Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Imaging Case Report
  • Published:

Preterm neonates with candidal brain microabscesses: a case series

Journal of Perinatology volume 29, pages 323–326 (2009)Cite this article

Candida infections are common in the neonatal intensive care unit (NICU) with incidence ranging from 2 to 20%.1, 2, 3 End organ infection can involve the kidneys, central nervous system (CNS), eyes, heart, bones, joints, liver and spleen. The CNS has been reported to be the second most commonly involved organ, with incidence ranging from less than 10 to 67%;4 however, head imaging looking for CNS involvement is not routinely carried out in practice.5, 6 Candida may cause meningitis, ventriculitis, endophthalmitis or parenchymal infections.7 Brain abscesses are an uncommon and serious complication of neonatal candidal sepsis, occurring in 4% of infections with a 60% combined morbidity and mortality.4, 8, 9 This may underestimate the true incidence because of failure to actively seek CNS involvement.8, 10 Neonates with CNS candidiasis have been reported to have a poor neurological outcome, making accurate diagnosis and appropriate therapy of paramount importance.9, 10 There are limited reports in the literature of brain imaging of very low birth weight (VLBW) infants with CNS Candida infection.11, 12, 13 We present three cases of VLBW infants with Candida albicans fungemia who had brain microabscesses (<3 mm) detected by head ultrasound (HUS) and magnetic resonance imaging (MRI) who were successfully treated with prolonged therapy.

A 26-week gestational age 790-gram female infant was born to a 24-year-old woman. Blood cultures were negative; however, she received 7 days of ampicillin and gentamicin.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

References

  1. Brian Smith P, Steinbach WJ, Benjamin Jr DK . Invasive Candida infections in the neonate. Drug Resist Updat 2005; 8: 147–162.

    Article  CAS  Google Scholar 

  2. Fridkin SK, Kaufman D, Edwards JR, Shetty S, Horan T . Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995–2004. Pediatrics 2006; 117: 1680–1687.

    Article  Google Scholar 

  3. Zaoutis TE, Heydon K, Localio R, Walsh TJ, Feudtner C . Outcomes attributable to neonatal candidiasis. Clin Infect Dis 2007; 44: 1187–1193.

    Article  Google Scholar 

  4. Benjamin Jr DK, Poole C, Steinbach WJ, Rowen JL, Walsh TJ . Neonatal candidemia and end-organ damage: a critical apprisal of the literature using meta-analytic techniques. Pediatrics 2003; 112: 634–640.

    Article  Google Scholar 

  5. Rowen JL, Tate JM . Management of neonatal candidiasis. Neonatal Candidiasis Study Group. Pediatr Infect Dis J 1998; 17: 1007–1011.

    Article  CAS  Google Scholar 

  6. Benjamin DK, Garges H, Steinbach WJ . Candida bloodstream infection in neonates. Semin Perinatol 2003; 27: 375–383.

    Article  Google Scholar 

  7. Faix RG, Chapman RL . Central nervous system candidiasis in the high-risk neonate. Semin Perinatol 2003; 27: 384–392.

    Article  Google Scholar 

  8. Moylett EH . Neonatal Candida meningitis. Semin Pediatr Infect Dis 2003; 14: 115–122.

    Article  Google Scholar 

  9. Fernandez M, Moylett EH, Noyola DE, Baker CJ . Candidal meningitis in neonates: a 10-year review. Clin Infect Dis 2000; 31: 458–463.

    Article  CAS  Google Scholar 

  10. Friedman S, Richardson SE, Jacobs SE, O'Brien K . Systemic Candida infection in extremely low birth weight infants: short term morbidity and long term neurodevelopmental outcome. Pediatr Infect Dis J 2000; 19: 499–504.

    Article  CAS  Google Scholar 

  11. Marcinkowski M, Bauer K, Stoltenburg-Didinger G, Versmold H . Fungal brain abscesses in neonates: sonographic appearances and corresponding histopathologic findings. J Clin Ultrasound 2001; 29: 417–421.

    Article  CAS  Google Scholar 

  12. Sanchez-Portocarrero J, Perez-Cecilia E, Corral O, Romero-Vivas J, Picazo JJ . The central nervous system and infection by Candida species. Diagn Microbiol Infect Dis 2000; 37: 169–179.

    Article  CAS  Google Scholar 

  13. Huang CC, Chen CY, Yang HB, Wang SM, Chang YC, Liu CC . Central nervous system candidiasis in very low-birth-weight premature neonates and infants: US characteristics and histopathologic and MR imaging correlates in five patients. Radiology 1998; 209: 49–56.

    Article  CAS  Google Scholar 

  14. Chesney PJ, Justman RA, Bogdanowicz WM . Candida meningitis in newborn infants: a review and report of combined amphotericin B—flucytosine therapy. Johns Hopkins Med J 1978; 142: 155–160.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Sources of support: None

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Pediatrics, University of California at San Francisco, San Francisco, CA, USA

    B A Pahud, T L Greenhow & P S Weintrub

  2. Department of Pediatrics, Kaiser Permanente, San Francisco, CA, USA

    T L Greenhow

  3. Division of Neonatology, Department of Pediatrics, University of California at San Francisco, San Francisco, CA, USA

    B Piecuch

Authors
  1. B A Pahud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T L Greenhow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B Piecuch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P S Weintrub
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B A Pahud.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pahud, B., Greenhow, T., Piecuch, B. et al. Preterm neonates with candidal brain microabscesses: a case series. J Perinatol 29, 323–326 (2009). https://doi.org/10.1038/jp.2008.201

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2008.201

This article is cited by

Search

Advanced search

Quick links