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Potentially life-threatening emergency
Disseminated candidiasis in Infant/Neonate
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Potentially life-threatening emergency

Disseminated candidiasis in Infant/Neonate

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Contributors: Philip I. Song MD, Susan Burgin MD, Craig N. Burkhart MD, Dean Morrell MD
Other Resources UpToDate PubMed

Synopsis

Disseminated candidiasis, also known as invasive candidiasis, Candida septicemia, or systemic candidiasis, arises as a result of Candida species in the blood and is predominantly caused by Candida albicans species. Disseminated candidiasis is a serious illness that is associated with significant morbidity and mortality. Candida species on a blood culture should not be considered a contaminant. Disseminated candidiasis varies in its severity and clinical presentation. It can range from a mild presentation with cutaneous manifestations to more widespread and disseminated disease involving multiple organs, sepsis, and shock.

Neonatal candidiasis occurs after the first week of life (typically between the second and sixth week) and is acquired via an infected birth canal. It should not be confused with congenital candidiasis, which is acquired in utero and in which skin lesions are present at birth. Neonates predisposed to developing systemic Candida infection include those who are premature and, thus, have a very low birth weight, have received ventilatory support, or have been on intravenous (IV) catheterization for a considerable length of time; have received abdominal surgery; or have received broad-spectrum antibiotics. Systemic candidiasis has now become common among very low birth weight infants in intensive care units with an incidence of approximately 5%. The incidence decreases as birth weight increases, so that it is less than 1% in average weight newborns.

Multiple organ systems are often affected in candidemia, including the kidneys, with over half of patients manifesting some form of renal involvement, which may include candiduria, hypertension, renal failure, abscess formation, or the development of fungal balls leading to obstruction and hydronephrosis. Central nervous system (CNS) involvement is also frequent, occurring in one-third of cases, and may result in seizures and abscess formation. Premature infants in particular can develop hematogenous Candida meningoencephalitis, in which there is invasion of the CNS by Candida. Endophthalmitis is seen in almost half of all cases.

Half of neonatal patients display skin manifestations. Cutaneous manifestations of systemic Candida infection include a generalized dermatitis, which may be followed by desquamation. Other common skin findings range from discrete pustules and papules to nodules and necrotic skin. Macules may also be present. Systemic symptoms in infants include feeding intolerance, lethargy, temperature instability, apnea, and respiratory distress. Myalgias, arthralgias, and osteoarthritis may be present. Pneumonia occurs in 70% of patients.

Candida auris is a rare emerging cause of candidemia that is notable for high rates of mortality and for drug resistance.

Codes

ICD10CM:
B37.7 – Candidal sepsis

SNOMEDCT:
70572005 – Disseminated candidiasis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 02/01/2017
Last Updated: 03/24/2017
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Potentially life-threatening emergency
Disseminated candidiasis in Infant/Neonate
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Disseminated candidiasis : Chills, Fever, Mental status alteration, Scattered many, Myalgia, Smooth papules, BP decreased, Pustules
Clinical image of Disseminated candidiasis
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