SYSTEMIC CANDIDIASIS IN VERY LOW-BIRTH-WEIGHT INFANTS (LESS-THAN 1,500 GRAMS)

Abstract

Five patients with a mean birth wt of 829 g had a diagnosis of systemic candidiasis [Candida albicans] during their stay in a newborn intensive care unit. All infants survived with minimal sequelae following aggressive early treatment with amphotericin B and 5-flucytosine. A review of these 5 extremely premature infants and 26 previously reported patients suggests the following: disseminated candidiasis is common in the absence of positive findings in blood, CSF and/or urine cultures; transient candidemia rarely resolves without therapy; meningitis and osteoarthritis occur more frequently than in older patients with disseminated disease; and premature infants tolerate amphotericin B and 5-flucytosine well. Infants who have systemic cultures positive for candidiasis should be treated by removing all factors that predispose to systemic candidiasis (indwelling catheters, broad-spectrum antibiotics); early initiation of systemic antifungal therapy with amphotericin B and 5-flucytosine; and searching for additional foci of disease. After the disease is recognized and treatment is prompt and aggressive, outcome can be substantially improved.