Neonatal candidosis: clinical picture, management controversies and consensus, and new therapeutic options

2002 ◽  
Vol 49 (suppl_1) ◽  
pp. 69-73 ◽  
Author(s):  
Eugene Leibovitz
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Amphotericin B ◽  
Fungal Infections ◽  
Dose Range ◽  
High Dose ◽  
Pharmacokinetic Studies ◽  
High Morbidity ◽  
First Line ◽  
Candida Infections

Abstract Candida infections are increasingly being recognized as a major cause of septicaemia in neonatal intensive care units, and are associated with high morbidity (25%) and mortality (25–54%). Low birth weight pre-term infants are especially vulnerable to this devastating disease. The most frequently encountered fungal infections are caused by Candida albicans, Candida parapsilosis and, rarely, by Candida tropicalis. Amphotericin B (with or without flucytosine) is the treatment of choice for Candida infections in neonates. Conventional amphotericin B use is often limited by its severe side effects, although these tend to be fewer in neonates than in adults. Possible alternatives to amphotericin B include triazoles (such as fluconazole) and lipid preparations of amphotericin B. Liposomal encapsulation of amphotericin B has been shown to decrease the toxicity of the drug while maintaining its antifungal activity. The liposomal formulation AmBisome has proved to be effective in the treatment of severe fungal infections in adult and paediatric immunocompromised patients who fail to respond to conventional amphotericin B. The experience with AmBisome in the treatment of fungal infections in neonates is limited, and the drug has been used mainly in infants either failing conventional amphotericin B or having intolerable toxicity. Pharmacokinetic studies have not yet been performed in neonates. Three uncontrolled studies published between 1997 and 1998 on AmBisome (dose range 1–7 mg/kg/day) in the treatment of neonatal candidosis revealed that the drug was effective and safe. New information is accumulating on the safe use of high-dose AmBisome (5–7 mg/kg/day) in very low birth weight infants, and successful use of the drug as first-line therapy of neonatal candidosis. These promising results suggest a potential role for AmBisome as an additional first-line treatment of systemic candidosis in neonates.

Liposomal Amphotericin-B (AmBisome) for Treatment of Disseminated Fungal Infections in Two Infants of Very Low Birth Weight

PEDIATRICS ◽  
1992 ◽  
Vol 89 (6) ◽  
pp. 1259-1261
Author(s):  
H. LACKNER ◽  
W. SCHWINGER ◽  
C. URBAN ◽  
W. MÜLLER ◽  
E. RITSCHL ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Amphotericin B ◽  
Very Low Birth Weight ◽  
Central Venous Catheterization ◽  
Fungal Infections ◽  
Hepatic Necrosis ◽  
Venous Catheterization ◽  
Prolonged Antibiotic Therapy ◽  
Intravenous Fat Emulsions

Systemic fungal infections represent an increasing problem among low birth weight neonates.1-4 The necessity of many invasive procedures such as endotracheal intubation, central venous catheterization, prolonged antibiotic therapy, and hyperalimentation including intravenous fat emulsions increases the risk of nosocomial infections.4,5 Amphotericin-B (Amph-B) combined with 5-fluorocytosine is reported to be the treatment of choice for disseminated fungal infections. However conventional Amph-B medication is often limited due to severe side effects. Fever, chills, bronchospastic reactions, nephrotoxicity, and hepatic necrosis have been reported frequently.2,6 Previous experiences with immunocompromised patients indicate that the liposomal encapsulation of amphotericin-B decreases its toxicity while maintaining its effectiveness as an antifungal agent.7-12

scholarly journals Pharmacotherapy of Rhino-Orbital- Cerebral Mucormycosis

2021 ◽  
Vol 70 (2) ◽  
Author(s):  
Manisha Bisht ◽  
Sampan Singh Bist
Keyword(s):  
Amphotericin B ◽  
Early Stage ◽  
Short Review ◽  
Medical Intervention ◽  
High Dose ◽  
High Morbidity ◽  
First Line ◽  
Basic Principles ◽  
Resource Limited ◽  
Amphotericin B Deoxycholate

The aim of this study is Recently there is an alarming increase in the incidence of mucormycosis in patients diagnosed with Covid -19. In this short review, we will discuss the basic principles of mucormycosis treatment, antifungal agents used along with update on pharmacotherapeutic guidelines recommended for management of mucormycosis. Searching the Pubmed with the key words “mucormycosis and covid 19 ”, “ Treatment of mucormycosis”, “ antifungal used in Mucormycosis revealed many articles, and the relevant articles were screened. Mucormycosis is an aggressive disease which is difficult to diagnose in early stage with high morbidity and mortality. Multimodal therapeutic approach consisting of early diagnosis, urgent surgical and medical intervention and elimination of predisposing factors is key to successful management of this condition. First-line antifungal agent is high-dose liposomal amphotericin B although amphotericin B deoxycholate may be the viable option in resource limited settings.

