title: Disseminated candidemia refractory to caspofungin therapy in an infant with extremely low birth weight.
abstract: Systemic fungal infections have high morbidity and mortality rates in neonates, especially neonates with an extremely low birth weight (ELBW). Here, we describe a 21-day-old ELBW female infant with an amphotericin B-unresponsive congenital Candida albicans infection that was treated with caspofungin. Blood sterilization was performed during the first episode, but a second episode of candidemia occurred after the discontinuation of caspofungin. Blood sterilization was again performed during the second round of caspofungin treatment, but fungal endocarditis and renal fungal balls still developed during the second episode. Caspofungin can be considered for invasive candidiasis in premature infants, especially in life-threatening situations. As for the focal lesions, more aggressive treatments other than just parenteral antibiotics should be considered. The literature regarding caspofungin therapy for neonatal candidiasis is also reviewed.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Meng-Ju
authors.initials: MJ
authors.lastname: Li
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Lu
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Chou
authors.forename: Ping-Ing
authors.initials: PI
authors.lastname: Lee
authors.forename: Luan-Yin
authors.initials: LY
authors.lastname: Chang
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Huang
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects / Q000302:isolation & purification*; D058387:Candidemia / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D000077336:Caspofungin; D054714:Echinocandins / Q000009:adverse effects / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D055666:Lipopeptides
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin