Breakthrough Candida Infection in a Preterm Infant with Congenital Cutaneous Candida albicans Infection

ABSTRACT

Amphotericin B is the primary antifungal agent used for candida sepsis in neonates. Breakthrough candidemia was not reported in neonates during either amphotericin B or liposomal amphotericin B (AmBisome) treatment. We describe a case of a premature infant with congenital cutaneous candida infection, who had two episodes of breakthrough infection, from Candida albicans and Candida parapsilosis, while he was treated with amphotericin B and AmBisome, respectively. We discuss the pathogenesis of breakthrough infections, and the relevance of antifungal resistance and sensitivities testing.

KEYWORDS

Congenital cutaneous candidiasis - amphotericin B - fluconazole - antifungal susceptibilities testing

REFERENCES

• 1 Stoll B J, Hansen N, Fanaroff A A et al.. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network.  Pediatrics. 2002;  110 258-291
• 2 Khoory B J, Vino L, Dall'agnola A, Fanos V. Candida infections in newborn: a review.  J Chemother. 1999;  11 367-378
• 3 Freidman S, Richardson S E, Jacobs S E, O'Brien K. Systemic Candida infection in extremely low birth weight infants: short term morbidity and long term neurodevelopmental outcome.  Pediatr Infect Dis J. 2000;  19 499-504
• 4 Rowen J L, Tate J M. Management of neonatal candidiasis.  Pediatr Infect Dis J. 1998;  17 1007-1011
• 5 Juster-Reicher A, Leibovitz E, Linder N et al.. Liposomal amphotericin B (AmBisome) in the treatment of neonatal candidiasis in very low birth weight infants.  Infection. 2000;  28 223-226
• 6 Scarcella A, Pasquariello M B, Giugliano B, Vendemmia M, De Lucia A. Liposomal amphotericin B treatment for neonatal fungal infections.  Pediatr Infect Dis J. 1998;  17 146-148
• 7 Adler-Shohet F, Waskin H, Lieberman J M. Amphotericin B lipid for neonatal invasive candidiasis.  Arch Dis Child Fetal Neonatal Ed. 2001;  84 F131-F133
• 8 Hann I M, Prentice H G. Lipid based amphotericin B: a review of the last 10 years of use.  Int J Antimicrob Agents. 2001;  17 161-169
• 9 Krcmery V, Huttova M, Mateicka M et al.. Breakthrough fungemia in neonates and infants caused by Candida albicans and Candida parapsilosis susceptible to fluconazole in vitro.  J Antimicrob Chemother. 2001;  48 521-525
• 10 Darmstadt G L, Dinulos J G, Miller Z. Congenital cutaneous candidiasis: clinical presentation, pathogenesis and management guidelines.  Pediatrics. 2000;  105 438-444
• 11 Krcmery V, Oravacova E, Spanik S et al.. Nosocomial breakthrough fungemia during antifungal prophylaxis or empirical antifungal therapy in 41 cancer patients receiving antineoplastic chemotherapy: analysis of aetiology, risk factors and outcome.  J Antimicrob Chemother. 1998;  41 373-380
• 12 Nucci M, Colombo A L. Risk factors for breakthrough candidemia.  Eur J Clin Microbiol Infect Dis. 2002;  21 209-211
• 13 Walsh T J, Finberg R W, Arndt C et al.. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia.  N Engl J Med. 1999;  340 764-771
• 14 Walsh T J, Pappas P, Winston D J et al.. Voriconazole compared with Liposomal Amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever.  N Engl J Med. 2002;  346 225-234
• 15 Hong Nguyen M, Peacock J E, Morris A J et al.. The changing face of candidemia: emergence on non-Candida albicans species and antifungal resistance.  Am J Med. 1996;  100 617-623
• 16 National Committee for Clinical Laboratory Standards .Reference method for broth dilution antifungal susceptibility testing of yeast. Approved standard M27-P Villanova, PA; National Committee for Clinical Laboratory Standards 1992
• 17 Rex J H, Pfaller M A, Galgiani J N et al.. Development of interpretive breakpoints for antifungal susceptibility testing: conceptual framework and analysis of in vitro-in vivo correlation data for fluconazole, itraconazole, and candida infections.  Clin Infect Dis. 1997;  24 235-247
• 18 Perea A, Patterson T F. Antifungal resistance in pathogenic fungi.  Clin Infect Dis. 2002;  35 1073-1080
• 19 Nguyen M H, Clancy C J, Yu V L et al.. Do in vitro susceptibility data predict the microbiologic response to amphotericin B? Results of a prospective study of patients with Candida fungemia.  J Infect Dis. 1998;  177 425-430
• 20 Huang Y C, Kao H T, Lin T Y, Kuo A J. Antifungal susceptibility testing and the correlation with clinical outcome in neonatal candidemia.  Am J Perinatol. 2001;  18 141-146