Infection

, Volume 24, Issue 3, pp 263–266 | Cite as

Fluconazole inCandida albicans sepsis during pregnancy: Case report and review of the literature

  • E. C. Wiesinger
  • C. Wenisch
  • S. Breyer
  • W. Graninger
  • Sylvia Mayerhofer
Case Report

Summary

Candida sepsis during pregnancy is a rare but life-threatening complication of infection withCandida albicans. In contrast to the situation with other antimicrobial agents, there exists only limited experience with systemic antifungal therapy during pregnancy. A recent report focuses on amphotericin B treatment in systemic fungal infection during pregnancy. The present report discusses a pregnant patient withCandida albicans sepsis and endophthalmitis as well as candida infection of the oral and genital mucous membranes, after hyperalimentation and broad spectrum antibiotic therapy via a central venous catheter. The patient was treated with 10 mg/kg fluconazole from week 16 of gestation for a total duration of 50 days. Adverse effects did not occur and the rest of the pregnancy proceeded favourably for both the mother and the baby.

Keywords

Candida Amphotericin Fluconazol Central Venous Catheter Mucous Membrane 

Therapie einer Candidasepsis mit Fluconazol während Schwangerschaft: Fallbericht und Literaturübersicht

Zusammenfassung

Eine Candidasepsis während der Schwangerschaft gehört zu den seltenen aber lebensbedrohlichen Infektionen mit diesem Keim. Im Gegensatz zu den meisten Antibiotika gibt es nur geringe Erfahrung in der antimykotischen Therapie bei dieser Erkrankung. Jüngst erst wurde eine Arbeit über Therapie mit Amphotericin B in der Schwangerschaft publiziert. In unserem Fallbericht diskutieren wir eine Patientin, die im Anschluß an eine Therapie mit Breitspektrum-Antibiotika und zentralvenöser parenteraler Ernährung eine Candidasepsis mit Endophthalmitis und oraler sowie genitaler Schleimhautbeteiligung erlitt. Wir behandelten mit 10 mg/kg Fluconazol ab der 16. Schwangerschaftswoche über insgesamt 50 Tage. Es traten keine Nebenwirkungen auf und die weitere Schwangerschaft verlief für Mutter und Kind komplikationslos.

