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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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2
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Santacruz E, Plumptre I, Yim K, O'Donnell P, Baltz J. Onychodystrophy in an 8-week-old male. Pediatr Dermatol 2024; 41:124-126. [PMID: 37357345 DOI: 10.1111/pde.15376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/25/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Elise Santacruz
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Isabella Plumptre
- Department of Dermatology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Kaitlyn Yim
- Department of Pathology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Patrick O'Donnell
- Department of Pathology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Julia Baltz
- Department of Dermatology, University of Massachusetts, Worcester, Massachusetts, USA
- Dermatology Professionals, Inc, East Greenwich, Rhode Island, USA
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3
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Shope C, Cotton CH, Wine Lee L. Congenital erosive and vesicular dermatosis healing with reticulated and supple scarring: Two cases secondary to fungal infection. Pediatr Dermatol 2023; 40:900-903. [PMID: 36813738 DOI: 10.1111/pde.15286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
Congenital erosive and vesicular dermatosis (CEVD) is a rare skin condition that most commonly presents as erosive and vesicular lesions on the trunk and extremities in premature infants and heals with characteristic reticulated and supple scarring (RSS). The exact pathogenesis of CEVD is unknown and is typically a diagnosis of exclusion. We present the cases of two extremely premature neonates with Candida septicemia who were found to have diffuse, erythematous skin eruptions shortly after birth that ultimately healed with RSS. Through these cases, we highlight the importance of including fungal infection in the work-up of CEVD healing with RSS.
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Affiliation(s)
- Chelsea Shope
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Colleen H Cotton
- Division of Dermatology, Children's National Hospital, Washington, DC, USA
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Lara Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
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4
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Akutsu A, Otsubo Y, Suzumura H, Yoshihara S. Congenital cutaneous candidiasis in one infant among a twin sibling pair. Arch Dis Child Fetal Neonatal Ed 2022; 107:637. [PMID: 34045281 DOI: 10.1136/archdischild-2021-322107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Akira Akutsu
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Yuto Otsubo
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Hiroshi Suzumura
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
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5
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Neonatal sepsis and the skin microbiome. J Perinatol 2022; 42:1429-1433. [PMID: 35817842 DOI: 10.1038/s41372-022-01451-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022]
Abstract
Neonatal sepsis is a major cause of morbidity and mortality in preterm infants. Preterm and very low birth weight infants are particularly susceptible to sepsis due to their immature skin barrier, naive immune system, exposure to broad-spectrum antibiotics, and insertion of medical devices. Neonatal intestinal dysbiosis has been linked to neonatal sepsis; however, the cutaneous microbiome likely plays a role as well, as common sepsis pathogens also dominate the skin flora. This review summarizes our current understanding of the infant skin microbiome and common causative pathogens in neonatal sepsis, as well as the relationship between the two. A better understanding of the role of the skin microbiome in the pathogenesis of neonatal sepsis may guide future prophylaxis and treatment.
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Salusti-Simpson M, Marghoob N, Greene L, Morley K. Congenital cutaneous candidiasis in a full-term neonate. Pediatr Dermatol 2022; 39:952-954. [PMID: 35879203 PMCID: PMC10087360 DOI: 10.1111/pde.15088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Abstract
We present a case of a full-term neonate born with respiratory distress and a widespread erythematous rash, who was found to have congenital cutaneous candidiasis (CCC). The significance of this report is to contribute to the pre-existing literature on the rarity of CCC, but also to share a case of a patient who was successfully treated conservatively with topical antifungal agents only.
