Perinatology.  2017 Sep;28(3):99-102. 10.14734/PN.2017.28.3.99.

Intra-Amniotic Candida Infection Treated by Liposomal Amphotericin B in a Patient with Cervical Insufficiency

• Kang HS
• Yang SH
• Kim HS
• Park JW

• KMID: 2392431
• DOI: http://doi.org/10.14734/PN.2017.28.3.99

Abstract

Intra-amniotic Candida infection is uncommon but the consequence can be catastrophic. Transcervical amphotericin B and intra-amniotic fluconazole administration were identified in the literature. We present a case with intact membranes and ongoing pregnancy treated by maternal intravenous liposomal amphotericin B. A primipara who underwent cerclage placement before fetal viability was diagnosed with intra-amniotic Candida infection. Although maternal intravenous liposomal amphotericin B eradicated fungi in the amniotic cavity, Escherichia coli invasion caused devastating chorioamnionitis. The newborn delivered at 27⁺³ weeks' gestation did not survive due to respiratory distress syndrome and sepsis. Despite negative conversion of intra-amniotic culture results for fungi after treatment, another pathogen such as bacteria could ascend into the amniotic cavity via weakened membranes. Clinicians should consider broad-spectrum antibiotics as well as antifungal agents in this setting.

Keyword

Amniotic fluid; Infection; Candida albicans; Liposomal amphotericin B; Uterine cervical insufficiency

MeSH Terms

Amniotic Fluid
Amphotericin B*
Anti-Bacterial Agents
Antifungal Agents
Bacteria
Candida albicans
Candida*
Chorioamnionitis
Escherichia coli
Female
Fetal Viability
Fluconazole
Fungi
Humans
Infant, Newborn
Membranes
Pregnancy
Sepsis
Amphotericin B
Anti-Bacterial Agents
Antifungal Agents
Fluconazole

Figure

• 

  Fig. 1 Time table of use of broad-spectrum antibiotics and antifungal agents. AF, amniotic fluid; HD, hospital day.

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