InfectiousDisease

Question 1

Congenital cutaneous candidiasis
-what is it?
-risk factors?
-incidence?
-classic cord finding?
-skin findings
-treatment

(January 2022)

Answer 1

-invasive fungal infection involving the dermis and epidermis / typically presents at or within a few days after birth / ascending infection from maternal genital tract / penetration through the amniotic sac can occur without ROM

-preterm labor, extreme prematurity, and foreign bodies (ie cervical suture). Candida chorio often presents with PTL but no maternal fever

-very rare, 0.1% of all NICU admissions

-grossly yellow-white pinpoint nodules on cord c/w sub amnionic microabscesses classic for Candida chorio

-variable skin findings including desquamation, M-P eruption “beefy”, papule, pustules, diffuse erythroderma, yellow plaques or secretions, dry/flaky skin

-prompt systemic antifungal coverage (aka ampho B deoxycholate) + empiric Staph coverage. important to send aerobic and fungal skin cultures, blood, and CSF (if no rash on back) for 14+ days

Question 2

Late Onset Sepsis:

-environmental and host factors
-clinical signs
-pathogens (G+, G-, etc)

Answer 2

• presence of central lines, prolonged mechanical ventilation, NICU staff, NICU environment and surfaces. Host factors GA, IUGR, delayed enteral feeding, critical illness/co-morbidities, microbiome derangements/history of prolonged empiric antibiotic exposure, surgical treatment, length of hospital stay, genetic factors

-systemic signs like hyper/hypothermia, feeding intolerance. cardiorespiratory signs like tachy/Brady/hypotension, apnea, tachypnea, increased FiO2 or support needs. CNS signs lethargy, hypotonia, seizures

-Gram(+) think CoNS, Enterococcus, Staph aureus, Group B Strep.
Gram(-) E.coli, Klebsiella, Enterobacter, Pseudomonas, Serratia, Acinetobacter. Viruses (parainfluenza, echo/adeno/entero-virus, coronavirus, coxsackie, rhinovirus. fungal Candida albicans and C. parapsilosis)