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Candida funisitis and various rashes of congenital cutaneous candidiasis. A, White-yellow plaques of the umbilical cord. B, Silver strain of these plaques demonstrating yeast invading the umbilical cord. C, Erythematous rash on the abdomen. D, Dry macular lesions on back. Downloaded from https://academic.oup.com/cid/article-abstract/64/10/1387/2967977 by guest on 04 February 2019
Source publication
Background
Congenital cutaneous candidiasis is a challenging diagnosis at times due to various rash presentations and inadequate early treatment is associated with high rates of dissemination and death. Given the rarity of the disease, data on the effects of early diagnosis, dermatologic presentation, and antifungal treatment on outcomes are lackin...
Contexts in source publication
Context 1
... included 1 or more of the following skin findings: peeling, sloughing, or desquamation (62%); macular papular rashes (48%); pus- tules and/or papules (40%); diffuse erythema (33%); yellow- ish plaques or secretions (19%); and/or dry flaking, scaling, or cracking skin (19%). Additionally, funisitis was present in 19% of cases (Figure 3). A constellation of 2 or more of these types of skin findings was described in 57% (12 of 21) of patients at presentation. ...
Context 2
... included 1 or more of the following skin findings: peeling, sloughing, or desquamation (62%); macular papular rashes (48%); pustules and/or papules (40%); diffuse erythema (33%); yellowish plaques or secretions (19%); and/or dry flaking, scaling, or cracking skin (19%). Additionally, funisitis was present in 19% of cases (Figure 3). A constellation of 2 or more of these types of skin findings was described in 57% (12 of 21) of patients at presentation. ...
Citations
... Vertical transmission of Candida spp. may result in severe forms of early-onset systemic infection in the neonate, with cutaneous congenital candidiasis (CCC) being a common clinical feature [57][58][59]. ...
... CCC is triggered by an intrauterine infection through vaginal colonization by Candida albicans, which is present during pregnancy in 20-30% of cases; however, only 1% of individuals develop congenital infection, explaining the low incidence of the disease. The rash typically appears within 36-72 h after birth, depending on the inoculum, number of organisms, and neonatal immune response [57,62,63]. ...
... Infants with CCC have an extensive maculopapular rash with massive desquamation, resembling staphylococcal scalded skin syndrome. Other findings include pustules, cracking skin, funisitis, diffuse erythema, desquamation, and placental infection with abscesses or yellow plaques or secretions [57,58,64]. Leukocytosis and fluid and electrolyte imbalances are common in premature newborns. ...
Vulvovaginal candidiasis (VVC) is a common condition that can lead to significant discomfort , affecting approximately 70-75% of women at least once in their lives. During pregnancy, the prevalence of VVC is estimated to be around 20%, peaking at about 30% in the third trimester, with a number of specific risk factors predisposing to yeast infection being identified and needing elucida-tion. This review aims to provide updated knowledge on candidiasis during pregnancy, addressing risk factors and maternal and neonatal outcomes, as well as discussing optimal therapeutic strategies to safeguard mothers and newborns. The bibliographic search involved two biomedical databases, PubMed and Embase, without imposing time limits. Among all Candida spp., Candida albicans remains the most frequent causative species. The hyperestrogenic environment of the vaginal mucosa and reduced immune defenses, physiological effects of pregnancy, create conditions favorable for Candida spp. vaginal colonization and hence VVC. Recent evidence shows an association between VVC and adverse obstetric outcomes, including premature membrane rupture (PROM), chorioam-nionitis, preterm birth, and puerperal infections. Prompt and effective management of this condition is therefore crucial to prevent adverse obstetric outcomes, maternal-fetal transmission, and neonatal disease. Additional studies are required to confirm the benefits of systemic treatment for maternal candida infection or colonization in preventing premature birth or neonatal systemic candidiasis.
... intensive care unit (NICU) admissions, with most cases occurring in preterm infants <37 weeks gestation. 4 We describe here, a case of a full-term neonate with congenital systemic candidiasis and CCC. The infant developed candidemia due to Candida albicans and the same yeast was isolated in blood, urine and skin cultures. ...
... 6 CCC typically presents at or within a few days of birth. 4 Typical pustules usually appear on the palms and soles of feet. The lesions vary in form, and different stages are often observed simultaneously. ...
... 2,13 CCC is an invasive infection of the skin, and even in the absence of positive blood, urine or CSF cultures, requires systemic treatment for a minimum of 14 days for both preterm and full-term infants. 4 Prompt treatment should start at the time of rash presentation. Delayed or systemic treatment less than 14 days is associated with dissemination to the blood. ...
