Antenatal infections with Candida species.

Abstract

SUMMARY The clinical, pathological, and microbiological features of 18 pregnancies complicated by intrauterine infection with Candida sp. are described. Chorioamnionitis with Candida sp. can be recognised macroscopically at birth. Penetration of the umbilical cord and membranes is associated with an intense fetal inflammatory response. The infection characteristically presents in infants of very low birthweight as pneumonia or a skin infection. In nearly every case the organism can be recovered from the gastric aspirate. A case control study showed that there is a striking association between chorioamnionitis caused by Candida sp. and the presence of a foreign body (an intrauterine contraceptive device or a cervical suture) in the mother's genital tract in pregnancy. This feature in the perinatal history of an infant of short gestation who exhibits a very high neutrophil count should alert the clinician to the possible presence of chorioamnionitis due to Candida sp.

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

“…For this reason, term infants with congenital candidiasis should be evaluated for an immunodeficiency. Early reviews demonstrate that half of the patients were preterm infants and that without systemic therapy, these patients, as well as full-term infants with pneumonia, died (107,226,501). Whyte et al described similar findings for 18 cases of histopathologic Candida chorioamnionitis, with 15 leading to neonatal infection (all in infants with birth weight of Ͻ2,000 grams), and for 12 cases at Ͻ28 weeks' gestation (501).…”

“…In one series of cases of chorioamnionitis, Candida was isolated from the fetal surface of the placenta in only 0.8% of infections (313). Candida chorioamnionitis and congential infection has been associated with the presence of an intrauterine contraceptive device in about 25% of cases, probably due to heavy fungal colonization (107,226,501). Congenital fungal infection was first described in term infants who presented with pustules, vesicles, skin abscesses, and an erythematous maculopapular rash of the trunk and extremities, at times leading to desquamation (42,105).…”

“…The incidence of vaginal fungal colonization during pregnancy has been reported to be between 25 and 46%, with 85 to 90% of these cases being due to C. albicans and the remainder being due predominantly to C. glabrata and C. tropicalis (175,501). Despite frequent fungal colonization, chorioamnionitis caused by Candida is a rare event, with almost all vertical transmission occurring when the infant passes through the birth canal via cutaneous contact with or swallowing or aspiration of fungi (313,501). Treatment of maternal Candida vaginosis and UTIs during pregnancy may decrease the inoculum to which the infant is exposed and may potentially prevent vertical transmission (386).…”

Candida Chorioamnionitis After Serial Therapeutic Amniocenteses: A Possible Association

“…Despite the high frequency of maternal vaginal candidal colonization (ϳ34%), 3 the rarity of monilial chorioamnionitis (6.5% of women in preterm labor with intact membranes and positive amniotic fluid cultures) 1 implies that factors beyond the presence of the fungus favor the initiation of placental and/or fetal infection. Four possible explanations have been proposed for Candida reaching the upper genital tract and causing chorioamnionitis: (1) direct invasion from the vagina after premature rupture of membranes, (2) sealed ruptures of the amnion, (3) migration across an intact amnion, and (4) a foreign body in the genital tract, such as an intrauterine contraceptive device or cerclage.…”

“…6 Case series and individual reports have highlighted the possible etiologic role of the retained intrauterine contraceptive device and cervical cerclage. 3 In a prior case report of congenital mucocutaneous candidiasis after amniocentesis performed to assess fetal lung maturity, 7 it was conjectured that Candida could be introduced into the amniotic sac by the use of contaminated instruments, colonization of maternal skin, or puncture of fetal membranes allowing entry of ascending vaginal organisms. In the present case, infection related to repetitive amniocenteses may be an addition to the above list.…”