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Neonatal candidiasis
Other Resources UpToDate PubMed

Neonatal candidiasis

Contributors: Ansa Ahmed MD, Art Papier MD, Craig N. Burkhart MD, Lowell A. Goldsmith MD, MPH, Dean Morrell MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Neonatal candidiasis can develop perinatally or postnatally: it can be acquired by passage through an infected birth canal, develop postnatally from invasive procedures or infected catheters, or be related to breaks in the skin of the neonate. It is seen after the first week of life, in contrast to congenital candidiasis, which is present at birth.
 
Affected infants may present with a varying clinical picture.

Localized Disease
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.

Systemic Infection
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
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.

Codes

ICD10CM:
P37.5 – Neonatal candidiasis

SNOMEDCT:
414821002 – Neonatal candidiasis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Vesiculopustular rashes in the neonate may be divided into infectious, transient, or persistent dermatoses. The first goal in all vesiculopustular eruptions in the neonate is to rule out infectious etiologies.

Infectious Vesiculopustular Dermatoses
  • Neonatal herpes simplex virus (HSV)
  • Neonatal varicella
  • Scabies
  • Bullous impetigo
  • Neonatal listeriosis
  • Invasive Haemophilus influenzae infection
  • Group A streptococcal infection
  • Pseudomonas
  • Cytomegalovirus infection of newborn
  • Primary cutaneous aspergillosis of premature infants
  • Early congenital syphilis
Transient Noninfectious Vesiculopustular Dermatoses
  • Erythema toxicum neonatorum
  • Transient neonatal pustular melanosis
  • Miliaria crystallina and Miliaria rubra
  • Neonatal acne
  • Acropustulosis of infancy
  • Pustular eruption in Down syndrome
Persistent Noninfectious Vesiculopustular Dermatoses
  • Incontinentia pigmenti
  • Eosinophilic pustular folliculitis in infancy
  • Langerhans cell histiocytosis
  • Hyperimmunoglobulinemia E syndrome
  • Pustular psoriasis

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Management Pearls

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Therapy

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References

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Last Reviewed:03/25/2023
Last Updated:03/26/2023
Copyright © 2024 VisualDx®. All rights reserved.
Neonatal candidiasis
A medical illustration showing key findings of Neonatal candidiasis (Cutaneous) : Diaper area, Erythroderma, Oral white plaque, Scaly plaque, Vesicle
Clinical image of Neonatal candidiasis - imageId=120247. Click to open in gallery.  caption: 'Numerous pustules on the palm and fingers, a crust on the middle digit, and papules and crusting at the wrist.'
Numerous pustules on the palm and fingers, a crust on the middle digit, and papules and crusting at the wrist.
Copyright © 2024 VisualDx®. All rights reserved.