Intra-amniotic fluconazole therapy for Candida albicans intra-amniotic infection.
BACKGROUND
The consequences of intra-amniotic Candida infection can be devastating. Currently, standard management includes delivery. We identified only one previous case reporting intrauterine antifungal therapy, which used transcervical amphotericin B. We present two cases of intra-amniotic Candida infection treated with intra-amniotic fluconazole instilled before membrane rupture.


METHODS
Two patients presented with intra-amniotic Candida albicans infection that was diagnosed during previability. Both underwent cerclage placement before culture results were available. Aggressive antifungal therapy was instituted using oral, vaginal, and intra-amniotic fluconazole instilled through serial amniocenteses. Both fetuses survived without sequelae.


CONCLUSIONS
Intra-amniotic Candida infection is associated with preterm rupture of membranes, preterm labor, severe neonatal infection, and fetal death. Early diagnosis and treatment is essential.
Florida State University College of Medicine, Sacred Heart Women's Hospital, Pensacola, Florida, USA. lisambean@gmail.com
Lisa M
LM
Bean
Jessica R
JR
Jackson
William J
WJ
Dobak
Timothy R
TR
Beiswenger
James A
JA
Thorp
D000037:Abruptio Placentae / Q000601:surgery; D000328:Adult; D000650:Amnion; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage*; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy*; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007267:Injections; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000382:microbiology; D047928:Premature Birth / Q000382:microbiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D015725:Fluconazole