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Affiliation(s)
| | - Nadeem Marghoob
- University of Vermont Medical Center, Burlington, Vermont, USA
| | - Laura Greene
- University of Vermont Medical Center, Burlington, Vermont, USA
| | - Keith Morley
- University of Vermont Medical Center, Burlington, Vermont, USA
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Shibata M, Kaneko K, Umehara N, Matsui H, Kawai T, Nakadate H, Murashimia A, Sago H. A pregnant woman with thymoma-associated pure red cell aplasia. BMC Pregnancy Childbirth 2022; 22:795. [PMID: 36303124 PMCID: PMC9608914 DOI: 10.1186/s12884-022-05145-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background Pure red cell aplasia (PRCA) is a hematological disorder characterized by anemia with severe reticulocytopenia caused by a marked reduction in erythroid precursors in the bone marrow. PRCA is known to be associated with pregnancy, but thymoma-associated PRCA during pregnancy is very rare, and its successful management has not been reported. Case presentation A 37-year-old primiparous woman with severe anemia was referred to our center at 27 weeks’ gestation. She was diagnosed with PRCA based on bone aspiration findings at 33 weeks’ gestation. Magnetic resonance imaging (MRI) revealed an anterior mediastinal mass 4 cm in size suspected of being thymoma. She was therefore diagnosed with thymoma-associated PRCA during pregnancy. Surgery for thymoma was planned after delivery, since the imaging findings were suggestive of early-stage thymoma (Masaoka stage I or II). With transfusion of a total 3,360 ml of red blood cells (RBCs) during pregnancy, the patient gave birth to a baby girl weighing 2,548 g at 40 weeks’ gestation. The baby showed transient congenital cutaneous candidiasis. The placental pathology revealed subamniotic inflammation with a fungal structure. Treatment with topical anti-fungal cream immediately ameliorated the baby’s skin lesion. Maternal anemia did not improve after delivery; however, the thymoma did not increase in size. At five months after delivery, the mother underwent thymectomy with oral cyclosporine A. A pathological examination revealed Masaoka stage II-a thymoma. She completely had recovered from anemia at six months after surgery. Cyclosporine A treatment was discontinued three years after surgery. Remission has been sustained for four years since surgery. Conclusions A very rare case of thymoma-associated PRCA during pregnancy was diagnosed without any subjective symptoms and was expectantly managed, resulting in a good prognosis. Although bone marrow aspiration during pregnancy is an invasive test, it is important to confirm the diagnosis. Conservative management with blood transfusion was possible for early-stage thymoma-associated PRCA during pregnancy. Active surveys, including MRI, for PRCA during pregnancy led to the detection of thymoma at an early stage and the achievement of a preferable pregnancy outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05145-5.
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Affiliation(s)
- Megumi Shibata
- grid.63906.3a0000 0004 0377 2305Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Kayoko Kaneko
- grid.63906.3a0000 0004 0377 2305Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Nagayoshi Umehara
- grid.63906.3a0000 0004 0377 2305Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Hitoshi Matsui
- grid.63906.3a0000 0004 0377 2305Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Toshinao Kawai
- grid.63906.3a0000 0004 0377 2305Division of Immunology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Hisaya Nakadate
- grid.63906.3a0000 0004 0377 2305Division of Hematology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Atsuko Murashimia
- grid.63906.3a0000 0004 0377 2305Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Haruhiko Sago
- grid.63906.3a0000 0004 0377 2305Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
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Talbert JA, Lu J, Spicer SK, Moore RE, Townsend SD, Gaddy JA. Ameliorating Adverse Perinatal Outcomes with Lactoferrin: An Intriguing Chemotherapeutic Intervention. Bioorg Med Chem 2022; 74:117037. [DOI: 10.1016/j.bmc.2022.117037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022]
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Abstract
As the at-risk population expands and new antifungal resistance patterns develop, it is critical to understand and recognize cutaneous manifestations of old and emerging fungal diseases. PURPOSE OF REVIEW The aim of this review is to provide an overview of the most frequent and emerging deep cutaneous fungal infections following either primary inoculation or secondary spread after haematogenous seeding in disseminated infections in different geographical areas. RECENT FINDINGS Fungal skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions based on the site of the infection, route of acquisition of the pathogen, epidemiological setting and the virulence of the fungus in relation to the host. The approach to a patient suspected of having a fungal SSTI is complex and usually poses a major diagnostic challenge. The treatment approach should include attempts at immune reconstitution, targeted antifungal therapy and/or aggressive surgical debridement. SUMMARY Fungal SSTIs can be an important cause of morbidity and mortality in both immunocompromised and immunocompetent patients and are being reported with increasing frequency worldwide.