Congenital systemic candidiasis is a rare disease observed in both full-term and preterm infants. It can occur with or without congenital cutaneous candidiasis (CCC) and to date, only a few cases have been reported in the literature. We report here, a case of a full-term newborn who presented with diffuse skin eruptions at birth. Blood, urine, and skin scraping cultures were positive and the aetiological agent was Candida albicans. After six weeks of anti-fungal treatment with fluconazole, the newborn was cured. Early diagnosis is crucial in preventing complications caused by candidiasis in newborns.
... One of the most accepted risk factors is the presence of an intrauterine foreign body (intrauterine device or cervical cerclage) 2 . CCC can occur in infants regardless of the type of delivery, duration of rupture of membranes, or maternal diagnosis of candida vaginosis 3 . It is more common in preterm neonates under 27 weeks of gestational age, as well as in those with extremely low birth weight 4 ...
... Treatment of clinically stable term neonates without evidence of disseminated disease can be controversial. Nonetheless, studies also indicate that topical and shorter treatment cycles (< 14 days) are risk factors for the dissemination of Candida into the bloodstream 3 . In our case, due to the extensive mucocutaneous involvement with a higher risk of invasion, it was decided to initiate systemic ...
Congenital cutaneous candidiasis (CCC) is a rare condition in neonates, mainly in term neonates, that develops in the 1st week of life. Its broad clinical spectrum makes it challenging to differentiate it from other exanthemas in the newborn. The involvement of palms and soles and the presence of pustules are important clinical clues for the differential diagnosis, with cultural examination confirming the diagnosis by identification of Candida spp. Treatment of clinically stable term neonates without evidence of invasive disease is currently controversial. We report a case of CCC in a term newborn with no evidence of invasive disease that evolved into a clinical cure after systemic and topical antifungal treatment.
... Although candida chorioamnionitis is rare, congenital cutaneous candidiasis at birth leads to a poor prognosis in preterm infants. In full-term infants, congenital cutaneous candidiasis has been reported to be immediately relieved by topical anti-fungal cream [19][20][21]. Although the underlying pathology is unknown, a negative effect on the maternal immune system induced by thymoma and/or further immunological alterations associated with pregnancy may be associated with the occurrence of neonatal cutaneous candidiasis. ...
Background
Pure red cell aplasia (PRCA) is a hematological disorder characterized by anemia with severe reticulocytopenia caused by a marked reduction in erythroid precursors in the bone marrow. PRCA is known to be associated with pregnancy, but thymoma-associated PRCA during pregnancy is very rare, and its successful management has not been reported.
Case presentation
A 37-year-old primiparous woman with severe anemia was referred to our center at 27 weeks’ gestation. She was diagnosed with PRCA based on bone aspiration findings at 33 weeks’ gestation. Magnetic resonance imaging (MRI) revealed an anterior mediastinal mass 4 cm in size suspected of being thymoma. She was therefore diagnosed with thymoma-associated PRCA during pregnancy. Surgery for thymoma was planned after delivery, since the imaging findings were suggestive of early-stage thymoma (Masaoka stage I or II). With transfusion of a total 3,360 ml of red blood cells (RBCs) during pregnancy, the patient gave birth to a baby girl weighing 2,548 g at 40 weeks’ gestation. The baby showed transient congenital cutaneous candidiasis. The placental pathology revealed subamniotic inflammation with a fungal structure. Treatment with topical anti-fungal cream immediately ameliorated the baby’s skin lesion. Maternal anemia did not improve after delivery; however, the thymoma did not increase in size. At five months after delivery, the mother underwent thymectomy with oral cyclosporine A. A pathological examination revealed Masaoka stage II-a thymoma. She completely had recovered from anemia at six months after surgery. Cyclosporine A treatment was discontinued three years after surgery. Remission has been sustained for four years since surgery.
Conclusions
A very rare case of thymoma-associated PRCA during pregnancy was diagnosed without any subjective symptoms and was expectantly managed, resulting in a good prognosis. Although bone marrow aspiration during pregnancy is an invasive test, it is important to confirm the diagnosis. Conservative management with blood transfusion was possible for early-stage thymoma-associated PRCA during pregnancy. Active surveys, including MRI, for PRCA during pregnancy led to the detection of thymoma at an early stage and the achievement of a preferable pregnancy outcome.
... 11 Candida spp. is frequently linked with erythematous dermatitis in the early stages of newborn birth infections. 12 E-coli, other gram-negative aerobes, L monocytogenes, and Staphylococcus aureus infection may be linked with late neonatal sepsis. In recent years, the occurrence of infant listeriosis has decreased substantially. ...
