Congenital Cutaneous Candidiasis: Prompt Systemic Treatment Is Associated With Improved Outcomes in Neonates.
BACKGROUND
Congenital cutaneous candidiasis (CCC) is a challenging diagnosis due to various rash presentations. Inadequate early treatment is associated with high rates of dissemination and death. The effects of early diagnosis, dermatologic presentation, and antifungal treatment on outcomes are lacking.


METHODS
CCC cases were reviewed from 2 academic neonatal intensive care units (NICUs) from 2004 to 2015. We defined CCC as a diffuse rash involving the body, extremities, face or scalp, and/or funisitis, presenting in the first week (≤7 days), with identification of Candida species from skin or mucous membrane cultures, and/or by culture or staining of the placenta or umbilical cord.


RESULTS
CCC occurred in 0.1% of all NICU admissions (21 of 19 303) and 0.6% of infants <1000 grams birth weight. Median gestational age of CCC infants was 26 3/7 (range, 23 0/7-40 4/7) weeks. Skin findings were commonly present on the day of birth [median (range): 0 (0-6) days], appearing most frequently as a desquamating, maculopapular, papulopustular, and/or erythematous diffuse rash. When systemic antifungal therapy was started empirically at the time of rash presentation and continued for a median (interquartile range) of 14 (14-15) days, all patients survived and none developed dissemination. Delaying systemic treatment, exclusive use of nystatin, and treating for <10 days was associated with Candida bloodstream dissemination.


CONCLUSIONS
CCC is an invasive infection that presents as a diffuse rash in preterm and term infants. Prompt systemic antifungal treatment at the time of skin presentation for ≥14 days prevents dissemination and Candida-related mortality.
Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine and Children's Hospital, Charlottesville.
David A
DA
Kaufman
Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania; and.
Sarah A
SA
Coggins
Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine and Children's Hospital, Charlottesville.
Santina A
SA
Zanelli
Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
Jörn-Hendrik
JH
Weitkamp
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D002177:Candidiasis / Q000382:microbiology / Q000517:prevention & control*; D002179:Candidiasis, Cutaneous / Q000097:blood / Q000151:congenital* / Q000175:diagnosis / Q000188:drug therapy*; D004333:Drug Administration Routes; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy* / Q000382:microbiology; D007363:Intensive Care Units, Neonatal; D008297:Male; D008499:Medical Records; D009761:Nystatin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D012867:Skin / Q000382:microbiology; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents; D009761:Nystatin
Candida; congenital infection; diagnosis; newborns.; treatment