Late onset neonatal Candida albicans osteomyelitis and arthritis: a case report and literature review.

Abstract

Objectives: Invasive candidiasis in neonates is an important cause of morbidity and mortality in the neonatal intensive care unit. Well known complications from invasive Candida albicans infections include kidney infections, endophthalmitis, endocarditis, meningitis and dermatitis. Candida arthritis and osteomyelitis have been reported less frequently, but have been observed months to even years after systemic antifungal therapy for candidiasis was completed.

Case report: We present a preterm neonate with a fungal proven central line associated infection, treated with antifungal therapy, who developed secondary a delayed presentation of osteomyelitis and arthritis as a complication of the Candida albicans fungemia. The infection was suspected by a positive serum beta-D-glucan (BDG) test and the diagnosis of invasive Candida infection was proven by tissue culture. Prolonged treatment during six months with oral fluconazole cured the infection in this case. A literature review revealed limited guidance on how to manage this complication in neonatal and pediatric patients. Previously described cases received amphotericin B more often than fluconazole, but both options appear to be curative. However, compared to amphotericin B, fluconazole has less adverse effects, such as nephrotoxicity, has better tissue penetration and can be administered orally.

Conclusions: Skeletal infections secondary to Candida albicans infections in the neonatal population are serious, but prolonged oral treatment is curative in most cases. It is important to raise awareness for the long lag time between initial infection and secondary complication, so these newborns receive a close follow-up. The beta-D-glucan serum antigen tests can be contributive to a timely diagnosis.