LATE ONSET CANDIDA KRUSEI SEPTICAEMIA IN A NEONATE WHICH RESPONDED TO FLUCONAZOLE MONOTHERAPY: A CASE REPORT

---

M.B. Adigun¹, A.E. Akindolire¹, W.A. Adedeji²

1. Department of Paediatrics, University College Hospital, Ibadan.
2. Department of Clinical Pharmacology, University College Hospital, Ibadan.

Abstract

Systemic candida infections in the neonatal population are commonly seen especially in low birth weight, preterm neonates admitted to the Neonatal Intensive Care Unit. Albicans spp is the most commonly isolated but in more recent times, fluconazole resistant spp such as Candida krusei have been reported to cause healthcare associated infections. This is a case of a 12-day old, term, low birth weight (2.45 kg), male neonate delivered to a 32-year-old P2+0 (2A) through elective caesarian section (CS) at term. He was well till the 12th day of life when he developed respiratory distress and sub-optimal oxygen saturation requiring supplemental oxygen. Chest x-ray showed prominent vascular markings with no active focal lung lesion and he was managed for suspected Aspiration Pneumonitis until a blood culture on the 10th day of admission yielded Candida krusei. He had a monotherapy of intravenous fluconazole, made progressive clinical improvement and was discharged on oral fluconazole to complete a 6 weeks course on outpatient basis.

Keywords: Premenarchial, Transverse vaginal septum

Introduction

Neonatal candida infections and outbreaks of infections are common in newborn units especially neonatal intensive care units and in the preterm, low birth weight patients.^1,4 Candida infections mimic symptoms of sepsis and often routine blood culture do not report/culture fungal organisms and therefore diagnosis require a high index of suspicion. Firstline treatment is usually with fluconazole which is readily available and which many units also use as fungal prophylaxis for susceptible patients. In recent times however there have been increasing reports of rarer species such as Candida krusei, well known for being fluconazole resistant.^2,3 Despite this known potential for resistance, studies have shown the susceptibility of some strains of Candida krusei to fluconazole.

We report a rare case of Candida krusei septicaemia in a low-birth-weight neonate which was successfully treated with fluconazole monotherapy.

CASE PROFILE
A 12-day old, term male neonate delivered to a 32- year-old P2+0 (2 alive) woman through elective caesarean section on account of a previous caesarean section scar and maternal request at 38+5 weeks gestational age. He presented on account of difficulty with breathing and low-grade fever of a day duration. He had been feeding well, and there was no history suggestive of aspiration. There was no cough nor bluish discolouration of his lips and mucosa.

Mother registered for antenatal care at a tertiary healthcare centre. There was no history of hypertension or diabetes mellitus before or during the pregnancy. There was no known maternal risk factor for sepsis. His birth weight was 2.45kg and he cried well at delivery. He was commenced on breastfeeding shortly after delivery and had been on exclusive breastfeeding till presentation. He had received Bacille Calmette Guerin (BCG), Hepatitis B vaccine (HBV) and Oral polio vaccine (OPV). He was brought to our facility without any prior interventions or medications.

On examination at presentation, he was acutely ill, not pale, not cyanosed, anicteric and had no peripheral oedema. He was in severe respiratory distress (with nasal flaring, subcostal, intercostal recession), tachypnoiec with respiratory rate of 66cycles per minute, heart rate was 140beats per minute. His weight at admission was 2.7kg