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Messina A, Mariani A, Brandolisio R, Tavella E, Germano C, Lipari G, Leo L, Masturzo B, Manzoni P. Candidiasis in Pregnancy: Relevant Aspects of the Pathology for the Mother and the Fetus and Therapeutic Strategies. Trop Med Infect Dis 2024; 9:114. [PMID: 38787047 PMCID: PMC11125970 DOI: 10.3390/tropicalmed9050114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Vulvovaginal candidiasis (VVC) is a common condition that can lead to significant discomfort, affecting approximately 70-75% of women at least once in their lives. During pregnancy, the prevalence of VVC is estimated to be around 20%, peaking at about 30% in the third trimester, with a number of specific risk factors predisposing to yeast infection being identified and needing elucidation. This review aims to provide updated knowledge on candidiasis during pregnancy, addressing risk factors and maternal and neonatal outcomes, as well as discussing optimal therapeutic strategies to safeguard mothers and newborns. The bibliographic search involved two biomedical databases, PubMed and Embase, without imposing time limits. Among all Candida spp., Candida albicans remains the most frequent causative species. The hyperestrogenic environment of the vaginal mucosa and reduced immune defenses, physiological effects of pregnancy, create conditions favorable for Candida spp. vaginal colonization and hence VVC. Recent evidence shows an association between VVC and adverse obstetric outcomes, including premature membrane rupture (PROM), chorioamnionitis, preterm birth, and puerperal infections. Prompt and effective management of this condition is therefore crucial to prevent adverse obstetric outcomes, maternal-fetal transmission, and neonatal disease. Additional studies are required to confirm the benefits of systemic treatment for maternal candida infection or colonization in preventing premature birth or neonatal systemic candidiasis.
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Affiliation(s)
- Alessandro Messina
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Alessia Mariani
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Romina Brandolisio
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy; (R.B.); (E.T.)
- Department of Maternal, Neonatal and Infant Medicine, University of Torino School of Medicine, 10125 Turin, Italy
| | - Elena Tavella
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy; (R.B.); (E.T.)
- Department of Maternal, Neonatal and Infant Medicine, University of Torino School of Medicine, 10125 Turin, Italy
| | - Chiara Germano
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Giovanni Lipari
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Livio Leo
- Division of Obstetrics and Gynecology, Hopital Beauregard, AUSL Valleè d’Aoste, 11100 Aosta, Italy;
| | - Bianca Masturzo
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy; (R.B.); (E.T.)
- Department of Maternal, Neonatal and Infant Medicine, University of Torino School of Medicine, 10125 Turin, Italy
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Pinto TN, Kohn A, da Costa GL, Oliveira LMA, Pinto TCA, Oliveira MME. Candida guilliermondii as an agent of postpartum subacute mastitis in Rio de Janeiro, Brazil: Case report. Front Microbiol 2022; 13:964685. [PMID: 36212821 PMCID: PMC9537450 DOI: 10.3389/fmicb.2022.964685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Candida spp. can cause mild-to-severe human infections. Certain species have been described as the etiologic agent of human mastitis, inflammation of the breast tissue. Mastitis affects millions of lactating women and can be a source of disease transmission to the infant. In this work, we report the detection of the unusual etiologic agent of human mastitis, Candida guilliermondii, isolated from the milk of a puerperal woman with subacute mastitis in Rio de Janeiro, Brazil. Species identification was performed by MALDI-TOF MS and genetic sequencing. The patient had a full recovery after antifungal therapy.
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Affiliation(s)
- Tatiane Nobre Pinto
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alana Kohn
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Laura M. A. Oliveira
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tatiana C. A. Pinto
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Manoel M. E. Oliveira
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- *Correspondence: Manoel M. E. Oliveira, ;
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Abstract
Congenital cutaneous candidiasis is an infrequent invasive fungal infection that usually appears in the first days of life. Extremely low birth weight infants are the most frequently affected. Classic presentation includes diffuse extensive erythematous rash with papules, plaques, pustules and vesicles, which later undergoes desquamation. Systemic dissemination is common in extremely low birth weight infants. Blood, urine and cerebrospinal fluid evaluation should be included in the initial assessment. Early and prolonged treatment has been associated with decreased mortality. We report the case of congenital cutaneous candidiasis in a preterm infant. Early skin lesion recognition allowed establishing adequate treatment in the first hours of life.
