Clinical Features and Outcomes of Renal Mycetoma Complicated by Candida Sepsis in Newborn Infants.

Choi,  Bo Geum; Kim,  Chun Soo; Lee,  Sang Lak

doi:2012.19.4.237

Neonatal Med > Volume 19(4); 2012 > Article

Original Article

Journal of the Korean Society of Neonatology 2012;19(4):237-244.
DOI: https://doi.org/10.5385/jksn.2012.19.4.237 Published online December 25, 2012.

Clinical Features and Outcomes of Renal Mycetoma Complicated by Candida Sepsis in Newborn Infants.

Bo Geum Choi, Chun Soo Kim, Sang Lak Lee

Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea. cskim@dsmc.or.kr

Abstract

PURPOSE
The kidney is a common site of end organ involvement in patients with candidemia. This study was undertaken to investigate clinical features and outcomes of renal mycetoma complicated by Candida sepsis in neonates.
METHODS
A retrospective analysis of the medical records and radiologic images was conducted in a neonatal intensive care unit over a 9-year period (2002-2010).
RESULTS
During the study period, there were 69 episodes of Candida sepsis. C. albicans was the most common pathogen (49.2%), and C. parapsilosis was the second (42%), but emerging. Of the 42 patients who underwent ultrasound examination in early phase of infection, renal mycetoma was observed in 8 cases (19.1%). Renal mycetoma was more frequently developed in patients with C. albicans sepsis than those with non-albicans candidemia, but the result was not significant. The demographic characteristics of the two groups of patients who had Candida sepsis (with renal mycetoma vs. without renal mycetoma) were similar. Candiduria was more common in the mycetoma group (P<0.01). In addition, the duration of antifungal medication was longer in patients with mycetoma (P<0.001). On follow-up ultrasounds, improvement and resolution of renal echogenic lesions took a median time of 2 and 5 months respectively for the mycetoma group.
CONCLUSION
Candiduria may be an initial sign of renal mycetoma complicated by Candida sepsis in newborn infants. Echogenic foci on the renal ultrasound are persistent for a considerable period after antifungal therapy, and therefore follow-up evaluations are important.

Key Words: Candida; Sepsis; Mycetoma; Kidney; Neonate