s
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Home Print this page Email this page Small font size Default font size Increase font size Users Online: 742

 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 15  |  Issue : 1  |  Page : 49-51

Congenital cutaneous candidiasis from an asymptomatic mother


Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India

Date of Web Publication2-May-2014

Correspondence Address:
Sahana Sahana Srinivas
Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.131844

Rights and Permissions
  Abstract 

Congenital cutaneous candidiasis is an uncommon and benign infection presenting at birth or within 6 days of life in neonates exposed to candida in utero. It presents with generalized erythematous macules, papules, vesicles and pustules with or without systemic symptoms. We describe a full term newborn child with congenital cutaneous candidiasis born to an asymptomatic mother. Awareness of this condition is necessary to make an early diagnosis and differentiate from other neonatal infections.

Keywords: Asymptomatic, congenital, cutaneous candidiasis


How to cite this article:
Srinivas SS, Bhardwaj P. Congenital cutaneous candidiasis from an asymptomatic mother. Indian J Paediatr Dermatol 2014;15:49-51

How to cite this URL:
Srinivas SS, Bhardwaj P. Congenital cutaneous candidiasis from an asymptomatic mother. Indian J Paediatr Dermatol [serial online] 2014 [cited 2019 Sep 21];15:49-51. Available from: http://www.ijpd.in/text.asp?2014/15/1/49/131844


  Introduction Top


Congenital cutaneous candidiasis is a rare neonatal infection presenting at birth or within 6 days of life who are exposed to candida in utero. Although, this disorder is usually benign, self-limiting in full term infants, it can be life-threatening in premature neonates. [1] It is usually seen in infants with maternal candidal vulvovaginitis. Lesser than 100 cases have been reported in the literature over the past 40 years and few from Indian literature. [2] We report a neonate diagnosed as congenital cutaneous candidiasis born to an asymptomatic mother.


  Case report Top


The present case report is about a 2-day-old male child born at term by vaginal delivery to a 21-year-old primigravida mother presented with multiple fluid filled lesions on the trunk and extremities from birth. The child did not have any systemic infections. The mother had normal prenatal history and no complications during pregnancy. There was no history of vaginal secretions or premature rupture of membrane prior at onset of labor. Physical examination was normal. Cutaneous examination showed generalized maculopapular eruptions with multiple vesicles and pustules on face, trunk, back and extremities. Few areas showed exfoliation. Palms and soles showed multiple vesicles and pustules [Figure 1] and [Figure 2]. Mucous membrane nails and scalp was normal. Systemic examination was normal.
Figure 1: Multiple erythematous macules present on face, trunk and extremities

Click here to view
Figure 2: Multiple vesicles and pustules with exfoliation present on trunk and palms

Click here to view


Investigations revealed normal hemogram. Serum chemistry profile and chest X-ray was normal. Tzanck smear from vesicles was negative for multinucleated giant cells. Scrapings for potassium hydroxide mount showed budding yeast cells and pseudohyphae [Figure 3]. Based on history and clinical examination diagnosis of congenital cutaneous candidiasis was made. Child was put on topical antifungals. Skin lesions resolved within 2 weeks.
Figure 3: KOH examination showing budding yeast cells

Click here to view



  Discussion Top


Congenital candidiasis was first reported in 1960 by Sonnenschein et al. [3] This is a rare condition in newborn infants whose mother has an intrauterine candida infection prior to delivery. Although 20-25% of all pregnant women develop candida vulvovaginitis, only a small number of infants born to infected women develop congenital candidiasis. [4] Congenital cutaneous candidiasis frequently occurs in preterm infants, with other risk factors such as maternal vaginal candidiasis, prolonged rupture of membranes, administration of antibiotics, foreign body in the uterus such as an contraceptive device or cervical suture and chorioamnionitis due to candida by amniocentesis. [5]