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10
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Invasive fungal infections in neonates: a review. Pediatr Res 2022; 91:404-412. [PMID: 34880444 DOI: 10.1038/s41390-021-01842-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/16/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022]
Abstract
Invasive fungal infections remain the leading causes of morbidity and mortality in neonates, especially preterm and very low birth weight infants. Most invasive fungal infections are due to Candida or Aspergillus species, and other fungi are increasingly reported and described. Appropriate identification and treatment are required to augment activity and reduce the toxicity of antifungal drugs. Successful use of antifungals in the vulnerable neonatal population is important for both prevention and treatment of infection. Strategies for prevention, including prophylactic antifungal therapy as well as reducing exposure to modifiable risk factors, like limiting antibiotic exposure, discontinuation of central catheters, and hand hygiene are key techniques to prevent and decrease rates of invasive fungal infections. In conclusion, this is a review of the most common causes, prevention strategies, prophylaxis, and treatment of invasive fungal infections in neonates.
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11
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Jani S, Ariss R, Chawla S. A Preterm Infant with a Characteristic Erythematous and Scaly Rash After Birth. Neoreviews 2021; 21:e495-e498. [PMID: 32611569 DOI: 10.1542/neo.21-7-e495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Sanket Jani
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, MI
| | - Ralph Ariss
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Michigan, Detroit, MI
| | - Sanjay Chawla
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, MI
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12
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Skin Fungal Infections in Children: Diagnostic Challenges. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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13
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Goldstein JA, Gallagher K, Beck C, Kumar R, Gernand AD. Maternal-Fetal Inflammation in the Placenta and the Developmental Origins of Health and Disease. Front Immunol 2020; 11:531543. [PMID: 33281808 PMCID: PMC7691234 DOI: 10.3389/fimmu.2020.531543] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Events in fetal life impact long-term health outcomes. The placenta is the first organ to form and is the site of juxtaposition between the maternal and fetal circulations. Most diseases of pregnancy are caused by, impact, or are reflected in the placenta. The purpose of this review is to describe the main inflammatory processes in the placenta, discuss their immunology, and relate their short- and long-term disease associations. Acute placental inflammation (API), including maternal and fetal inflammatory responses corresponds to the clinical diagnosis of chorioamnionitis and is associated with respiratory and neurodevelopmental diseases. The chronic placental inflammatory pathologies (CPI), include chronic villitis of unknown etiology, chronic deciduitis, chronic chorionitis, eosinophilic T-cell vasculitis, and chronic histiocytic intervillositis. These diseases are less-well studied, but have complex immunology and show mechanistic impacts on the fetal immune system. Overall, much work remains to be done in describing the long-term impacts of placental inflammation on offspring health.
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Affiliation(s)
- Jeffery A. Goldstein
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kelly Gallagher
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Celeste Beck
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Rajesh Kumar
- Section of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital and Northwestern University, Chicago, IL, United States
| | - Alison D. Gernand
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
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Sjonnesen KM, Abdul Aziz AN, Vayalumkal JV. A preterm neonate with diffuse rash at birth. Paediatr Child Health 2020; 25:340-341. [PMID: 32963644 DOI: 10.1093/pch/pxz103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kirsten M Sjonnesen
- Section of Pediatric Neurology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta
| | - Ahmad Nizar Abdul Aziz
- Section of Neonatalogy, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia
| | - Joseph Varkey Vayalumkal
- Section of Infectious Diseases, Department of Pediatrics, University of Calgary and Calgary Zone, Infection Prevention and Control, Alberta Health Services; Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta
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Abstract
Vesicles, pustules and vesiculopustules are frequent in newborns and infants and mostly self-limiting. In order to differentiate the rare life-threatening diseases and to therefore initiate the treatment in a timely manner, knowledge of vesicular, pustular and vesiculopustular dermatoses in early childhood is necessary.
