Risk Factors, Diagnosis, and Treatment of Neonatal Fungal Liver Abscess: A Systematic Review of the Literature

Abstract

(1) Background: Although invasive fungal infections are a major cause of neonatal morbidity and mortality, data on the incidence and outcomes of localized abscesses in solid organs due to fungal infections are scarce. The aim of this study was to consolidate evidence and enhance our understanding on neonatal liver abscesses due to invasive fungal infections. (2) Methods: An electronic search of the PubMed and Scopus databases was conducted, considering studies that evaluated fungal liver abscesses in the neonatal population. Data on the epidemiology, clinical course, treatment, and outcome of these infections were integrated in our study. (3) Results: Overall, 10 studies were included presenting data on 19 cases of neonatal fungal liver abscesses. Candida spp. were the most common causative pathogens (94.7%). Premature neonates constituted the majority of cases (93%), while umbilical venous catheter placement, broad spectrum antibiotics, and prolonged parenteral nutrition administration were identified as other common predisposing factors. Diagnosis was established primarily by abdominal ultrasonography. Medical therapy with antifungal agents was the mainstay of treatment, with Amphotericin B being the most common agent (47%). Abscess drainage was required in four cases (21%). Eradication of the infection was achieved in the majority of cases (80%). (4) Conclusions: Even though fungal liver abscess is a rare entity in the neonatal population, clinicians should keep it in mind in small, premature infants who fail to respond to conventional treatment for sepsis, particularly if an indwelling catheter is in situ. A high index of suspicion is necessary in order to achieve a timely diagnosis and the initiation of the appropriate treatment.

Candida auris Infection, a Rapidly Emerging Threat in the Neonatal Intensive Care Units: A Systematic Review

“…For the majority of cases, there were no data concerning the age of gestation. Of the 31 neonates with a documented gestational age, 20 were preterm neonates (64.5%), with a median gestational age of 28 weeks (IQR [26][27][28][29][30][31][32][33][34]. The median patient age (among the 264 cases with reported data) during disease onset was 21 (range: 1-71) days.…”

“…Invasive Candidiasis (IC) is the third most common cause of late-onset sepsis in VLBW neonates and an important cause of morbidity and mortality in the NICU [ 56 ]. The frequency of IC in NICUs ranges between 0.5 and 20% and varies between centers and patient population and is inversely proportional to gestational age and birth weight, with a higher frequency documented in neonates with an extremely low birth weight (ELBW) [ 26 , 56 , 57 ]. However, cases of neonatal IFI caused by other fungal species are increasingly reported in the international literature.…”

“…Many factors are involved in this rise, including invasive procedures, such as catheterizations of central veins and arteries, gastrointestinal tract invasive procedures, and the use of broad-spectrum antimicrobial therapies in the context of neonatal sepsis [ 23 ]. These infections also complicate the clinical course of term neonates with underlying health problems that are hospitalized in the NICU [ 26 ]. There are various international guidelines on the management, therapy, and prevention of invasive candidiasis in neonatal patients, most of which are based on what is known about neonatal C. albicans and C. parapsilosis infections [ 27 , 28 , 29 ].…”