Neonatal candida guilliermondii sepsis-An unusual bug in neonatal intensive care unit

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Case Report

Author Details : Uma Raju, Shashank Panwar, Geetanjali Srivastava, Harshal Khade, Prasanna Srinivas

Volume : 2, Issue : 3, Year : 2016

Article Page : 123-126

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Abstract

Fungemia particularly due to candida species is a well-recognized entity in Neonatal Intensive Care Units(NICU). A cause of concern is the increasing occurrence of sepsis due to non-albicans candida species. These are associated with increasing morbidity and drug resistance.
We report a rare case of neonatal sepsis due to Candida Guilliermondii, a yeast which was considered to rarely cause infection in humans. The neonate, born in an outreach facility, was admitted in NICU with features of systemic, CNS and dermatological manifestations. The initial investigation revealed thrombocytopenia with positive CRP and CSF suggestive of infection for which empirical antibiotic therapy(Vancomycin+Meropenem) in meningitic doses was started. Initial blood culture was sterile. Thrombocytopenia progressively worsened and patient manifested dermatological lesions in the form of hyperpigmented macular lesions over face which progressed caudally. In view of clinical sepsis, persistent thrombocytopenia and dermatological manifestations, a fungal etiology of sepsis was suspected. Blood and urine culture for fungus was sent and patient was started on IV Fluconazole along with topical antifungal ointment (Clotrimazole). Blood culture grew Candida Guilliermondii which was sensitive to Caspofungin, Micafungin, Flucytosine and resistant to Fluconazole and Amphotericin B. As the patient had already been on fluconazole therapy for 4 days on which she had shown clinical improvement in the form of improved activity, some regression of hyperpigmented patches and thrombocytopenia, IV fluconazole along with topical clotrimazole was continued for 3 weeks. After three weeks of antifungal therapy, there was normalising of haematological parameters in the form of resolving of thrombocytopenia, negative CRP and CSF studies within normal limits.
The neonate was treated successfully with intravenous Fluconazole, in spite of antibiotic sensitivity pattern suggesting its resistance in-vitro. This demonstrates a difference in in-vivo and in-vitro efficacy of drugs and the necessity of exercising clinical judgement before rapidly changing antibiotic therapy which could in the long run stem development of drug resistance.

Keywords: Candida Guilliermondi, Neonatal non-albican candida sepsis, Antifungals

How to cite : Raju U, Panwar S, Srivastava G, Khade H, Srinivas P, Neonatal candida guilliermondii sepsis-An unusual bug in neonatal intensive care unit. IP Int J Med Paediatr Oncol 2016;2(3):123-126

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