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Georgescu TA, Lisievici AC, Munteanu O, Furtunescu FL, Bratu OG, Berceanu C, Bohîlţea RE. Congenital systemic candidiasis: a comprehensive literature review and meta-analysis of 44 cases. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:673-680. [PMID: 33817708 PMCID: PMC8112788 DOI: 10.47162/rjme.61.3.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Systemic candidiasis is a frequent complication in neonatal units, but congenital systemic candidiasis is an unusual diagnosis, observed in both full-term and preterm infants, with less than 50 cases reported to date. Congenital candidiasis presents with a wide spectrum of symptoms, ranging from diffuse skin eruptions to severe systemic disease, resulting in fetal demise or early neonatal death. Although management guidelines have been published almost two decades ago, due to the rarity of this type of infection, conclusive recommendations are difficult to establish, since they are based on anecdotal experience. In this paper, we present a comprehensive meta-analysis of the current scientific knowledge regarding congenital candidiasis, which spans 54 years and includes a total of 44 cases.
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Affiliation(s)
- Tiberiu Augustin Georgescu
- Department of Anatomy, Department of Public Health and Management, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Obstetrics and Gynecology, University Emergency Hospital, Bucharest, Romania; ,
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Lesions requiring wound management in a central tertiary neonatal intensive care unit. World J Pediatr 2017; 13:165-172. [PMID: 27878785 DOI: 10.1007/s12519-016-0070-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/22/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Most of the skin disorders that occur in neonatal intensive care units are due in part to the immaturity and vulnerability of the neonatal skin. Various iatrogenic diagnostic and therapeutic procedures are also conducive to iatrogenic damage. This study was to review the neonates admitted to our neonatal intensive care unit who needed wound management, and to assess the most common skin injuries and wounds, and their aetiology. METHODS Data were extracted from medical records of neonates who needed wound management in our Neonatal Intensive Care Unit between January 31, 2012 and January 31, 2013. Information about gestational age, sex, birth weight, area of involvement, wound aetiology, and therapy were collected. RESULTS Among the 211 neonates observed, wound management was required in 10 cases of diaper dermatitis, 7 epidermal stripping, 6 extravasation injuries, 5 pressure ulcers, 1 surgical wound and infection, 1 thermal burn, and 5 other lesions. CONCLUSIONS International guidelines in neonatal wound care practice are not available, and further research concerns are clearly needed. Dressings and antiseptic agents should be chosen with great care for application to neonates, with particular attention to the prevention of adverse events in this sensitive population. Team work among dermatologists, neonatologists and nurses is crucial for the successful treatment of neonates.
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Al-Rusan RM, Darwazeh AMG, Lataifeh IM. The relationship of Candida colonization of the oral and vaginal mucosae of mothers and oral mucosae of their newborns at birth. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:459-463. [PMID: 28283094 DOI: 10.1016/j.oooo.2017.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Vaginal Candida colonization is common during pregnancy. Vaginal Candida may transmit vertically to the mouth of newborns during labor. The aim of this study was to assess and compare oral Candida colonization between vaginally born newborns and cesarean-born newborns and to investigate the association of the mother's vaginal and oral Candida colonization and the newborn's oral colonization at the time of delivery. STUDY DESIGN Culture swabs were collected from the oral and vaginal mucosae of 100 pregnant women and from the oral mucosa of their 100 full-term newborns. Fifty (50%) of the mothers gave birth vaginally and the other 50 (50%) by cesarean section. RESULTS The prevalence of oral and vaginal Candida in pregnant mothers was 49% and 40%, respectively. Oral Candida colonization in newborns was 7%. Oral Candida was isolated from 5 of 50 (10%) in the vaginally born group and from 2 of 50 (4%) in the cesarean-born group (P = .44). In vaginally born group, oral Candida was isolated from 5 of 20 (25%) in those born to mothers with vaginal colonization of Candida, and 0 of 30 (0.0%) in mothers without vaginal colonization of Candida (P = .007). CONCLUSIONS The mother's vaginal Candida may constitute an important source of oral Candida in the newborns, particularly in those delivered vaginally.
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Affiliation(s)
- Rund M Al-Rusan
- Postgraduate Student, Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Jordan
| | - Azmi M G Darwazeh
- Professor in Oral Medicine, Department of Oral Medicine and Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Jordan.
| | - Isam M Lataifeh
- Professor in Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Jordan
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Genetic diversity among Candida albicans isolates associated with vertical transmission in preterm triplets. Mycopathologia 2014; 178:285-90. [PMID: 25151365 DOI: 10.1007/s11046-014-9803-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/13/2014] [Indexed: 01/11/2023]
Abstract
We report a case of congenital candidiasis in triplets, in the context of premature labor at 25 weeks gestation, without symptomatic vaginitis or chorioamnionitis. All three infants died as a result of prematurity, aggravated by systemic candidiasis. Multi-locus sequence typing confirmed vertical transmission of Candida albicans from the mother to the triplets and revealed a slight diversity among the strains isolated from the neonates.
