Congenital Sepsis with Candida albicans—A Rare Event in the Neonatal Period: Report of Two Cases and Literature Review
Abstract
:1. Introduction
2. Material and Methods
2.1. Case Reports
2.1.1. Case Report 1
Medical History
Initial Assessment, Hematology, and Radiology Investigations
Microbiology Investigations, Treatment
Clinical Course and Outcome
2.1.2. Case Report 2
Medical History
Initial Assessment, Investigations, and Management
Microbiology Investigations and Treatment
Clinical Course, Complications, and Outcome
2.2. Review of the Literature
3. Discussion
3.1. General Aspects
3.1.1. Epidemiological Aspects
3.1.2. Classification
3.1.3. Etiology
3.1.4. Risk Factors
3.1.5. Risk Factors for Invasive Congenital Candidiasis
3.1.6. Comments on Reported Cases
3.2. Physiopathology
3.2.1. Transmission Pathways
3.2.2. Comments on Reported Cases
3.3. Clinical Aspects
3.3.1. Cutaneous Involvement
3.3.2. Systemic Involvement
3.3.3. Comments on Reported Cases
3.4. Diagnosis
3.4.1. Suspected Candidiasis at Birth
3.4.2. Blood Culture
3.4.3. Other Laboratory Investigations
3.4.4. Imaging
3.4.5. Differential Diagnosis
3.4.6. Comments on Reported Cases
3.5. Treatment
3.5.1. General Aspects
3.5.2. Antifungals
3.5.3. Supportive Treatment
3.5.4. Comments on Reported Cases
3.6. Clinical Course and Complications
3.6.1. General Aspects
3.6.2. Comments on Reported Cases
3.7. Prevention
4. Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patient 1 | Patient 2 | |
---|---|---|
Gestational age | 39 weeks | 28 weeks |
Birth weight | 3600 g | 1250 g |
Maternal history | Vaginal discharge and genital itching one week before delivery | 132 h of membrane rupture, intravenous ampicillin for 5 days, associated with ceftriaxone at birth |
Maternal vaginal cultures | No pathogen growth at admission in our unit (2nd day after delivery) | No pathogen growth 5 days before delivery, C. albicans was isolated in cultures sampled at birth |
Clinical onset | At birth, with characteristic rash | The 4th day, respiratory distress syndrome |
Clinical course | No other signs or symptoms suggestive of sepsis, rash entirely resolved by DOL 13 | Re-initiated respiratory support (after initial treatment for respiratory distress syndrome due to surfactant deficiency with Bubble CPAP and surfactant), weaned on HHHFNC on DOL 15, oxygen-independent at DOL 41 |
Complications | None | Hepatic and renal involvement |
Discharge | DOL 24 | DOL 58 |
Follow up | Normal growth and development at the age of 2 | Recently discharged, follow-up scheduled |
Patient 1 | Patient 2 | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
12 h | Day 1 | Day 3 | Day 12 | Day 17 | 12 h | Day 1 | Day 2 | 86 h | Day 5 | Day 10 | Day 15 | Day 20 | |
Blood count and differential | |||||||||||||
Platelets (103/µL) (range 150,000–400,000) ‡ | 434 | 412 | 389 | 354 | - | - | 374 | - | - | 331 | 356 | - | - |
Leucocytes (/µL) (range 9000–26,000) ‡ | 17,440 | 14,430 | 11,280 | 9760 | - | - | 23,300 | - | - | 21,240 | 15,050 | - | - |
Neutrophils (/µL) (range 2700–14,400) ‡ | 10,580 | 7540 | 6820 | 5730 | - | - | 15,090 | - | - | 14,350 | 9030 | - | - |
Monocytes (%) (range 0–2%) ‡ | 1.4 | 12 | 12.5 | 4.1 | - | - | 8.4 | - | - | 9.5 | 5 | - | - |
Inflammatory markers | |||||||||||||
