Candidiasis sistémica intrauterina y choque séptico en un neonato / Congenital intrauterine candida infection and septic shock in a newborn. A case report

Introducción. La infección sistémica intrauterina en el recién nacido debio a Candida albicans, se presenta con muy poca frecuencia en las unidades de cuidados intensivos neonatales. Debido a la gran diversidad de procedimientos a que son sometidos en forma invasiva, los neonatos presentan con una frecuencia mayor un cuadro clínico sugestivo de sepsis por C. Albicans aproximadamente después de la segunda semana de vida. Caso clínico. Se trata de recién nacido femenino pretérmino, de 29 semanas de edad gestacional, con peso al nacer de 950 g. Obtenido por parto eutócico, se describe en la historia perinatal con antecedente materno de control de la natalidad con dispositivo intrauterino y vulvovaginitis inespecífica. La recién nacida presentó cuadro clínico de sepsis con choque séptico inicial en fase temprana a las 19 horas de vida que la llevaron a su defunción, reportándose 48 horas después cultivos positivos: hemocultivo, cultivo de jugo gástrico, secreción bronquial y cotiledón placentario para C. albicans. Conclusiones. El diagnóstico de candidiasis sistémica intrauterina, en el período neonatal, sigue siendo tarea difícil a pesar de los adelantos recientes en métodos diagnósticos empleados

Coagulase negative staphylococcal septicemia in newborns.

The case records of 2177 newborn infants admitted in the Neonatal Intensive Care Unit (NICU) from January, 1989, through July, 1990, with positive blood cultures for coagulase-negative staphylococci (C-NS) were evaluated. Seventy four (3.4%) neonates yielded C-NS in blood cultures during the study period. Of these, 58 (2.7%) infants had clinical and hematological features compatible with the diagnosis of septicemia. Remaining 16 babies with positive cultures had no evidence of sepsis, and were designated as "C-NS bacteremia". The age at which positive cultures were obtained differed between the bacteremic and septicemic groups. In bacteremic group, the onset occurred between one to four days of age. In contrast, in septicemic group the range was 6-20 days, with a mean of 10.22 (+/- 3.53) days. More than two third of total cases of C-NS sepsis were premature and low birth weight (LBW). Prominent clinical features included lethargy, poor feeding and fever. Besides this apneic spells were seen predominantly in babies weighing less than 1500 g. Further, before the diagnosis of C-NS sepsis, more than half of neonates had received prolonged intravenous fluid therapy, a quarter had undergone umbilical catheterization and a further quarter needed a ventilator support. Overall mortality in C-NS sepsis was 17.24%, distinctly higher in neonates with RDS and those requiring mechanical ventilation (p less than 0.05). Only 1.34% C-NS isolates were resistant to all routinely used antibiotics and sensitivity was maximum with newer cephalosporins, ciproflox and amikacin.

Coagulase negative staphylococcal septicemia in newborns.

A retrospective analysis of 254 newborns having blood cultures positive for coagulase negative staphylococci (CONS), and admitted in the neonatal unit of a Rural Medical College Hospital over a period of five years, was done for various clinical and perinatal characteristics as well as antimicrobial sensitivity profile of isolates. Of them, 118 (46.5%) neonates had clinical evidence of sepsis with CONS as the only growth in blood culture, and were designated as having CONS septicemia. Majority of them were delivered in this hospital itself and by normal vaginal delivery. Preterms and LBW babies constituted 23.7 and 59.4% of total cases, respectively. Other high risk perinatal factors for infection were present in 66.1% cases. Approximately two third of these cases developed sepsis within first three days of life. Early onset sepsis was more frequently seen in neonates with history of assisted delivery or perinatal asphyxia. Overall mortality in these cases was 15.6%, being significantly higher in offspring of outside deliveries and normal vaginal deliveries, in preterm and LBW babies and slightly higher in presence of birth asphyxia. Only 15.3% CONS isolates were resistant to all routinely used antibiotics and sensitivity was maximum with gentamicin followed by ampicillin. A difference in sensitivity pattern of CONS causing EOS and LOS was also recorded.

Candidiasis diseminada en prematuros: estudio anatomopatológico; clínico y micológico de 4 casos / Diseminated candidiasis in prematures: anatomopathological; clinical and micological study of 4 cases

Se describen 4 casos de infección diseminada por Candida albicans, en prematuros de entre 26 y 33 semanas de gestación, y entre 760 y 2.580 g de peso al nacer, inclusive. Todos presentaron signos clínicos de insuficiencia respiratoria y de septicemia. La necropsia demostró en todos ellos signos anatomopatológicos de hipoxia intensa, y en 3 casos evidencias morfológicas que indican a la mucosa gastrointestinal como puerta de entrada y diseminación micótica. La distribución de los organos comprometidos y la reacción inflamatoria tisular es semejante a la descrita en adultos, con y sin granulocitopenia