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Clinical manifestations and diagnosis of Candida infection in neonates

Mohan Pammi, MD, PhD
Section Editor
Leonard E Weisman, MD
Deputy Editor
Carrie Armsby, MD, MPH


Candida has emerged as an important cause of neonatal infections with significant morbidity and mortality, especially in extremely low and very low birth weight infants, defined as birth weights below 1000 g and 1500 g, respectively [1-5]. The clinical manifestations of Candida infection in the neonate vary, ranging from localized infections of the skin and mucous membranes to life-threatening systemic infection with multisystem organ failure. Host risk factors, such as prematurity and the use of invasive procedures, are important determinants that influence the severity and type of neonatal Candida infection [3,5].

The clinical manifestations of Candida infection in the neonate will be reviewed here. The etiology, treatment, and prevention of neonatal candidal infections are discussed separately, as are the clinical manifestations of Candida in older infants and children. (See "Epidemiology and risk factors for Candida infection in neonates" and "Treatment of Candida infection in neonates" and "Candida infections in children".)


The various presentations of Candida infections in the newborn can be separated into the following categories [6]:

Mucocutaneous candidiasis, which includes oropharyngeal involvement (thrush) or diaper dermatitis.

Systemic candidiasis typically due to catheter-related or localized infections that progress to disseminated infections and multiorgan involvement.