C-RP (mg/L) (normal value < 5 mg/L) | 19.38 | 8.3 | 7.4 | 1.6 | 3.1 | 2.1 | 1.3 | <1 | 41.4 | 36.6 | 14.3 | 12.5 | 2.9 |
Biochemistry | |||||||||||||
Blood glucose (mg/dL) (range 40–60 mg/dL 0–24 h, 40–100 mg/dL > 24 h of life) | 63.1 | 74 | 85 | - | - | 59 | 77 | 57 | 123 | 49 | 87 | 89 | 78 |
AST (U/L) (range 11–70 U/L) | 38.4 | 34 | 29 | 27 | 15 | 29 | 29 | 114 | 107 | 87 | 20 | 27 | 28 |
ALT (U/L) (range 0–70 U/L | 13.3 | 16 | 18 | 15 | 14 | <7 | <7 | 14 | 21 | 22 | 9 | 8 | 9 |
Creatinine (mg/dL) (range 0.31–0.53 mg/mL) | 1.01 | 0.61 | 0.52 | 0.54 | 0.45 | 0.52 | 0.85 | 0.97 | 1.15 | 1.25 | 0.91 | 0.75 | 0.54 |
BUN (mg/dL) (range 11–36 mg/mL) | 30.5 | 12 | 13 | 15 | 24 | 24 | 63 | 83 | 79 | 74 | 37 | 26 | 19 |
Total bilirubin (mg/dL) § | 3.4 | 4.3 | 5.5 | 1.2 | 0.17 | 2.3 | 4.6 | 6.8 | 6.9 | 6.9 | 1.7 | - | - |
Imaging | |||||||||||||
Thoraco-abdominal radiography | No lung or abdominal involvement | Suggestive of respiratory distress syndrome due to surfactant deficiency on DOL 0; pronounced reticular, micronodular bilateral lung interstitium on DOL 5 | |||||||||||
Abdominal ultrasound | Abdominal situs inversus on DOL 2; no abdominal parenchymal involvement on DOL 2 and 10 | Gross, inhomogenous, patchy echogenic areas disseminated, almost throughout the entire liver on DOL 9; fine granular echogenic areas limited to the fourth hepatic segment by DOL6 14; normal hepatic ultrasound structure on DOL 45 | |||||||||||
Doppler echocardiography | Small PDA, PFO, right-sided aortic arch (DOL 1) | Small PDA, PFO on DOL 4 and 14 | |||||||||||
Microbiology | |||||||||||||
Blood culture | Positive for C. albicans at admission, no growth at 14 days | Positive for C. albicans on DOL 0 and 11, negative on DOL 18 | |||||||||||
Nasal swab culture | No pathogen identified | No pathogen identified on DOL 4 and 18 | |||||||||||
Gastric aspirate | No pathogen identified | C. albicans isolated on DOL 0, and 4, no pathogen growth on DOL 18 | |||||||||||
Pharyngeal culture | No pathogen identified | C. albicans isolated on DOL 4, no pathogen growth on DOL 18 | |||||||||||
Umbilical line tip culture | C. albicans (in situ for 2 days) | C. albicans (in situ for 5 days) |
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Teacoe, D.A.; Cormoș, R.C.; Toma, D.A.; Ștef, L.; Cucerea, M.; Muțiu, I.; Chicea, R.; Popescu, D.; Chicea, E.D.; Boicean, A.G.; et al. Congenital Sepsis with Candida albicans—A Rare Event in the Neonatal Period: Report of Two Cases and Literature Review. Microorganisms 2024, 12, 1869. https://doi.org/10.3390/microorganisms12091869
Teacoe DA, Cormoș RC, Toma DA, Ștef L, Cucerea M, Muțiu I, Chicea R, Popescu D, Chicea ED, Boicean AG, et al. Congenital Sepsis with Candida albicans—A Rare Event in the Neonatal Period: Report of Two Cases and Literature Review. Microorganisms. 2024; 12(9):1869. https://doi.org/10.3390/microorganisms12091869
Chicago/Turabian StyleTeacoe, Dumitru Alin, Roxana Cristina Cormoș, Diana Adela Toma, Laura Ștef, Manuela Cucerea, Irina Muțiu, Radu Chicea, Dragoș Popescu, Eugen Dan Chicea, Adrian Gheorghe Boicean, and et al. 2024. "Congenital Sepsis with Candida albicans—A Rare Event in the Neonatal Period: Report of Two Cases and Literature Review" Microorganisms 12, no. 9: 1869. https://doi.org/10.3390/microorganisms12091869