THE MANAGEMENT OF FUNGAL OBSTRUCTIVE UROPATHY IN NEONATES AND INFANTS

Obstructive uropathy caused by upper urinary tract fungal ball formati on is an uncommon but well recognized clinical entity. The clinical co urse and management of an infant with unilateral fungal ball obstructi on is described. Ultrasound and Tc-diaminotetraethylpentacetic acid (D TPA) renal scan contributed significantly to the diagnosis and managem ent of this patient. Complete resolution of the obstruction was achiev ed by treatment with intravenous amphotericin B and oral 5-flurocytosi ne. The clinical course and management of 35 patients described in the literature indicate that prematurity, use of broadspectrum antibiotic s, prolonged hospital stay and the use of intravascular catheters are predisposing factors. The mortality rate is 34%. Young age, small size , the presence of candidaemia and withholding antifungal therapy are p oor prognostic factors. A rational plan of treatment, extrapolated fro m the literature, is presented which may help to reduce the mortality rate in this condition.