CONGENITAL DISSEMINATED CANDIDIASIS IN VE RY PRETERM INFANTS

Background. - Despite the frequency of vaginal vaginal yeast colonizat ion, serious candidiasis infections in pregnant patients or neonates r emain rare. Four cases of disseminated congenital candidiasis in very preterm infants are reported. Case reports. - Congenital Candida albic ans infection has been diagnosed in four very preterm infants. In thre e cases, the mothers had intrauterine devices in place throughout preg nancy. A careful macroscopic examination of the umbilical cord and pla centa after birth has allowed an early management strategy in three ca ses. In all cases, a serious infectious alveolitis occurred. A pronoun ced increase in white blood cells (> 50,000/mm(3)) and high levels of both segmented neutrophil and band cells, despite the frequent normali ty of the CRP, constituted other features. Infection was controlled by parenteral amphotericin B or fluconazole. In one case, serious thromb ocytopenia occurred after the first amphotericin B injection requiring substitution for fluconazole. The outcome was unfavourable in two cas es with an extensive periventricular leukomalacia. Conclusion. - Conge nital candidiasis in these four very preterm neonates has several feat ures in common: intrauterine contraceptive device during pregnancy, ch aracteristic chorioamnionitis and funisitis, high WBC count, infectiou s alveolitis. Fluconazole as alternative to amphotericine B therapy is proposed.