Intra-AmnioticCandidaInfection Treated by Liposomal Amphotericin B in a Patient with Cervical Insufficiency

Abstract

Intraamniotic Candida infection is uncommon but the consequence can be catastrophic. Transcer vical amphotericin B and intraamniotic fluconazole administration were identified in the literature. We present a case with intact membranes and ongoing pregnancy treated by maternal intravenous liposomal amphotericin B. A primipara who underwent cerclage placement before fetal viability was diagnosed with intraamniotic Candida infection. Although maternal intravenous liposomal amphotericin B eradicated fungi in the amniotic cavity, Escherichia coli invasion caused devastating chorioamnionitis. The newborn delivered at 27 +3 weeks' gestation did not survive due to respiratory distress syndrome and sepsis. Despite negative conversion of intraamniotic culture results for fungi after treatment, another pathogen such as bacteria could ascend into the amniotic cavity via weak ened membranes. Clinicians should consider broadspectrum antibiotics as well as antifungal agents in this setting.