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Payne MS, Kemp MW, Kallapur SG, Kannan PS, Saito M, Miura Y, Newnham JP, Stock S, Ireland DJ, Kramer BW, Jobe AH. Intrauterine Candida albicans infection elicits severe inflammation in fetal sheep. Pediatr Res 2014; 75:716-22. [PMID: 24632681 PMCID: PMC4530618 DOI: 10.1038/pr.2014.35] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/07/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Preventing preterm birth and subsequent adverse neonatal sequelae is among the greatest clinical challenges of our time. Recent studies suggest a role for Candida spp. in preterm birth and fetal injury, as a result of their colonization of either the vagina and/or the amniotic cavity. We hypothesized that intraamniotic Candida albicans would cause a vigorous, acute fetal inflammatory response. METHODS Sheep carrying singleton pregnancies received single intraamniotic injections of either saline (control) or 10(7) colony-forming units C. albicans 1 or 2 d prior to surgical delivery and euthanasia at 124 ± 2 d gestation. RESULTS Colonization of the amniotic cavity by C. albicans resulted in a modest inflammatory response at 1 d and florid inflammation at 2 d, characterized by fetal thrombocytopenia, lymphopenia, and significant increases of inflammatory cytokines/chemokines in the fetal membranes skin, lung, and the amniotic fluid. CONCLUSION Acute colonization of the amniotic cavity by C. albicans causes severe intrauterine inflammation and fetal injury. C. albicans is a potent fetal pathogen that can contribute to adverse pregnancy outcomes.
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Affiliation(s)
- Matthew S. Payne
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia
| | - Matthew W. Kemp
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia,CORRESPONDING AUTHOR: Matthew W. Kemp Ph.D., School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia 6009., Phone: 61-8-6488-7970, Fax: 61-8-6488-7971,
| | - Suhas G. Kallapur
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia,Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Centre, University of Cincinnati School of Medicine Cincinnati, Ohio USA
| | - Paranthaman Senthamarai Kannan
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Centre, University of Cincinnati School of Medicine Cincinnati, Ohio USA
| | - Masatoshi Saito
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia,Division of Perinatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Yuichiro Miura
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia,Division of Perinatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - John P. Newnham
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia
| | - Sarah Stock
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia,MRC Centre for Reproductive Health Queen’s Medical Research Institute University of Edinburgh Edinburgh, UK
| | - Demelza J. Ireland
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia
| | - Boris W. Kramer
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia,Department of Paediatrics, School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Alan H. Jobe
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Western Australia,Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Centre, University of Cincinnati School of Medicine Cincinnati, Ohio USA
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Abstract
We describe two full-term infants who presented with congenital cutaneous candidiasis (CCC) and compare their clinical presentation and outcome with that of neonatal candidiasis and chronic mucocutaneous candidiasis. Although candidal vulvovaginitis occurs in up to one-third of pregnancies, CCC is uncommon and can be confused with more-serious pustular disorders that present in neonates. Greater awareness of CCC is essential to make an early diagnosis and distinguish it from other infections.
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Affiliation(s)
- Kathy D Tieu
- Department of Dermatology, Naval Medical Center San Diego, San Diego, California 92123-2300, USA
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Amaral-Lopes S, Moura A. Neonatal fungal sepsis by Candida krusei: A report of three cases and a literature review. Med Mycol Case Rep 2012; 1:24-6. [PMID: 24371729 DOI: 10.1016/j.mmcr.2012.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 04/06/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022] Open
Abstract
Candida krusei has been recognised as a potentially multidrug resistant fungal pathogen due to its intrinsic fluconazole resistance and reports of decreased susceptibility to amphotericin B. Moreover, the medical literature provides only four articles that report on four cases of fungemia caused by C. krusei in newborns. The objective of this study was to report on the clinical and epidemiological characteristics of three cases of fungal sepsis in the neonates caused by C. krusei.
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Affiliation(s)
- Selma Amaral-Lopes
- Medicine Faculty/Federal University of Bahia, Largo do Terreiro de Jesus S/N, Centro Histórico, Salvador, Bahia, Brazil
| | - Andressa Moura
- Resident Physician Maternity Hospital Professor José MM Neto, Salvador, Bahia, Brazil
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Current awareness on yeast. Yeast 2010. [DOI: 10.1002/yea.1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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