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Affiliation(s)
- Regina Fölster-Holst
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Rosalind-Franklin-Straße 7, 24105, Kiel, Deutschland.
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Pek JH, Gan MY, Yap BJ, Seethor STT, Greenberg RG, Hornik CPV, Tan B, Lee JH, Chong SL. Contemporary trends in global mortality of sepsis among young infants less than 90 days old: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e038815. [PMID: 32737098 PMCID: PMC7398098 DOI: 10.1136/bmjopen-2020-038815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Neonatal sepsis has a high mortality rate that varies across different populations. We aim to perform a contemporary global evidence synthesis to determine the case fatality rates of neonatal sepsis, in order to better delineate this public health urgency and inform strategies to reduce fatality in this high-risk population. METHODS AND ANALYSIS We will search PubMed, Cochrane Central, Embase and Web of Science for articles in English language published between January 2010 and December 2019. All clinical trials and observational studies involving infants less than 90 days old with a clinical diagnosis of sepsis and reported case fatality rate will be included. Two independent reviewers will screen the studies and extract data on study variables chosen a priori. Quality of evidence and risk of bias will be assessed using Cochrane Collaboration's tool and ROBINS-I. Results will be synthesised qualitatively and pooled for meta-analysis. ETHICS AND DISSEMINATION No formal ethical approval is required as there is no collection of primary data. This systematic review and meta-analysis will be disseminated through conference meetings and peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42020164321.
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Affiliation(s)
- Jen Heng Pek
- Emergency Medicine, Sengkang General Hospital, Singapore
| | - Ming Ying Gan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bei Jun Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christoph Paul Vincent Hornik
- Division of Critical Care Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Bobby Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
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Thakre A, Jadhav V, Kazi R, Shelar A, Patil R, Kharat K, Zore G, Karuppayil SM. Oxidative stress induced by piperine leads to apoptosis in Candida albicans. Med Mycol 2020; 59:366-378. [PMID: 32658959 DOI: 10.1093/mmy/myaa058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/24/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022] Open
Abstract
Candida albicans is a member of pathogens with potential drug resistance threat that needs novel chemotherapeutic strategies. Considering the multifarious biological activities including bioenhancer activity, anti-Candida potential of piperine was evaluated against planktonic/biofilm and hyphal growth of C. albicans alone or in combination as a synergistic agent with fluconazole. Piperine inhibits planktonic growth at or less than 15 μg/ml, hyphae induction at 5 μg/ml concentration, and exhibits stage-dependent activity against biofilm growth of a fluconazole-resistant strain of C. albicans (ATCC10231). Though piperine couldn't kill inoculum completely at minimum inhibitory concentration (MIC), it is fungicidal at higher concentrations, as shown in apoptosis assay. FIC index values indicate that piperine exhibits excellent synergistic activity with fluconazole against planktonic (0.123) and biofilm (0.215) growth of an FLC resistant strain. Mode of anti-Candida activity was studied by identifying piperine responsive proteins wherein the abundance of 25 proteins involved in stress response, signal transduction and cell cycle were modulated (22 up and 3 down-regulated) significantly in response to piperine (MIC50). Modulation of the proteins involved suggests that piperine affects membrane integrity leading to oxidative stress followed by cell cycle arrest and apoptosis in C. albicans. Flow cytometry-based mitochondrial membrane potential (MMP), cell cycle and apoptosis assay, as well as real-time quantitative polymerase chain reaction analysis of selected genes, confirms piperine induced oxidative stress (TRR1), cell cycle arrest and apoptosis (CaMCA1). Based on our results, we conclude that piperine inhibits planktonic and difficult-to treat-biofilm growth of C. albicans by affecting membrane integrity thereby inducing oxidative stress and apoptosis. LAY ABSTRACT Piperine inhibit Candida albicans growth (planktonic and biofilm) significantly in our study. Piperine exhibits excellent synergistic potential with fluconazole The proteome analysis suggests that piperine induced membrane damage leads to oxidative stress followed by cell cycle arrest and apoptosis.