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References

  1. 1.
    Weinberg, E. D. Pregnancy associated depression of cell mediated immunity. Rev. Infect. Dis. 6 (1984) 814–831.PubMedGoogle Scholar
  2. 2.
    Smith, C. B. Candidiasis: pathogenesis, host resistance and predisposing factors. In:Bodey, G. P., Fainstein, V. (eds.): Candidiasis. Raven, New York 1985, pp. 53–70.Google Scholar
  3. 3.
    Thong, Y. H., Steele, R. W., Vincent, M. M., Hensen, S. A., Bellanti, J. A. Impairedin vitro cell mediated immunity to rubella virus during pregnancy. N. Engl. J. Med. 289 (1973) 604–606.PubMedGoogle Scholar
  4. 4.
    Kumar, A., Madden, D. L., Nankervis, G. A. Humoral and cell mediated immune responses to herpes virus antigens during pregnancy — a longitudinal study. J. Clin. Immunol. 4 (1984) 12–17.PubMedGoogle Scholar
  5. 5.
    Fong, I. W., Read, S., Mc Clearly, P.: Cell mediated immunity in women with recurrent vulvovaginal moniliasis. 27th ICAAC, 1987.Google Scholar
  6. 6.
    Hurley, R., De Luovois, J. Candida vaginitis. Postgrad. Med. J. 55 (1979) 645–647.PubMedGoogle Scholar
  7. 7.
    Henzl, M. Vulvovaginal candidiasis. Historical perspectives and current trends. J. Reprod. Med. 31 (1986) 641.Google Scholar
  8. 8.
    Bodey, G. P. Candidiasis in cancer patients. Am. J. Med. 77 (Suppl. 4D) (1984) 13–19.Google Scholar
  9. 9.
    Bodey, G. P. The emergence of fungi as major hospital pathogens. J. Hosp. Infect. 11 (Suppl. A) (1988) 411–426.PubMedGoogle Scholar
  10. 10.
    Calandra, T., Bille, J., Scheider, R., Mosiman, F., Francioli, P. Clinical significance of candida isolated from the peritoneum in surgical patients. Lancet ii (1989) 1437–1440.Google Scholar
  11. 11.
    Gaines, J. D., Remington, J. S. Diagnosis of deep infection with candida. A study of candida precipitants. Ann. Intern. Med. 132 (1973) 699–702.Google Scholar
  12. 12.
    Inman, W., Pearce, G., Wilton, L. Safety of fluconazole in the treatment of vaginal candidiasis. A prescription-event monitoring study with special reference to the outcome of pregnancy. Eur. J. Clin. Pharmacol. 46 (1994) 115–118.PubMedGoogle Scholar
  13. 13.
    Lee, B. E., Feinberg, M., Abraham, J. J., Murthy, A. R. Congenital malformations in an infant born to a woman treated with fluconazole. Pediatr. Infect. Dis. J. 11 (1992) 1062–1064.PubMedGoogle Scholar
  14. 14.
    Wey, S. B., Pfaller, M. A., Wenzel, R. P.: Attributable mortality and excess length of stay due to nosocomial candidemai. 27th ICAAC, 1987, abstr. 77.Google Scholar
  15. 15.
    Komshian, S. V., Uwaydah, A. K., Sobel, J. D., Crane, L. R. Fungemia caused byCandida species andTorulopsis glabrata in the hospitalized patient: frequency, characteristics and evaluation of factors influencing outcome. Rev. Infect. Dis. 11 (1989) 379–390.PubMedGoogle Scholar
  16. 16.
    Potasman, I., Leibovitz, Z., Sharf, M. Candida sepsis in pregnancy and the postpartum period. Rev. Infect. Dis. 13 (1991) 146–149.PubMedGoogle Scholar
  17. 17.
    Dean, J. L., Wolf, J. E., Ranzini, A. C., Laughlin, M. A. Use of amphotericin B during pregnancy: a case report and review. Clin. Infect. Dis. 18 (1994) 364–368.PubMedGoogle Scholar
  18. 18.
    Gentry, L. D., Price, M. F. Urinary and genital candida infection. In:Bodey, G. P., Fainstein, V. (eds.): Candidiasis. Raven, New York 1985, pp. 169–179.Google Scholar
  19. 19.
    Foley, G. E., Winter, W. D. Increased mortality following penicillin therapy of chick embryos infected withCandida albicans var.stellatoidea. J. Infect. Dis. 85 (1949) 268–274.PubMedGoogle Scholar
  20. 20.
    Smith, C. V., Horenstein, J., Platt, L. D. Intraamniotic infection withCandida albicans associated with a retained intrauterine contraceptive device: a case report. Am. J. Obstet. Gynecol. 159 (1988) 123–124.PubMedGoogle Scholar
  21. 21.
    Schweid, A. I., Hopkins, G. B. Monilial chorionitis associated with an intrauterine contraceptive device. Obstet. Gynecol. 31 (1968) 719–721.PubMedGoogle Scholar
  22. 22.
    Schlosser, R. L., Zubeov, A., Bollinger, M. V., von Loewenich, V. Congenital candida infections. Monatsschr. Kinderheilkunde 141 (11) (1993) 864–867.Google Scholar
  23. 23.
    Fox, L. P. Fatal superinfection with monilia in gynecological surgery. Am. J. Obstet. Gynecol. 110 (1971) 285–290.PubMedGoogle Scholar
  24. 24.
    Chaim, W., Mazor, M., Wiznitzer, A. The prevalence and clinical significance of intraamniotic infection withCandida species in women with preterm labor. Arch. Gynecol. Obstet. 251 (1992) 9–15.PubMedGoogle Scholar
  25. 25.
    Meyers, B. R., Lieberman, T. W., Ferry, A. P. Candida endophthalmitis complicating candidemia. Ann. Intern. Med. 79 (1973) 647–653.PubMedGoogle Scholar
  26. 26.
    Edwards, J. E., Foos, R. Y., Montgomerie, J. Z., Guze, L. B. Ocular manifestations of candida septicemia: review of 76 cases of hematogenous candida endophthalmitis. Medicine Baltimore 53 (1974) 47–75.PubMedGoogle Scholar
  27. 27.
    Michelson, P. E., Stark, W., Reeser, F., Green, W. R. Endogenous candida endophthalmitis: report of 13 cases of 16 from literature. Int. Ophthalmol. Clin. 11 (1971) 125–147.Google Scholar
  28. 28.
    Smale, L. E., Waechter, K. G. Dissemination of coccidioidomycosis in pregnancy. Am. J. Obstet. Gynecol. 107 (1970) 356–361.PubMedGoogle Scholar
  29. 29.
    Moguchenok, E. A. Study of embryotoxic and teratogenic effects of amphotericin B and methyl derivate of amphotericin B in rats after their intravenous and intraamniotic administration. Antibiot. Khimioter. 37 (1992) 25–28.Google Scholar
  30. 30.
    Tachibana, M., Noguchi, Y., Monro, A. M. Toxicology of fluconazole in experimental animals. In:Fromtling, R. A. (ed.): Recent trends in the discovery, development and evaluation of antifungal agents. Prous Science, S. A. 1987, pp. 93–102.Google Scholar
  31. 31.
    Rubin, P. C., Wilton, L. V., Inman, W. H. W. Fluconazole and pregnancy: results of a prescription event-monitoring study. Int. J. Gynecol. Obstet. 37 (1992) 25–27.Google Scholar
  32. 32.
    Brammer, K. W., Farrow, P. R., Faulkner, J. K. Pharmacokinetics and tissue penetration of fluconazole in humans. Rev. Infect. Dis. 12 (1990) 318–326.Google Scholar
  33. 33.
    O'Day, D. M., Foulds, G., Williams, T. E., Robinson, R. D., Allen, R. H., Head, W. S. Ocular uptake of fluconazole following oral administration. Arch. Ophthalmol. 108 (1990) 1006–1008.PubMedGoogle Scholar
  34. 34.
    Abe, M., Ishikawa, H. Ocular penetration of fluconazole. J. Eye 8 (1991) 1479–1481.Google Scholar
  35. 35.
    Filler, S. G., Crislip, M. A., Mayer, C. L., Edwards, J. E. Jr. Comparison of fluconazole and amphotericin B for treatment of disseminated candidiasis and endophthalmitis in rabbits. Antimicrob. Agents Chemother. 35 (1991) 288–292.PubMedGoogle Scholar
  36. 36.
    Graninger, W., Presterl, E., Schneeweiss, B., Teleky, B., Georgopoulos, A. Treatment ofCandida albicans fungemia with fluconazole. J. Infect. 26 (1993) 133–146.PubMedGoogle Scholar

Copyright information

© MMV Medizin Verlag GmbH München 1996

Authors and Affiliations

  • E. C. Wiesinger
    • 1
  • C. Wenisch
    • 1
  • S. Breyer
    • 1
  • W. Graninger
    • 1
  • Sylvia Mayerhofer
    • 2
  1. 1.Dept. of Internal Medicine IDiv. of Infectious Diseases and ChemotherapyAustria
  2. 2.Div. of Immunology, Allergy and Infectious Diseases, Dept. of DermatologyUniversity of Vienna, Medical SchoolViennaAustria

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