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Literature review current through: Nov 2017. | This topic last updated: Sep 08, 2015.
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  1. Kossoff EH, Buescher ES, Karlowicz MG. Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases. Pediatr Infect Dis J 1998; 17:504.
  2. Beck-Sague CM, Azimi P, Fonseca SN, et al. Bloodstream infections in neonatal intensive care unit patients: results of a multicenter study. Pediatr Infect Dis J 1994; 13:1110.
  3. Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110:285.
  4. Fridkin SK, Kaufman D, Edwards JR, et al. Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995-2004. Pediatrics 2006; 117:1680.
  5. Saiman L, Ludington E, Pfaller M, et al. Risk factors for candidemia in Neonatal Intensive Care Unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J 2000; 19:319.
  6. Hundalani S, Pammi M. Invasive fungal infections in newborns and current management strategies. Expert Rev Anti Infect Ther 2013; 11:709.
  7. Faix RG. Invasive neonatal candidiasis: comparison of albicans and parapsilosis infection. Pediatr Infect Dis J 1992; 11:88.
  8. Fairchild KD, Tomkoria S, Sharp EC, Mena FV. Neonatal Candida glabrata sepsis: clinical and laboratory features compared with other Candida species. Pediatr Infect Dis J 2002; 21:39.
  9. Rowen JL. Mucocutaneous candidiasis. Semin Perinatol 2003; 27:406.
  10. Rowen JL, Atkins JT, Levy ML, et al. Invasive fungal dermatitis in the < or = 1000-gram neonate. Pediatrics 1995; 95:682.
  11. Faix RG, Kovarik SM, Shaw TR, Johnson RV. Mucocutaneous and invasive candidiasis among very low birth weight (less than 1,500 grams) infants in intensive care nurseries: a prospective study. Pediatrics 1989; 83:101.
  12. Gupta P, Faridi MM, Rawat S, Sharma P. Clinical profile and risk factors for oral candidosis in sick newborns. Indian Pediatr 1996; 33:299.
  13. Daftary SS, Desai SV, Shah MV, Daftary SN. Oral thrush in the new-born. Indian Pediatr 1980; 17:287.
  14. Hoppe JE. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: review and reappraisal. Pediatr Infect Dis J 1997; 16:885.
  15. Bendel CM. Candidiasis. In: Infectious diseases of the Fetus and Newborn Infant, 7th ed, Remington JS et al (Ed), Elsevier Saunders, Philadelphia 2010. p.1055.
  16. Melville C, Kempley S, Graham J, Berry CL. Early onset systemic Candida infection in extremely preterm neonates. Eur J Pediatr 1996; 155:904.
  17. Darmstadt GL, Dinulos JG, Miller Z. Congenital cutaneous candidiasis: clinical presentation, pathogenesis, and management guidelines. Pediatrics 2000; 105:438.
  18. Roqué H, Abdelhak Y, Young BK. Intra amniotic candidiasis. Case report and meta-analysis of 54 cases. J Perinat Med 1999; 27:253.
  19. Almeida Santos L, Beceiro J, Hernandez R, et al. Congenital cutaneous candidiasis: report of four cases and review of the literature. Eur J Pediatr 1991; 150:336.
  20. Baley JE, Rivers A, Clapp DW. Two year outcome of systemic candidiasis in VLBW infants. Ped Res 1988; 23:441A.
  21. Butler KM, Baker CJ. Candida: an increasingly important pathogen in the nursery. Pediatr Clin North Am 1988; 35:543.
  22. Baley JE, Kliegman RM, Fanaroff AA. Disseminated fungal infections in very low-birth-weight infants: clinical manifestations and epidemiology. Pediatrics 1984; 73:144.
  23. Dyke MP, Ott K. Severe thrombocytopenia in extremely low birthweight infants with systemic candidiasis. J Paediatr Child Health 1993; 29:298.
  24. Noyola DE, Fernandez M, Moylett EH, Baker CJ. Ophthalmologic, visceral, and cardiac involvement in neonates with candidemia. Clin Infect Dis 2001; 32:1018.
  25. Barton M, O'Brien K, Robinson JL, et al. Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls. BMC Infect Dis 2014; 14:327.
  26. Bodey GP, Luna M. Skin lesions associated with disseminated candidiasis. JAMA 1974; 229:1466.
  27. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503.
  28. Phillips JR, Karlowicz MG. Prevalence of Candida species in hospital-acquired urinary tract infections in a neonatal intensive care unit. Pediatr Infect Dis J 1997; 16:190.
  29. Bryant K, Maxfield C, Rabalais G. Renal candidiasis in neonates with candiduria. Pediatr Infect Dis J 1999; 18:959.
  30. Benjamin DK Jr, Fisher RG, McKinney RE Jr, Benjamin DK. Candidal mycetoma in the neonatal kidney. Pediatrics 1999; 104:1126.
  31. Robinson JL, Davies HD, Barton M, et al. Characteristics and outcome of infants with candiduria in neonatal intensive care - a Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study. BMC Infect Dis 2009; 9:183.
  32. Karlowicz MG. Candidal renal and urinary tract infection in neonates. Semin Perinatol 2003; 27:393.