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Affiliation(s)
- Archana Thakre
- School of Life Sciences, Swami Ramanand Teerth Marathwada University, Nanded - 431606 (MS) India
| | - Vyankatesh Jadhav
- School of Life Sciences, Swami Ramanand Teerth Marathwada University, Nanded - 431606 (MS) India
| | - Rubina Kazi
- Division of Biochemical Sciences, CSIR-NCL, Pune, Pune-8 (MS) India
| | - Amruta Shelar
- Dept. of Biotechnology, Savitribai Phule Pune University, Pune-7, (MS) India
| | - Rajendra Patil
- Dept. of Biotechnology, Savitribai Phule Pune University, Pune-7, (MS) India
| | - Kiran Kharat
- Dept. of Biotechnology, Deogiri College, Aurangabad (MS) India
| | - Gajanan Zore
- School of Life Sciences, Swami Ramanand Teerth Marathwada University, Nanded - 431606 (MS) India
| | - S Mohan Karuppayil
- School of Life Sciences, Swami Ramanand Teerth Marathwada University, Nanded - 431606 (MS) India
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Fernández-Ruiz M, Mosqueda-Peña R, Pérez-Ayala A, Blázquez-Gamero D. Congenital cutaneous candidiasis associated with maternal peripartum candidemia. Rev Iberoam Micol 2020; 37:68-71. [PMID: 32493666 DOI: 10.1016/j.riam.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/01/2020] [Accepted: 02/21/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cutaneous congenital candidiasis (CCC) is a rare condition consisting of invasive fungal infection of the epidermis and dermis that mostly affects preterm infants. Maternal vaginal candidiasis is present in half of the cases, although the occurrence of invasive candidiasis during pregnancy or peripartum period is exceptional. CASE REPORT We present the case of a full-term infant that was born by vacuum-assisted vaginal delivery to an apparently healthy 33 year-old woman with no history of intravenous drug use or vaginal candidiasis during pregnancy. The newborn showed a diffuse maculopapular rash with respiratory distress and bilateral interstitial lung infiltrates, requiring nasal continuous positive airway pressure support. Blood cultures obtained from the mother due to intrapartum fever yielded Candida albicans. Cultures of vaginal discharge and neonate skin also yielded C. albicans with the same in vitro susceptibly pattern. No alternative source for candidemia was identified. The clinical course after starting a systemic antifungal therapy was favorable in both the mother and the neonate, with clearance of candidemia and resolution of the skin lesions. CONCLUSIONS CCC must be considered in full-term newborns with maculopapular rash at birth or during the first days of life. The absence of alternative sources for bloodstream infection in the present case suggests a potential etiopathogenic relationship between CCC and maternal candidemia. It is reasonable to rule out postpartum candidemia when CCC is suspected.
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Affiliation(s)
- Mario Fernández-Ruiz
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Rocío Mosqueda-Peña
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; Unit of Neonatology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Ana Pérez-Ayala
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Daniel Blázquez-Gamero
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; Unit of Pediatric Infectious Diseases, Department of Pediatrics, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain; Spanish Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
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19
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Congenital Cutaneous Candidiasis: Uncommon Entity or Underdiagnosed? CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Colantonio S, Hedin E, Li HOY, Gavigan G. Management of congenital cutaneous candidiasis in a healthy term baby: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19876707. [PMID: 31588361 PMCID: PMC6740067 DOI: 10.1177/2050313x19876707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The management of congenital cutaneous candidiasis in a healthy term neonate of normal birth weight is unclear. Often, healthy term neonates undergo extensive evaluation followed by systemic treatment, which may not be clinically warranted. Here, we present a case of a healthy term neonate with congenital cutaneous candidiasis, whose work-up was minimally invasive and was successfully treated with one oral dose of antifungals and topical antifungals, as well as a review of the literature.