Neonatal sepsis is a systemic disease caused by bacterial organisms, viral infections, or fungus that causes hemodynamic abnormalities and other clinical symptoms resulting in severe complications and may progress into mortality. Parturition can be used to diagnose organisms caused by the premature onset of sepsis in some cases, but only after an average of three days of life. Clinical manifestations of infection may also diagnose the organisms caused by the early onset of sepsis. Late sepsis can refer to any incident of sepsis from delivery to discharge in high-risk newborns, and the majority of them have been hospitalized for a lengthy period. Late-onset Guillain-Barré syndrome infections generally refer to the infections that occur between one week and up to three months post-labor. The precise load fraction for newborn sepsis varies by context, with differing load estimations between nations with varying lead levels. With the diversity of treatments utilized, explaining the degree of obstetric palsy is crucial and complicated. When comparing birthing sepsis rates, it is critical to understand if a tiny figure represents a total birth rate or another rate, such as a hospital admission number. As stated, it is critical to evaluate if population estimates based on the numbers of neonatal sepsis episodes have been recorded. This article aims to review the literature regarding neonatal sepsis from different aspects including, the etiology, risk factors, and different types and onset of neonatal sepsis.
... In an 11-year study of over 19,000 NICU admission (two units), Kaufman et al. reported a CCC incidence of 0.1%, with >90% of affected infants <37 weeks GA and the highest incident in ELBW infants (0.6%). 48 Risk factors for CCC include prematurity, vaginal foreign bodies (intrauterine device, cerclage), ruptured membranes, chorioamnionitis, and history of vaginal candidiasis (Table 1). [48][49][50] CCC typically presents with a rash in the first few days of life (71% on the first day, 0-6 days median) 48 . ...
... 48 Risk factors for CCC include prematurity, vaginal foreign bodies (intrauterine device, cerclage), ruptured membranes, chorioamnionitis, and history of vaginal candidiasis (Table 1). [48][49][50] CCC typically presents with a rash in the first few days of life (71% on the first day, 0-6 days median) 48 . The rash can consist of one or more of the following: peeling, sloughing, or desquamation (62%); maculopapular rash (48%); pustule/papule (40%); diffuse erythema (33%); yellow plaques or secretions (19%); dry flaking, scaling, or cracking skin (19%). ...
... 48 Risk factors for CCC include prematurity, vaginal foreign bodies (intrauterine device, cerclage), ruptured membranes, chorioamnionitis, and history of vaginal candidiasis (Table 1). [48][49][50] CCC typically presents with a rash in the first few days of life (71% on the first day, 0-6 days median) 48 . The rash can consist of one or more of the following: peeling, sloughing, or desquamation (62%); maculopapular rash (48%); pustule/papule (40%); diffuse erythema (33%); yellow plaques or secretions (19%); dry flaking, scaling, or cracking skin (19%). ...
Invasive fungal infections remain the leading causes of morbidity and mortality in neonates, especially preterm and very low birth weight infants. Most invasive fungal infections are due to Candida or Aspergillus species, and other fungi are increasingly reported and described. Appropriate identification and treatment are required to augment activity and reduce the toxicity of antifungal drugs. Successful use of antifungals in the vulnerable neonatal population is important for both prevention and treatment of infection. Strategies for prevention, including prophylactic antifungal therapy as well as reducing exposure to modifiable risk factors, like limiting antibiotic exposure, discontinuation of central catheters, and hand hygiene are key techniques to prevent and decrease rates of invasive fungal infections. In conclusion, this is a review of the most common causes, prevention strategies, prophylaxis, and treatment of invasive fungal infections in neonates.
... Congenital Candidiasis (CC) can be seen within the 1st week of life as a mucocutaneous infection [1]. It can present as diffuse rashes that prompt systemic antifungal treatment to prevent dissemination and candida-related mortality [2]. The disease indicates intrauterine infection if present at birth [3]. ...
... Because of worsening respiratory symptoms and high white blood cells, our patient was considered to have systemic involvement, and he was treated with amphotericin B in addition to local antifungal preparations. For cutaneous CC the presence of the diffuse rash alone covering more than one skin area indicates an invasive fungal infection and requires systemic treatment [2]. There have been no controlled clinical trials to determine the optimal length of therapy. ...
... There have been no controlled clinical trials to determine the optimal length of therapy. However, systemic therapy (enteral or intravenous) must be used for a minimum of 14-21 days to prevent dissemination and mortality [2]. Given the rarity of the disease, it is usually not considered in the initial differential diagnosis, which will delay patient recovery. ...
