Intracardiac fungal masses in high-risk neonates: clinical observations.
Four cases of intracardiac fungal masses occurred over 2 y amongst 7 cases of systemic candidiasis in a neonatal referral unit. The gestations and birthweights were 25, 23, 24 and 30 wk and 805, 605, 640 and 1395 g, respectively. The pedunculated, solitary right atrial masses were detected 2-17 d after diagnosing candidemia in 3 cases, whereas it was the presenting feature in the 4th. All had indwelling right atrial catheters and received multiple courses of broad-spectrum antibiotics. The masses were removed successfully in two cases fit for surgery. None survived despite antifungal therapy, including liposomal amphotericin B at 6 mg/kg/d. Early introduction of enteral feeds, minimization of prolonged exposure to broad-spectrum antibiotics and judicious use of central catheters may reduce the incidence of systemic candidiasis in high-risk neonates. Surveillance echocardiography and timely surgical intervention may reduce the mortality and/or morbidity related to intracardiac fungal masses.
Daftary
A S
AS
Department of Neonatology, Kirwan Hospital for Women, Thuringowa, Queensland, Australia.
Patole
S K
SK
Whitehall
J S
JS
D000666:Amphotericin B / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001724:Birth Weight; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D017809:Fatal Outcome; D005260:Female; D005865:Gestational Age; D006321:Heart / Q000382:microbiology*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal; D008297:Male; D018447:Medical Futility; D010289:Parenteral Nutrition, Total
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000666:Amphotericin B