Abstract
BACKGROUND: Fungal infection can be a significant complication for the critically ill neonate. However, the usefulness of extensive radiologic and ophthalmologic investigations in this population has not been thoroughly elucidated.
OBJECTIVE: To report the incidence of organ fungal involvement diagnosed by ancillary testing (echocardiogram, ophthalmologic examination, brain imaging, and renal ultrasound (RUS)) among neonatal intensive care unit (NICU) patients with Candida infection.
METHODS: This was a single center review of all NICU patients with Candida-positive cultures of blood, urine, peritoneal fluid, endotracheal tube aspirate, or cerebrospinal fluid from January 1, 1997 to June 1 2002. Data regarding the number of positive cultures, species isolated, and presence of specific risk factors and clinical symptoms were recorded for each case, as well as occurrence, timing and results of ancillary testing.
RESULTS: In all, 66 patients had at least one positive culture for Candida. The majority (71%) were <1500 g at birth, and mean gestational age was 29.5±5.6 weeks. Echocardiograms were obtained in 54/66 (82%), and ophthalmology examinations were obtained in 36/66 (55%); none of these was consistent with fungal involvement. Brain imaging was performed in 50/66 (76%), only one of which was positive, in a patient with 16 positive blood cultures for Candida albicans. RUS were performed in 58/66 (88%) of patients, with concerning findings for fungal involvement in seven of the studies. RUS findings alone did not appear to consistently influence the length of therapy.
CONCLUSIONS: Ancillary evaluations to investigate for fungal dissemination were undertaken frequently, but were of overall low yield. Although ancillary testing may be of limited additional value in centers with a low threshold for suspecting fungal infections and an aggressive approach to therapy, potentially important findings, which could impact management, may occur.
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References
Stoll BJ, Gordon T, Korones SB, et al. Late-onset sepsis in very low birth weight neonates; a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129:63–71.
Lee BE, Cheung P, Robinson JL, Evanochko C, Robertson CM . Comparative study of mortality and morbidity in premature infants (birth weight <1250 g) with candidemia or candidal meningitis. Clin Infect Dis 1998;27:559–565.
Saiman L, Ludington E, Dawson JD, et al. Risk factors for Candida species colonization of neonatal intensive care unit patients. Pediatr Infect Dis J 2001;20:1119–1124.
Baley JE, Kleigman RM, Fanaroff AA . Disseminated fungal infections in very low-birth-weight infants; clinical manifestation and epidemiology. Pediatrics 1984;73:144–152.
Johnson DE, Thompson TR, Green TP, Ferrieri P . Systemic candidiasis in very low birth weight infants (<1500 grams). Pediatrics 1984;73:138–143.
Faix RG . Systemic candida infections in infants in intensive care nurseries: high incidence of central nervous system involvement. J Pediatr 1984;105:616–622.
Makhoul IR, Kassis I, Smolkin T, Tamir A, Sujov P . Review of 49 neonates with acquired fungal sepsis: further characterization. Pediatrics 2001;107:61–66.
Benjamin Jr DK, Ross K, McKinney Jr RE, et al. When to suspect fungal infection in neonates: A clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia. Pediatrics 2000;106:712–718.
El-Masry FA, Neal TJ, Subhedar NV . Risk factors for invasive fungal infection in neonates. Acta Paediatr 2002;91:198–202.
Shah GK, Vander J, Eagle RC . Intralenticular Candida species abscess in a premature infant. Am J Ophthalmol 2000;123:390–391.
Stern JH, Calvano C, Simon JW . Recurrent endogenous candidal endophthalmitis in a premature infant. J Am Assoc Pediatr Ophthalmol Strabismus 2001;5:50–51.
Johnston TW, Cogen MS . Systemic candidiasis with cataract formation in a premature infant. J Am Assoc Pediatr Ophthalmol Strabismus 2000;4:386–388.
Clinch TE, Duker JS, Eagle Jr RC, Calhoun JH, Ausburger JJ, Fischer DH . Infantile endogenous candida endophthalmitis presenting as a cataract. Surv Ophthalmol 1989;34:107–112.
Drohan L, Colby CE, Brindle ME, Sanislo S, Ariagno RL . Candida (amphotericin-sensitive) lens abscess associated with decreasing arterial blood flow in a very low birth weight preterm infant. Pediatrics 2002;110:e65.
Benjamin Jr DK, Fisher RG, McKinney Jr RE, Benjamin DK . Candidal mycetoma in the neonatal kidney. Pediatrics 1999;104:1126–1129.
Gubbinw PO, Piscitelli SC, Danzinger LH . Candidal urinary tract infections: a comprehensive review of their diagnosis and management. Pharmacotherapy 1993;13:110–127.
Bryant K, Maxfield C, Rabalai G . Renal candidiasis in neonates with candiduria. Peditr Infect Dis J 1999;18:959–963.
Mayayo E, Moralejo J, Camps J, Guarro J . Fungal endocarditis in premature infants: case report and review. Clin Infect Dis J 1996;22:366–368.
Faix RG, Feick HJ, Frommelt P, Snider AR . Successful medical treatment of Candida parapsilosis endocarditis in a premature infant. Am J Perinatol 1990, 272–275.
Mogyorosy G, Soos G, Nagy A . Candida endocarditis in a premature infant. J Perinat Med 2000;28(5):407–411.
Zenker PN, Rosenberg EM, Van Dyke RB, Rabalais GP, Daum RS . Successful medical treatment of presumed Candida endocarditis in critically ill infants. J Pediatr 1991;119:472–477.
Marcinkowski M, Bauer K, Stoltenburg-Didinger G, et al. Fungal brain abscesses in neonates: sonographic appearance and corresponding histopathologic findings. J Clin Ultrasound 2001;29:417–420.
Noyola DE, Fernandez M, Moylett EH, Baker CJ . Ophthalmologic, visceral and cardiac involvement in neonates with candidemia. Clin Infec Dis 2001;32:1018–1023.
Chapman RL, Faix RG . Persistently positive cultures and outcome in invasive neonatal candidiasis. Pediatr Infect Dis J 2000;19:822–827.
Rowen JL, Tate JM . Management of neonatal candidiasis. Pediatr Infectious Dis J 1998;17:1007–1011.
Rowen JL, Rench MA, Kozinetz CA, Adams JM, Baker CJ . Endotracheal colonization with Candida enhance risk of systemic candidiasis in very low birth weight neonates. J Pediatr 1994;124:789–794.
Faix RG . Invasive neonatal candidiasis: a comparison of albicans and parapsillosis infection. Pediatr Infect Dis J 1992;11:88–93.
Butler KM, Rench MA, Baker CJ . Amphotericin B as a single agent in the treatment of systemic candidiasis in neonates. Pediatr Infect Dis J 1990;9:51–56.
Chapman RL . Candida infections in the neonate. Curr Opin Pediatr 2003;15:97–102.
Friedman S, Richardson SE, Jacobs SE, O'Brien K . Systemic Candida infection in extremely low birthweight infants: short term morbidity and long term neurodevelopmental outcome. Pediatr Infect Dis J 2000;19:499–504.
Phillips JR, Karlowicz G . Prevalence of Candida species in hospital-acquired urinary tract infections in a neonatal intensive care unit. Pediatr Infect Dis J 1997;16:190–194.
Abraham M, Mampilly T, Paul JP, V FJ . Renal failure from obstructive fungal mycetoma and fungal sepsis in an infant. Indian Pediatrics 2002;39:769–772.
Hari P, Srivastave A, Gupta AK, Srivastava RN . Neonatal renal failure due to obstructive candidal bezoars. Pediatr Nephrol 1997;11:497–499.
Visse D, Monnen L, Feitz W, Semmekrot B . Fungal Bezoars as cause of renal insufficiency in neonates and infants-recommended treatment strategy. Clin Nephrol 1998;49:198–201.
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Colby, C., Drohan, L., Benitz, W. et al. Low Yield of Ancillary Diagnostic Studies in Neonates Infected with Candida. J Perinatol 24, 241–246 (2004). https://doi.org/10.1038/sj.jp.7211076
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DOI: https://doi.org/10.1038/sj.jp.7211076