Disseminated Fungal Infections in Very Low-Birth-Weight Infants: Clinical Manifestations and Epidemiology

Abstract

In 1979 and 1980, an apparent increase in the occurrence of disseminated fungal infections was observed. Over 24 mo., a discrete group of 10 clinically diagnosed and 4 autopsy-diagnosed cases of systemic fungal infections in very low-birth-weight infants was observed. Prior to developing systemic fungal illness, these infants required prolonged total parenteral nutrition, central arterial or venous catheters and multiple courses of broad-spectrum antibiotics for documented or suspected bacterial sepsis. The clinically diagnosed disseminated fungal infection (10 infants) was noted at a mean age of 33 days with .gtoreq. 1 of the following: respiratory deterioration, abdominal distention, guaiac-positive stools, carbohydrate intolerance, candiduria, endophthalmitis, meningitis, abscesses, erythematous rash, temperature instability and hypotension. These signs and symptoms were seen as chronic or were intermittent in clinical course. The autopsy-diagnosed disseminated fungal infection (4 infants) was present at an earlier age with fewer recognizable predisposing factors and a more acute onset of infection. In both groups the diagnosis of systemic candidal infection was delayed, due to an inability to consistently recover the organism from blood, CSF or urine. The neonatologist caring for the very low-birth-weight infant needs to become more aware of these clinical entities. A high index of suspicion and ancillary diagnostic evaluation, such as retinoscopy or tissue biopsy, may be indicated in the critically ill, culture-negative patient.