Affected infants may present with a varying clinical picture.
Localized disease is limited to the development of mucocutaneous lesions and usually presents as thrush or diaper dermatitis, but other intertriginous areas may be involved.
A more widespread systemic infection occurs mostly in low birth weight infants. Cutaneous findings include diffuse erythema, vesicles, or pustules. The infant is lethargic, refuses to feed, is apneic, or is in respiratory distress. There is temperature instability and hyperglycemia. Meningitis, urinary tract infection, or candidal septicemia may occur. More severe cases may result in multi-organ failure.
Widespread Cutaneous Infection
The development of a widespread cutaneous candidal infection that resembles an erosive dermatitis may also be seen in extremely low birth weight infants. Risk factors for the development of this type of neonatal candidiasis include prematurity, abdominal surgery, intravenous catheterization, and broad-spectrum antibiotic use as well as steroid administration and hyperglycemia. Infants with widespread cutaneous involvement can present with macular, papular, vesicular, or pustular lesions. Erosive and ulcerative lesions develop with crust formation.
Candida auris is an emerging cause of candidemia that is notable for high rates of mortality and for drug resistance. See below and the US Centers for Disease Control and Prevention (CDC) Information for Laboratorians and Health Professionals for more detailed information.
P37.5 – Neonatal candidiasis
414821002 – Neonatal candidiasis
Differential Diagnosis & Pitfalls
Infectious Vesiculopustular Dermatoses