Congenital cutaneous candidiasis is a rare disease that is usually misdiagnosed as a type of benign neonatal eruption. We report on a preterm infant born with diffuse skin rashes that evolved into various forms and misleading the diagnosis. The persistence of respiratory distress and worsening of chest X-ray findings should alert the physician to systemic involvement. A high index of suspicion and prompt systemic treatment can improve survival rates
... Congenital candidiasis (CC) is an extremely rare condition that results from an intrauterine infection by Candida species and usually manifests itself at birth or during the first days of life [1,2]. It can produce a wide spectrum of disease ranging from a diffuse skin eruption to severe systemic infection with high morbidity and mortality, particularly in low birth weight and extremely low birth weight infants [1][2][3][4][5][6]. ...
... Congenital candidiasis (CC) is an extremely rare condition that results from an intrauterine infection by Candida species and usually manifests itself at birth or during the first days of life [1,2]. It can produce a wide spectrum of disease ranging from a diffuse skin eruption to severe systemic infection with high morbidity and mortality, particularly in low birth weight and extremely low birth weight infants [1][2][3][4][5][6]. The clinical variability of CC can make it a challenging diagnostic and its similarity to more common causes of skin eruptions in the newborn can delay the diagnosis and increase the risk for adverse sequelae [1]. ...
... It can produce a wide spectrum of disease ranging from a diffuse skin eruption to severe systemic infection with high morbidity and mortality, particularly in low birth weight and extremely low birth weight infants [1][2][3][4][5][6]. The clinical variability of CC can make it a challenging diagnostic and its similarity to more common causes of skin eruptions in the newborn can delay the diagnosis and increase the risk for adverse sequelae [1]. ...
... These include, in particular, Enteroviruses and Rotaviruses. Systemic fungal infections are increasingly reported, with Candida albicans leading the way [7,8,49]. ...
Neonatal sepsis contributes significantly to neonatal morbidity and mortality and is a major public health challenge around the world. Depending on the mode of occurrence, a distinction is made between maternal-transmitted infection and that acquired in the postnatal period. Although the etiologies maternally transmitted diseases are well understood, those of postnatal acquired infections are variable depending on the epidemiology of each hospital environment. On the one hand, risk factors for maternal-transmitted infections are maternal sepsis, prolonged premature rupture of membranes, chorioamnionitis, and bacteriuria in the mother during pregnancy. On the other hand, risk factors for postnatal acquired infections are prematurity, low birth weight, lack of hygiene, and invasive therapeutic interventions. The diagnosis is based on a series of anamnestic, clinical and biological features. Although the positive diagnosis is based on the isolation of the germ by culture on a body sample (blood, cerebrospinal fluid, urine, etc.); its low sensitivity leads to the use of markers of the acute phase of inflammation such as C-reactive protein, procalcitonin and interleukins. New molecular biology techniques are promising and offer precise diagnosis with rapid results. Empirical management is a function of microbial ecology while definitive treatment is guided by the results of microbial culture. This article presents the essential elements for understanding neonatal sepsis and discusses new diagnosis and therapeutic management. It offers a thorough reading based on the issue of infections in newborns.
... These include, in particular, Enteroviruses and Rotaviruses. Systemic fungal infections are increasingly reported, with Candida albicans leading the way [7,8,49]. ...
Neonatal sepsis contributes significantly to neonatal morbidity and mortality and is a major public health challenge around the world. Depending on the mode of occurrence, a distinction is made between maternal-transmitted infection and that acquired in the postnatal period. Although the etiologies maternally transmitted diseases are well understood, those of postnatal acquired infections are variable depending on the epidemiology of each hospital environment. On the one hand, risk factors for maternal-transmitted infections are maternal sepsis, prolonged premature rupture of membranes, chorioamnionitis, and bacteriuria in the mother during pregnancy. On the other hand, risk factors for postnatal acquired infections are prematurity, low birth weight, lack of hygiene, and invasive therapeutic interventions. The diagnosis is based on a series of anamnestic, clinical and biological features. Although the positive diagnosis is based on the isolation of the germ by culture on a body sample (blood, cerebrospinal fluid, urine, etc.); its low sensitivity leads to the use of markers of the acute phase of inflammation such as C-reactive protein, procalcitonin and interleukins. New molecular biology techniques are promising and offer precise diagnosis with rapid results. Empirical management is a function of microbial ecology while definitive treatment is guided by the results of microbial culture. This article presents the essential elements for understanding neonatal sepsis and discusses new diagnosis and therapeutic management. It offers a thorough reading based on the issue of infections in newborns.