Disseminated Fungal Infections in Very Low-Birth-Weight Infants: Therapeutic Toxicity

PEDIATRICS ◽  
1984 ◽  
Vol 73 (2) ◽  
pp. 153-157
Author(s):  
Jill E. Baley ◽  
Robert M. Kliegman ◽  
Avroy A. Fanaroff
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Amphotericin B ◽  
Premature Infants ◽  
Antifungal Agents ◽  
Very Low Birth Weight ◽  
Fungal Infections ◽  
Invasive Procedures ◽  
Older Children ◽  
Low Birth Weight Infants

The improved survival of very low-birth-weight infants, who require prolonged hospitalization and many invasive procedures, increases the risks for nosocomial illnesses, such as disseminated fungal infections. In a 2-year period, systemic fungal infections were clinically diagnosed in ten infants. This necessitated the institution of antifungal therapy in extremely premature infants (mean birth weight 788 g, mean gestational age 28 weeks) despite the paucity of knowledge about the pharmacokinetics and toxicity of these drugs in the very immature patient. Despite the absence of reported toxicity in infants and older children, severe nephrotoxicity was commonly observed with oliguria/anuria, temporally related to the administration of amphotericin B in seven of these infants. Additional evidence of nephrotoxicity included either a rise in creatinine levels (≥1.3 mg/dL), an increase in BUN (≥30 mg/dL), hypokalemia (≤2.9 mEq/L), or hyperkalemia (≥6.0 mEq/L). Six of these seven drug-toxic infants died. Interruption of amphotericin B therapy, with reinstitution at a lower dose, was the most successful factor in alleviating the anuria. There is an urgent need for detailed pharmacokinetic and toxicity studies of antifungal agents in immature infants.

Which Is the Most Appropriate Dosage of Liposomal Amphotericin-B (AmBisome) for the Treatment of Fungal Infections in Infants of Very Low Birth Weight?

PEDIATRICS ◽  
1993 ◽  
Vol 91 (6) ◽  
pp. 1217-1218
Author(s):  
L. PEREIRA DA SILVA ◽  
J. M. VIDEIRA AMARAL ◽  
N. CORDEIRO FERREIRA
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Fungal Infection ◽  
Amphotericin B ◽  
Clinical Experience ◽  
Liposomal Amphotericin ◽  
Very Low Birth Weight ◽  
Fungal Infections ◽  
Liposomal Amphotericin B

To the Editor.— Lackner et al1 report on the excellent efficacy and lack of toxicity of 1 to 5 mg/kg per day of liposomal Amphotericin-B (AmBisome) administered to two infants of very low birth weight with disseminated fungal infection. We agree with the authors when they say that success in the treatment of two cases does not allow extrapolation of the same therapeutic schedule to an infants with identical multisystemic immaturity. We would like to report two cases from our own clinical experience with distinct characteristics.

Which Is the Most Appropriate Dosage of Liposomal Amphotericin-B (AmBisome) for the Treatment of Fungal Infections in Infants of Very Low Birth Weight?

PEDIATRICS ◽  
1993 ◽  
Vol 91 (6) ◽  
pp. 1218-1218
Author(s):  
H. LACKNER ◽  
CH. URBAN
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Fungal Infection ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Very Low Birth Weight ◽  
Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Maximal Effect ◽  
Low Birth Weight Infants

In Reply.— We read with great interest the results of Pereira da Silva and co-workers, who successfully treated two premature newborns with disseminated fungal infection using lower doses of liposomal Amphotericin-B (AmBisome) than we have reported in our paper.1 We agree with the authors that the most appropriate dosage of liposomal Amphotericin-B for the treatment of very low birth weight infants is still to be established, and that the main goal of treatment should be to use AmBisome in a dose with maximal effect but minimal toxicity.

scholarly journals Clinical profile of neonatal candidiasis in newborn nursery

2018 ◽  
Vol 5 (2) ◽  
pp. 334
Author(s):  
Mary James ◽  
Anuja J. S. ◽  
Praveen Jacob Ninan
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Clinical Profile ◽  
High Morbidity ◽  
Ventilator Support ◽  
Temperature Instability ◽  
Increased Risk ◽  
Study Population ◽  
Feed Intolerance ◽  
Candida Infections

Background: Candidiasis refers to infection with fungi of the genus candida. Candida infections are frequent and major causes of septicemia in neonatal intensive care units and are associated with high morbidity and mortality. Low birth weight preterm infants are especially vulnerable to these devastating infections. Candida infections are a major cause of septicemia in neonatal ICUs and may affect 1.6% to 12.9% of very low birth weight infants. The smaller the infant is, the greater is the likelihood for systemic fungal infection to develop.Methods: 40 Newborns with culture proven candidiasis admitted in new-born nursery of Government T. D Medical College, Alappuzha, were selected for the study. The significance of different parameters such as gender, gestational age, birth weight, Apgar score, duration of hospital stays, central venous catheter and use of third generation cephalosporins were analysed. Clinical profile like apnoea, feed intolerance, requirement of ventilator support, temperature instability, thrombocytopenia, hyperglycemia etc. were analyzed.Results: Out of 40 newborns 39 were preterms, 42% of study population were having a birth weight of 1-1.5 kg, 33% with a birth weight of 1.5-2 kg and 20% with a birth weight of <1 kg.75% of the study population were hospitalized for >1 week. In the study group 58% had feed intolerance, 52.5% needed ventilator support, 52.5% had temperature instability, 70% had thrombocytopenia 50% had apnea and 4% had hyperglycemia. The overall survival was 60%.Conclusions: Prematurity, low birth weight and prolonged hospital stay were associated with increased risk of candidiasis. Feed intolerance, increased need for ventilator support, apnea, temperature instability and thrombocytopenia were significant clinical parameters. 

