Brenuchon C, Lebas D, Rakza T, Piette F, Storme L, Catteau B
Clinique de Dermatologie, Hôpital Claude Huriez, CHRU Lille.
Ann Dermatol Venereol. 2006 Apr;133(4):341-6. doi: 10.1016/s0151-9638(06)70912-7.
Fungal agents, chiefly Candida albicans, are the cause of rising morbidity and mortality in newborn infants weighing less than 1500 g. We studied the particular cutaneous effects during the course of these infections.
This was a retrospective 3-year study in premature infants weighing less than 1500 g and hospitalized in the neonatal department of the Lille University Teaching Hospital. The patients included in the study presented sepsis with isolation of Candida in blood and/or urine culture.
Twelve infants were included (1.8%). The risk factors seen are those described in literature (broad-spectrum antibiotics, prolonged mechanical ventilation and parenteral nutrition, corticosteroids and central venous catheters). Infection occurred early (mean: D12) and affected extremely premature infants (mean: 25 weeks' amenorrhea) of low birth weight (mean: 758 g) generally born by vaginal delivery (9 of 12 infants). The sole fungal agent isolated was Candida albicans. In 10 of the 12 patients, a characteristic skin disorder was observed (erythema with erosion and desquamation). In 10 of the 12 patients, too, Candida was isolated from skin and/or mucosal samples.
Although it is now universally accepted that antifungal treatment should be initiated without delay for candidemia in septic newborn infants at risk, diagnosis of systemic candidiasis remains delicate. However, a specific pattern of skin involvement is very commonly seen that is atypical for candidiasis, but which in addition to its diagnostic value indicates early colonization with Candida (first 2 weeks of life). In this setting of immaturity of the skin and immune system, colonization and proliferation in skin and/or mucosa appear to constitute the first stage of systemic infection and we may speak of invasive cutaneous-mucosal candidiasis in extremely premature infants and initiate treatment designed to prevent the disease becoming systemic..
真菌病原体，主要是白色念珠菌，是导致体重不足1500克的新生儿发病率和死亡率上升的原因。我们研究了这些感染过程中的特殊皮肤影响。
这是一项对体重不足1500克并在里尔大学教学医院新生儿科住院的早产儿进行的为期3年的回顾性研究。纳入研究的患者表现为败血症，血液和/或尿液培养中分离出念珠菌。
纳入12名婴儿（1.8%）。观察到的危险因素与文献中描述的一致（广谱抗生素、长时间机械通气和肠外营养、皮质类固醇和中心静脉导管）。感染发生较早（平均：第12天），影响极低出生体重（平均：758克）的极早产儿（平均：停经25周），这些婴儿通常通过阴道分娩（12名婴儿中有9名）。分离出的唯一真菌病原体是白色念珠菌。12名患者中有10名观察到特征性皮肤病变（伴有糜烂和脱屑的红斑）。12名患者中的10名，皮肤和/或黏膜样本中也分离出念珠菌。
尽管目前普遍认为对于有败血症风险的新生儿念珠菌血症应立即开始抗真菌治疗，但系统性念珠菌病的诊断仍然棘手。然而，一种特定的皮肤受累模式非常常见，这对于念珠菌病来说是非典型的，但除了其诊断价值外，还表明念珠菌早期定植（出生后前2周）。在皮肤和免疫系统不成熟的这种情况下，皮肤和/或黏膜中的定植和增殖似乎构成了系统性感染的第一阶段，我们可以说在极早产儿中存在侵袭性皮肤黏膜念珠菌病，并启动旨在防止疾病发展为全身性的治疗。
