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Unusual fungal infections in the neonate

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


Fungal infections in neonates, other than those caused by Candida species, are uncommon. These are often overlooked because neonatal infections due to bacteria, viruses, and Candida are more prevalent [1]. Nonetheless, noncandidal fungal infections occur in neonates resulting in significant mortality and morbidity. They include aspergillosis, cutaneous and intestinal zygomycosis, Malassezia sepsis, trichosporonosis, Pichia sepsis, cryptococcosis, coccidioidomycosis, blastomycosis, and dermatophytosis.

Similarly to Candida infections, the incidence of noncandidal fungal infections in neonates appears to be increasing, particularly in preterm infants [2]. Preterm infants may be more vulnerable to fungal infections because of their immature immune systems and poorly developed epithelial skin and mucosal barriers, and the high rate of invasive procedures, such as central venous catheters and intubation, which compromise host defenses (eg, skin integrity). (See "Epidemiology and risk factors for Candida infection in neonates".)

Noncandidal fungal infections in the neonate and their treatment will be reviewed here. The epidemiology, clinical manifestations, treatment, and prevention of neonatal Candida infection are reviewed separately. (See "Epidemiology and risk factors for Candida infection in neonates" and "Candida infections in children" and "Candidemia and invasive candidiasis in children: Management".)


Aspergillus — Aspergillus species are ubiquitous molds commonly found in air, soil, decaying vegetation, and dust. Infections are most commonly caused by A. fumigatus, A. flavus, and A. niger. Mortality is very high in infected neonates, even when treated with antifungal therapy. (See 'Treatment' below.)

Reports of neonatal Aspergillus infection appear to be increasing. In a review of the literature from 2002, 16 of the 17 cases of primary cutaneous aspergillosis were published after 1990 [2,3].

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Literature review current through: Nov 2017. | This topic last updated: May 18, 2016.
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