Bladder Fungus Ball: A Reversible Cause of Neonatal Obstructive Uropathy

PEDIATRICS ◽  
1988 ◽  
Vol 81 (6) ◽  
pp. 826-829
Author(s):  
Barbara Baetz-Greenwalt ◽  
B. Debaz ◽  
Mary L. Kumar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Amphotericin B ◽  
Very Low Birth Weight ◽  
Obstructive Uropathy ◽  
Ureteropelvic Junction ◽  
Fungus Ball ◽  
Low Birth Weight Infants ◽  
Renal Obstruction ◽  
Bladder Irrigation

Very low birth weight infants often have multiple predisposing conditions for the development of invasive candidiasis. In patients with systemic candidiasis, the kidney is vulnerable to the formation of cortical abscesses or obstructive intrarenal masses ("fungus balls"), usually at the ureteropelvic junction. Ureteropelvic junction obstructive fungal uropathy necessitates invasive debridement to restore renal function. A very low birth weight infant, infected with Candida, was first seen with hypertension, renal insufficiency, and urine cultues positive for fungus; obstructive bladder fungus ball was diagnosed by ultrasography. Mechanical disruption with amphotericin B bladder irrigation was accomplished via ultrasographic guidance, relieving renal obstruction and insufficiency. Systemic antifungal therapy was completed with amphotericin B and flucytosine. The first reported case of bladder obstructive fungal uropathy in a neonate is added to a review of 16 cases of neonatal renal obstructive uropathy.

Fungal Infections in Premature Infants

PEDIATRICS ◽  
1984 ◽  
Vol 74 (3) ◽  
pp. 443-443
Author(s):  
JILL E. BALEY ◽  
ROBERT M. KLIEGMAN ◽  
AVROY A. FANAROFF
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Glucose Tolerance ◽  
Glucose Intolerance ◽  
Premature Infants ◽  
Glucose Control ◽  
Fungal Infections ◽  
Low Birth Weight Infant ◽  
Multiple Factors ◽  
Glucose Intake

In Reply.— Seventy percent of the low-birth-weight (LBW) infants whose condition was clinically diagnosed as systemic fungal infections demonstrated glucose intolerance. Langdon is correct that hyperglycemia, which may be found in young diabetic women, may encourage nonsystemic or local candidiasis. He is also correct that multiple factors may affect glucose tolerance in the sick low-birth-weight infant. Whereas it is possible that alterations in care or glucose intake might result in hyperglycemia, it is unusual for a low-birth-weight infant who has previously demonstrated stable glucose control to suddenly develop hyperglycemia and/or glycosuria at 5 weeks of age.

scholarly journals ANTI-CANDIDA ALBICANS ACTIVITY OF THE ASSOCIATION OF CITRONELAL WITH ANFOTERICIN B OR WITH CETOCONAZOLE

2019 ◽  
Vol 16 (31) ◽  
pp. 250-257
Author(s):  
Patrícia Duarte Costa SILVA ◽  
Brenda Lavínia Calixto dos SANTOS ◽  
Gustavo Lima SOARES ◽  
Wylly Araújo de OLIVEIRA
Keyword(s):  
Candida Albicans ◽  
Antifungal Activity ◽  
Amphotericin B ◽  
Inhibitory Concentration ◽  
Fungal Infections ◽  
Pathogenic Fungi ◽  
Mortality Rates ◽  
New Drugs ◽  
High Morbidity ◽  
Isolated Species

Fungal infections caused by species of the genus Candida are responsible for high morbidity and mortality rates, mainly affecting immunocompromised individuals. Among fungi, Candida albicans is the most frequently isolated species of clinical specimens. A problem associated with increased resistance of pathogenic fungi to the agents used in the therapeutic regimen and the limited number of drugs to cure these infections. As a result, the search for new drugs with antifungal activity has become increasingly important. The aim of this study is to study the antifungal activity of citronellal alone and in combination with amphotericin B or ketoconazole. The Minimal Inhibitory Concentration of citronellal, amphotericin B and ketoconazole against strains of Candida albicans were evaluated by the microdilution technique, and the Minimum Fungicide Concentration of citronellal against the same strains was also performed. Through the checkerboard methodology the effect of the combination of citronelal with amphotericin B or with ketoconazole was determined. This study showed that the association of citronellal with ketoconazole was shown to be an additive against one of the strains of C. albicans and indifferent to another strain. While the combined activity of citronellal and amphotericin B demonstrated an indifferent effect on the strains tested.

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