm infant born to a 33-year-old primagravida at approximately 32 weeks' gestation. The infant, who was delivered by cesarean section because of placenta previa, required intubation and resuscitation in the delivery room. Because of persistent respiratory distress and periods of apnea, the patient was transferred to the University of Minnesota Neonatal Intensive Care Unit at approximately 12 hours of age. Severe hyaline membrane disease necessitated the use of respiratory therapy, and an umbilical artery catheter was inserted to monitor blood gases. On the fifth hospital day, apnea, acidosis, and questionable pneumatosis intestinalis observed on an abdominal x-ray prompted the institution and continuance of penicillin and kanamycin therapy, although blood, urine and cerebrospinal fluid cultures remained sterile. Hyperalimentation through the umbilical arterial catheter was started on the sixth hospital day.