  33. Eckstein CW, Kass EJ. Anuria in a newborn secondary to bilateral ureteropelvic fungus balls. J Urol 1982; 127:109.
  34. Khan MY. Anuria from candida pyelonephritis and obstructing fungal balls. Urology 1983; 21:421.
  35. McDonnell M, Lam AH, Isaacs D. Nonsurgical management of neonatal obstructive uropathy due to Candida albicans. Clin Infect Dis 1995; 21:1349.
  36. Sirinelli D, Biriotti V, Schmit P, et al. Urinoma and arterial hypertension complicating neonatal renal candidiasis. Pediatr Radiol 1987; 17:156.
  37. Wynn JL, Tan S, Gantz MG, et al. Outcomes following candiduria in extremely low birth weight infants. Clin Infect Dis 2012; 54:331.
  38. Friedman S, Richardson SE, Jacobs SE, O'Brien K. Systemic Candida infection in extremely low birth weight infants: short term morbidity and long term neurodevelopmental outcome. Pediatr Infect Dis J 2000; 19:499.
  39. Faix RG. Systemic Candida infections in infants in intensive care nurseries: high incidence of central nervous system involvement. J Pediatr 1984; 105:616.
  40. Fernandez M, Moylett EH, Noyola DE, Baker CJ. Candidal meningitis in neonates: a 10-year review. Clin Infect Dis 2000; 31:458.
  41. Chen JY. Neonatal candidiasis associated with meningitis and endophthalmitis. Acta Paediatr Jpn 1994; 36:261.
  42. Cohen-Wolkowiez M, Smith PB, Mangum B, et al. Neonatal Candida meningitis: significance of cerebrospinal fluid parameters and blood cultures. J Perinatol 2007; 27:97.
  43. Faix RG, Chapman RL. Central nervous system candidiasis in the high-risk neonate. Semin Perinatol 2003; 27:384.
  44. Adderson EE, Pappin A, Pavia AT. Spontaneous intestinal perforation in premature infants: a distinct clinical entity associated with systemic candidiasis. J Pediatr Surg 1998; 33:1463.
  45. Robertson NJ, Kuna J, Cox PM, Lakhoo K. Spontaneous intestinal perforation and Candida peritonitis presenting as extensive necrotizing enterocolitis. Acta Paediatr 2003; 92:258.
  46. Kaplan M, Eidelman AI, Dollberg L, Abu-Dalu K. Necrotizing bowel disease with candida peritonitis following severe neonatal hypothermia. Acta Paediatr Scand 1990; 79:876.
  47. Mintz AC, Applebaum H. Focal gastrointestinal perforations not associated with necrotizing enterocolitis in very low birth weight neonates. J Pediatr Surg 1993; 28:857.
  48. Baley JE, Annable WL, Kliegman RM. Candida endophthalmitis in the premature infant. J Pediatr 1981; 98:458.
  49. Mittal M, Dhanireddy R, Higgins RD. Candida sepsis and association with retinopathy of prematurity. Pediatrics 1998; 101:654.
  50. Noyola DE, Bohra L, Paysse EA, et al. Association of candidemia and retinopathy of prematurity in very low birthweight infants. Ophthalmology 2002; 109:80.
  51. Tadesse M, Dhanireddy R, Mittal M, Higgins RD. Race, Candida sepsis, and retinopathy of prematurity. Biol Neonate 2002; 81:86.
  52. Haroon Parupia MF, Dhanireddy R. Association of postnatal dexamethasone use and fungal sepsis in the development of severe retinopathy of prematurity and progression to laser therapy in extremely low-birth-weight infants. J Perinatol 2001; 21:242.
  53. Bharwani SK, Dhanireddy R. Systemic fungal infection is associated with the development of retinopathy of prematurity in very low birth weight infants: a meta-review. J Perinatol 2008; 28:61.
  54. Karlowicz MG, Giannone PJ, Pestian J, et al. Does candidemia predict threshold retinopathy of prematurity in extremely low birth weight (</=1000 g) neonates? Pediatrics 2000; 105:1036.
  55. Swanson H, Hughes PA, Messer SA, et al. Candida albicans arthritis one year after successful treatment of fungemia in a healthy infant. J Pediatr 1996; 129:688.
  56. Harris MC, Pereira GR, Myers MD, et al. Candidal arthritis in infants previously treated for systemic candidiasis during the newborn period: report of three cases. Pediatr Emerg Care 2000; 16:249.
  57. Ward RM, Sattler FR, Dalton AS Jr. Assessment of antifungal therapy in an 800-gram infant with candidal arthritis and osteomyelitis. Pediatrics 1983; 72:234.
  58. Mayayo E, Moralejo J, Camps J, Guarro J. Fungal endocarditis in premature infants: case report and review. Clin Infect Dis 1996; 22:366.
  59. Pana ZD, Dotis J, Iosifidis E, Roilides E. Fungal Endocarditis in Neonates: A Review of Seventy-one Cases (1971-2013). Pediatr Infect Dis J 2015; 34:803.
  60. Briones CR, Villanueva-Uy ME, Uy HG. The use of polymerase chain reaction in neonatal candidemia. Pediatr Res 2003; 53:396A.
  61. Tirodker UH, Nataro JP, Smith S, et al. Detection of fungemia by polymerase chain reaction in critically ill neonates and children. J Perinatol 2003; 23:117.