Fungal endocarditis with right ventricular candidal mycetoma in a premature neonate

Prematür yenidoğanlarda mantar miçetoma nadirdir ve sıklıkla mortaliteyle sonuçlanır. Olguların çoğunda tanı postmortem konulur. Burada Candida albicans ile kan dolaşımı enfeksiyonu gelişen, ardından endokardit ve miçetoma ile komplike olan 30 haftalık preterm bir yenidoğan olgusunu sunduk. Bu yenidoğanın başlangıçta çoklu antibiyotik kullanmayı gerektiren Klebsiella sepsisi vardı. Total parenteral beslenme için periferden konulan bir santral venöz kateter kullanıldı. Doğumdan sonraki 24. günde kandidemi gelişti, 14 gün süreyle flukonazol ile tedavi edildi ve iyileşme gösterdi. Daha sonra 60. günde kolestaz gelişti ve bozulan karaciğer fonksiyon testleri ve sürekli trombositopeni ile birlikte apne, bradikardi ve satürasyon bozuklukları ortaya çıktı. Kan kültüründe tekrar C. albicans üredi. Ekokardiyografide sağ ventrikülü dolduran bir miçetoma ile triküspid kapak üzerinde büyük bir mantar vejetasyonu görüldü. Damar yoluyla amfoterisin B ve flukonazol tedavisi yanında diğer gereken tıbbı destekler yapıldı ancak hastanın genel durumu bozularak iki hafta sonra kaybedildi

Fungal mycetoma or endocarditis is rare in premature neonates and it is often associated with high mortality. In the majority of the cases diagnosis is made postmortem. Here we report a 30-week-old preterm neonate who developed Candida albicans blood stream infection complicated by endocarditis and subsequent mycetoma. Initially, this neonate had Klebsiella sepsis requiring multiple antibiotic courses. A peripherally inserted central venous catheter was used to give total parenteral nutrition. On day 24 of life, he developed candidemia, treated with 14 day course of fluconazole and shown improvement. Further, on day 60 of life he developed cholestasis, deranged liver function tests and persistent thrombocytopenia along with apnea, bradycardia and desaturations. Blood culture again grew again C. albicans. Echocardiography showed large fungal vegetation on tricuspid valve with a mycetoma filling the right ventricle. He was treated with intravenous amphotericin B, fluconazole and supportive measures, but he deteriorated and succumbed after two weeks. J Microbiol Infect Dis 2015;5(3): 142-145Key words: Prematureneonate, candida sepsis, endocarditis, mycetoma

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Journal of Microbiology and Infectious Diseases-Cover
  • ISSN: 2146-3158
  • Başlangıç: 2011
  • Yayıncı: Sağlık Araştırmaları Derneği
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