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  • Perinatal/Neonatal Case Presentation
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Perinatal/Neonatal Case Presentation

Fungal endocarditis

Journal of Perinatology volume 26, pages 509–510 (2006)Cite this article

Endocarditis is a rare manifestation of systemic Candidiasis in premature infants who require intensive care and often need multiple antifungal agents. Endocarditis caused by Candida is associated with high mortality and morbidity.1 Successful treatment often requires prolonged systemic antifungal therapy as well as surgical intervention.2, 3 We report a case of fungal sepsis and endocarditis in a premature infant who was successfully treated with antifungal therapy in conjunction of thrombolytic therapy without need for surgical intervention.

This male infant was born at 27 weeks gestation with birth weight 1000 g to a 22 years old G1 P0 woman with suspected chorioamnionitis. He was delivered by cesarean section owing to complete breech presentation and Apgar scores were 3, 5 and 7 at 1, 5 and 10 min after delivery. He had respiratory distress syndrome and received mechanical ventilation for 3 days. Sepsis work-up was performed at birth and intravenous ampicillin and gentamicin were given for 72 h when blood cultures were considered negative. On day 12, he had increasing respiratory distress with multiple episodes of apnea, bradycardia and arterial desaturation. He was subsequently reintubated and a complete sepsis work-up was performed. The white blood cell count was elevated to 40 000 with an increased percentage of immature polymorphonuclear cells. Intravenous Vancomycin and Cefotaxime were administered for 7 days. Again, cultures were negative for bacteria and fungi. A Broviac central catheter was inserted on day of life 20 for poor venous access and administration of total parental nutrition. Another sepsis work-up occurred on day of life 27 and again administration of intravenous Vancomycin and Cefotaxime were started, but also Amphotericin B was begun. Blood and cerebrospinal fluid cultures grew Candida albicans so the Vancomycin and Cefotaxime were discontinued. Owing to worsening of respiratory symptoms, and positive repeat fungal cultures, intravenous Fluconazole was added. Antifungal agents were administered through the Broviac catheter. Repeated blood culture from the Broviac and a peripheral vein had no bacterial growth, but did grow Candida parapsilosis.

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  1. Department of Pediatrics, Metropolitan Hospital Center, New York Medical College, New York, NY, USA

    P A Ankola, S Perveen & B Fish

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  1. P A Ankola
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Correspondence to P A Ankola.

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Ankola, P., Perveen, S. & Fish, B. Fungal endocarditis. J Perinatol 26, 509–510 (2006). https://doi.org/10.1038/sj.jp.7211557

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