Baud O, Boithias C, Lacaze-Masmonteil T, Ville Y, Guibert M, Zupan V, Chabernaud J L, André P, Nordmann P, Frydman R, Dehan M
Service de pédiatrie et réanimation néonatales, hôpital Antoine-Béclère, Clamart, France.
Arch Pediatr. 1997 Apr;4(4):331-4. doi: 10.1016/s0929-693x(97)86449-4.
Despite the frequency of vaginal yeast colonization, serious candidiasis infections in pregnant patients or neonates remain rare. Four cases of disseminated congenital candidiasis in very preterm infants are reported.
Congenital Candida albicans infection has been diagnosed in four very preterm infants. In three cases, the mothers had intrauterine devices in place throughout pregnancy. A careful macroscopic examination of the umbilical cord and placenta after birth has allowed an early management strategy in three cases. In all cases, a serious infectious alveolitis occurred. A pronounced increase in white blood cells (> 50,000/mm3) and high levels of both segmented neutrophil and band cells, despite the frequent normality of the CRP, constituted other features. Infection was controlled by parenteral amphotericin B or fluconazole. In one case, serious thrombocytopenia occurred after the first amphotericin B injection requiring substitution for fluconazole. The outcome was unfavourable in two cases with an extensive periventricular leukomalacia.
Congenital candidiasis in these four very preterm neonates has several features in common: intrauterine contraceptive device during pregnancy, characteristic chorioamnionitis and funisitis, high WBC count, infectious alveolitis. Fluconazole as alternative to amphotericine B therapy is proposed.
尽管阴道酵母菌定植很常见，但孕妇或新生儿的严重念珠菌感染仍然很少见。本文报告了4例极早产儿播散性先天性念珠菌病。
4例极早产儿被诊断为先天性白色念珠菌感染。其中3例母亲在整个孕期都放置了宫内节育器。出生后对脐带和胎盘进行仔细的宏观检查，使3例得以采取早期管理策略。所有病例均发生了严重的感染性肺泡炎。尽管CRP常为正常，但白细胞显著增多（>50,000/mm³）以及分叶核中性粒细胞和杆状核细胞水平升高是其他特征。感染通过静脉注射两性霉素B或氟康唑得到控制。1例在首次注射两性霉素B后出现严重血小板减少症，需要改用氟康唑。2例发生广泛的脑室周围白质软化，预后不良。
这4例极早产新生儿的先天性念珠菌病有几个共同特征：孕期宫内节育器、特征性绒毛膜羊膜炎和脐带炎、白细胞计数高、感染性肺泡炎。建议用氟康唑替代两性霉素B进行治疗。
