title: [Maternofetal disseminated candidiasis and high-grade prematurity].
abstract: BACKGROUND
  Despite the frequency of vaginal yeast colonization, serious candidiasis infections in pregnant patients or neonates remain rare. Four cases of disseminated congenital candidiasis in very preterm infants are reported.
  
  
  METHODS
  Congenital Candida albicans infection has been diagnosed in four very preterm infants. In three cases, the mothers had intrauterine devices in place throughout pregnancy. A careful macroscopic examination of the umbilical cord and placenta after birth has allowed an early management strategy in three cases. In all cases, a serious infectious alveolitis occurred. A pronounced increase in white blood cells (> 50,000/mm3) and high levels of both segmented neutrophil and band cells, despite the frequent normality of the CRP, constituted other features. Infection was controlled by parenteral amphotericin B or fluconazole. In one case, serious thrombocytopenia occurred after the first amphotericin B injection requiring substitution for fluconazole. The outcome was unfavourable in two cases with an extensive periventricular leukomalacia.
  
  
  CONCLUSIONS
  Congenital candidiasis in these four very preterm neonates has several features in common: intrauterine contraceptive device during pregnancy, characteristic chorioamnionitis and funisitis, high WBC count, infectious alveolitis. Fluconazole as alternative to amphotericine B therapy is proposed.
authors.affiliation: Service de pédiatrie et réanimation néonatales, hôpital Antoine-Béclère, Clamart, France.
authors.forename: O
authors.initials: O
authors.lastname: Baud
authors.forename: C
authors.initials: C
authors.lastname: Boithias
authors.forename: T
authors.initials: T
authors.lastname: Lacaze-Masmonteil
authors.forename: Y
authors.initials: Y
authors.lastname: Ville
authors.forename: M
authors.initials: M
authors.lastname: Guibert
authors.forename: V
authors.initials: V
authors.lastname: Zupan
authors.forename: J L
authors.initials: JL
authors.lastname: Chabernaud
authors.forename: P
authors.initials: P
authors.lastname: André
authors.forename: P
authors.initials: P
authors.lastname: Nordmann
authors.forename: R
authors.initials: R
authors.lastname: Frydman
authors.forename: M
authors.initials: M
authors.lastname: Dehan
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007434:Intrauterine Devices; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole