Fungal skin infection in a neonatal intensive care unit patient

Abstract

Introduction & Objectives: Mature and intact epidermis is responsible for skin protection from invasion of various microorganisms (viruses, bacteria, fungi). Therefore all neonates, especially premature are at risk of cutaneous infection which is uncommon condition in the neonatal intensive care unit. However increasing cases have been reported due to a number of potential predisposing factors (mechanical ventilation, catheters, artificial nutrition, antibacterial therapy).Material & Methods: A 24 week, 584 g female neonate, II of the twins, born by vaginal delivery to a 35-year-old mother after premature rupture of membranes, was hospitalized to neonatal intensive care unit. Apgar scores were 3 and 6 at 1 and 5 minutes, respectively. The twins were placed into one neonatal incubator and vital signs were monitored. Mechanical ventilation, tube feeding, antibacterial and oxygen therapy was applied. 14 days later the II twin developed a widespread skin eruption while the I twin was not affected. Physical examination revealed symmetrical, annular erythematosquamous eruption with the scaling edge on the trunk and upper legs. Clinically lesions resembled tinea corporis. Results: A potassium hydroxide (KOH) examination of skin scrapings was positive for hyphae and Syncephalastrum spp. (Zygomycetes class) was cultured after 2 weeks. Candida and pathogenic bacteria from the skin lesions were not cultured, serology for lues (RPR, TPHA) was negative. We prescribed 1% clotrimazole cream for affected areas bid, fluconazole IV according to neonatal antifungal treatment guidelines. After 2 weeks of treatment the improvement of skin condition was noticed and 2 weeks later the lesions have cleared. After several days the lesions reoccurred on the trunk and topical treatment with 1% clotrimazole cream was repeated for 2 weeks. Successful antifungal therapy requires to search for possible contacts of fungal infection. Clinical exam...[...].