Congenital cutaneous candidiasis presents as an asymptomatic or as a disseminated infection with hepatosplenomegaly, sepsis or even death. Risks of dissemination are more common in neonates with very low birth weight, <1500 g or there is an evidence of respiratory distress. This is due to incompletely developed epidermal barrier and immature immune system. [6],[7] Skin lesions develop at or within 72 h of life and presents as erythematous macules which progresses to papules, vesicles and pustules on an erythematous base. The eruption usually involves trunk, extremities, diaper area, skin folds, palms and soles. A burn such as dermatitis, ecchymotic areas, onychia and paronychia has also been reported. [7] The presence of white microabscesses on the surface of placenta and umbilical cord is pathognomic for diagnosis. [8]

Congenital cutaneous candidiasis needs to be differentiated from staphylococcal infection, herpes simplex, syphilis, erythema toxicum neonatorum, transient neonatal pustular melanosis, drug eruptions and langerhans cell histiocytosis. It should be differentiated from neonatal cutaneous candidiasis which usually presents after 1 st week of life as oral thrush or diaper dermatitis. [9]

Diagnosis is confirmed by demonstration of budding yeast cells and pseudohyphae on potassium hydroxide examination. Neonates with disseminated infection may have positive blood, urine and cerebrospinal fluid cultures. The course of the disease is benign in full term infants and do not require any therapy. Topical antifungal is the treatment of choice. Systemic antifungals are indicated in disseminated infections. Amphotericin B (0.5-1 mg/kg/day) is the first line of treatment for systemic disease. Fluconazole (6-12 mg/kg/day) can be used as an alternative therapy if there is resistance or toxicity to amphotericin B develops. [10]

Our case attempts to highlight that congenital cutaneous candidiasis can be transmitted from an asymptomatic mother in a full term child. Though the cause of infection cannot be established, possibly there could be a subclinical rupture of membrane, which could have facilitated the infection. Early recognition of this condition is necessary to prevent unnecessary investigations and prevent mortality.

 
  References Top

1.Sket KV, Giachetti A, Sojo M, Garrido D, Lupo E, Brener P. Congenital cutaneous candidiasis. Arch Argent Pediatr 2013;111:556-8.  Back to cited text no. 1
[PUBMED]    
2.Torres-Alvarez B, Hernandez-Blanco D, Ehnis-Perez A, Castanedo-Cazares JP. Cutaneous congenital candidiasis in a full-term newborn from an asymptomatic mother. Dermatol Online J 2013;19:18967.  Back to cited text no. 2
    
3.Sonnenschein H, Taschdjian CL, Clark DH. Congenital cutaneous candidiasis. Am J Dis Child 1964;107:260-6.  Back to cited text no. 3
[PUBMED]    
4.Almeida Santos L, Beceiro J, Hernandez R, Salas S, Escriba R, Garcia Frias E, et al. Congenital cutaneous candidiasis: Report of four cases and review of the literature. Eur J Pediatr 1991;150:336-8.  Back to cited text no. 4
    
5.Jagtap SA, Saple PP, Dhaliat SB. Congenital cutaneous candidiasis: A rare and unpredictable disease. Indian J Dermatol 2011;56:92-3.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.Waguespack-LaBiche J, Chen SH, Yen A. Disseminated congenital candidiasis in a premature infant. Arch Dermatol 1999;135:510-2.  Back to cited text no. 6
    
7.Darmstadt GL, Dinulos JG, Miller Z. Congenital cutaneous candidiasis: Clinical presentation, pathogenesis, and management guidelines. Pediatrics 2000;105:438-44.  Back to cited text no. 7
[PUBMED]    
8.Diana A, Epiney M, Ecoffey M, Pfister RE. White dots on the placenta and red dots on the baby: Congential cutaneous candidiasis - A rare disease of the neonate. Acta Paediatr 2004;93:996-9.  Back to cited text no. 8
    
9.Pradeepkumar VK, Rajadurai VS, Tan KW. Congenital candidiasis: Varied presentations. J Perinatol 1998;18:311-6.  Back to cited text no. 9
    
10.Rowen JL, Tate JM. Management of neonatal candidiasis. Neonatal Candidiasis Study Group. Pediatr Infect Dis J 1998;17:1007-11.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed1579    
    Printed34    
    Emailed0    
    PDF Downloaded291    
    Comments [Add]    

Recommend this journal