Neonatal cutaneous fungal infections.
OBJECTIVE
Cutaneous fungal infections are not uncommon in newborns and are seen in premature or otherwise immunocompromised neonates as well as in healthy full-term neonates. Healthy newborns can develop clinical manifestations as a result of infection with Candida species or as a result of skin colonization with Malassezia species; cutaneous infection with other fungal pathogens is rare. Immunocompromised and premature neonates, however, are susceptible to infection with opportunistic pathogens and are also at higher risk for invasive infection with common pathogens such as Candida. This review discusses the fungal species associated with cutaneous fungal infection in neonates, emphasizes the relevant clinical features, and also reviews the use of newer antifungal agents, including lipid-associated amphotericin B, voriconazole, and caspofungin.


RESULTS
Neonatal cutaneous infections with opportunistic fungal pathogens, including Aspergillus and the Zygomycetes, have been reported with increasing frequency as advances in neonatal care have improved the survival rate in very low birthweight neonates. Although these infections are frequently fatal, survival in some neonates has been reported with the use of aggressive surgical debridement and systemic antifungal therapy. Newer antifungal agents, including voriconazole and caspofungin, show promise in the treatment of potentially fatal fungal infections in neonates.


CONCLUSIONS
Cutaneous fungal infections in neonates range from generally benign conditions such as congenital candidiasis and neonatal cephalic pustulosis to potentially fatal infections with opportunistic pathogens in very low birthweight or immunocompromised neonates. The prompt recognition and appropriate treatment of cutaneous fungal disease in neonates is critical to the prevention of adverse outcomes.
Smolinski
Kara N
KN
Division of Emergency Medicine, and Section of Pediatric Dermatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. smolinski@email.chop.edu
Shah
Samir S
SS
Honig
Paul J
PJ
Yan
Albert C
AC
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D003883:Arthrodermataceae; D000077336:Caspofungin; D003881:Dermatomycoses / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D054714:Echinocandins; D005658:Fungi; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D055666:Lipopeptides; D003904:Mitosporic Fungi; D010456:Peptides, Cyclic / Q000627:therapeutic use
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D000666:Amphotericin B; D000077336:Caspofungin