From the Guidelines
Neonatal candidiasis is a serious infection that requires prompt treatment, and the primary symptoms include nonspecific signs such as fever, lethargy, and respiratory distress, while treatment options include AmB deoxycholate, fluconazole, and removal of central venous catheters.
Symptoms of Neonatal Candidiasis
- Nonspecific signs and symptoms of infection, such as fever, lethargy, and respiratory distress 1
- Candida species can invade virtually all tissues, including the retina, brain, heart, lung, liver, spleen, and joints 1
- Meningoencephalitis is a common complication of candidemia in neonates, and CNS disease should be assumed to be present in neonates with candidemia and signs and symptoms suggesting meningoencephalitis 1
Treatment Options for Neonatal Candidiasis
- AmB deoxycholate at a dosage of 1 mg/kg daily is recommended for neonates with disseminated candidiasis 1
- Fluconazole at a dosage of 12 mg/kg daily is a reasonable alternative 1
- Removal of central venous catheters is strongly recommended to prevent prolonged infection, mortality, and long-term irreversible neurodevelopmental impairment 1
- Echinocandins should be used with caution and generally limited to situations in which resistance or toxicity preclude the use of fluconazole or AmB-d 1
Important Considerations
- Dosing of antifungal agents is substantially different for neonates than it is for older children and adults 1
- Neonates with extremely low birth weight are at high risk of death, neurodevelopmental impairment, and increased healthcare costs 1
- Candiduria in neonates should prompt an evaluation for disseminated Candida infection and warrants treatment 1
From the Research
Symptoms of Candidiasis in Infants
- Diffuse rash of variable morphology, which can appear as peeling, sloughing desquamation; maculopapular lesions; or, less commonly, pustules, vesicles, or bullae 2
- Systemic disease, resulting in fetal demise or early neonatal death 3
- Invasive fungal infections, associated with substantial morbidity and mortality rates, especially in pre-term infants 4
Treatment Options for Candidiasis in Infants
- Early diagnosis of Candida and prompt treatment with appropriate antifungal agents, such as fluconazole, amphotericin B deoxycholate, and micafungin 5
- Antifungal prophylaxis, particularly in neonatal intensive care units with a high incidence of candidemia 6
- Intravenous fluconazole to prevent disease progression in congenital cutaneous candidiasis 2
- Amphotericin B as the mainstay of antifungal therapy for candidemia in the neonatal intensive care unit, with newer agents such as echinocandins and azoles being evaluated 6