A CASE REPORT ON CONGENITAL SYSTEMIC CANDIDIASIS IN A PREMATURE NEONATE (EXTREME PRETERM INFANT)

Keywords: Congenital candidiasis, Candida albicans, neonatal sepsis, amphotericin B, Systemic fungal infection

Background: Congenital systemic candidiasis is a rare but severe infection, mainly affecting preterm and very low birth weight infants. Risk factors include maternal vaginal colonization, premature rupture of membranes (PROM), and lack of antenatal care. It often mimics bacterial sepsis with respiratory distress, anemia, feeding intolerance, and raised inflammatory markers, delaying diagnosis.

Objectives: To report a case of congenital systemic candidiasis in an extremely preterm infant, focusing on the clinical course, diagnostic challenges, antifungal resistance, and NICU management.

Methods: A male infant was born at 26 weeks (760 g) via spontaneous vaginal delivery after sudden PROM in an out-of-hospital setting. Clinical records, cultures, antifungal susceptibility, and follow-up data were reviewed.

Results: Blood culture confirmed Candida albicans within 48 hours, resistant to fluconazole/voriconazole but sensitive to amphotericin B. Skin swabs also grew Candida. Complications included respiratory distress syndrome (resolved with surfactant/ ventilation), intraventricular hemorrhage (regressed on follow-up), anemia requiring transfusions, feeding intolerance (transitioned to oral feeds), and patent ductus arteriosus (closed spontaneously). A later staphylococcal sepsis episode was treated successfully. The infant received 3 weeks of IV amphotericin B and comprehensive NICU care. Screening for disseminated disease was negative. After 146 days, he was discharged at 4.1 kg in stable condition.

Conclusion: This case demonstrates the high risk of systemic candidiasis in extremely preterm infants. Early suspicion, fungal cultures with susceptibility testing, and timely amphotericin B therapy were crucial for survival.
Multidisciplinary NICU management enabled favorable outcomes despite extreme prematurity.

References:
[1] Benjamin D. K. Jr. and Stoll B. J. (2007) Clin Perinatol., 34, 335–355. [2] Pappas P. G. et al. (2016) Clin Infect Dis., 62, e1–e50. [3] Kaufman D. and Manzoni P. (2010) Clin Perinatol., 37, 611–628. [4] Saiman L., Ludington E., Pfaller M. et al. (2000) Pediatr Infect Dis J., 19, 319–324. [5] Manzoni P., Farina D., Leonessa M. L. et al. (2011) Early Hum Dev., 87 Suppl 1, S59–62. [6] Rowen J. L. and Tate J. M. (2020) J Pediatr Infect Dis Soc., 9, 152–161.

Biography: Dr. Arshiya, MBBS, Dubai, currently gaining clinical experience from NICU, Dubai Hospital, aspiring to build her career in pediatrics. Actively engaged in evidence-based medicine, she focuses on improving outcomes through clinical practice and research. She has published close to 10 abstracts in different journals. She is also passionate in continuing medical education programs and workshops advancing her clinical and research expertise. She is committed to collaborating with senior colleagues and mentors to make a meaningful impact in pediatrics. (100 words)

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