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Affiliation(s)
- Sophia Colantonio
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erin Hedin
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Heidi Oi-Yee Li
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Geneviève Gavigan
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Rheumatology and Dermatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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21
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Aslan Kayıran M, Erdemir AV, Dağdelen D, Cebeci F, Koçoğlu E, Gürel MS. A rare fungal infection of infants: a diffuse case of mucocutaneous candidiasis. Int J Dermatol 2019; 59:259-262. [PMID: 31498879 DOI: 10.1111/ijd.14644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/06/2019] [Accepted: 08/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Melek Aslan Kayıran
- Department of Dermatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey
| | - Aslı V Erdemir
- Department of Dermatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey
| | - Deniz Dağdelen
- Department of Dermatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey
| | - Filiz Cebeci
- Department of Dermatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey
| | - Esra Koçoğlu
- Department of Medical Microbiology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet S Gürel
- Department of Dermatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey
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22
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Ott H. Guidance for assessment of erythroderma in neonates and infants for the pediatric immunologist. Pediatr Allergy Immunol 2019; 30:259-268. [PMID: 30702169 DOI: 10.1111/pai.13032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
Abstract
Neonatal and infantile erythroderma (NIE) represents the common clinical phenotype of heterogeneous diseases ranging from benign and transient skin conditions to fatal multiorgan disorders. NIE regularly demands a comprehensive diagnostic workup in a multiprofessional setting, especially if newborns and young infants with the disease develop a failure to thrive and concomitant infectious, neurologic, or metabolic complications. By obtaining a detailed medical history and performing a thorough clinical examination, targeted diagnostic steps can be scheduled for most affected children. If NIE occurs in the early neonatal period, lesional skin biopsy and histology are often indicated. Likewise, if monogenic skin or immunologic diseases are suspected, genetic testing with customized panels of potentially underlying genes is mandatory. Of note, if acute symptoms such as severe infections, metabolic acidosis, or seizures occur, rapid microbiologic and metabolic investigations are warranted to rule out immunodeficiency and inborn errors of metabolism.
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Affiliation(s)
- Hagen Ott
- Division of Pediatric Dermatology, Children's Hospital AUF DER BULT, Hannover, Germany.,Epidermolysis bullosa Centre, Hannover, Germany
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23
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Chen S, Shi Y. Progress of Research in Neonatal Sepsis. SEVERE TRAUMA AND SEPSIS 2019. [PMCID: PMC7119971 DOI: 10.1007/978-981-13-3353-8_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Neonatal sepsis remains a significant global problem with little progress made despite major efforts. At present, there is a lack of an accepted international consensus on the definition, diagnosis, and treatment of neonatal sepsis; the unclear understanding of the pathogenesis of neonatal sepsis leads to blindness in treatment, which will result in an unsatisfactory therapeutic outcome. In addition, some serious diseases caused by noninfectious factors, such as trauma, stress, asphyxia, and so on, have very similar pathophysiological results with neonatal sepsis. In this review we synthesize the recent advances in definition, incidence, causative agents, risk factors, pathophysiology, clinical manifestations, and diagnosis and treatment of neonatal sepsis. Of course, there are still many challenges to neonatal sepsis in many ways.
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24
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Matlock DN, Miquel-Verges F, Courtney SE. Invasive Fungal Dermatitis in Preterm Newborns. Clin Pediatr (Phila) 2018; 57:1354-1355. [PMID: 29929379 DOI: 10.1177/0009922818782162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- David N Matlock
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Hospital, Little Rock, AR, USA
| | - Franscesca Miquel-Verges
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Hospital, Little Rock, AR, USA
| | - Sherry E Courtney
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Hospital, Little Rock, AR, USA
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25
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Lakdawala N, Humphrey SR. Diffuse papulopustular eruption in a newborn. Pediatr Dermatol 2018; 35:683-684. [PMID: 30211459 DOI: 10.1111/pde.13513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nikita Lakdawala
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stephen R Humphrey
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
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26
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Heerema-McKenney A. Defense and infection of the human placenta. APMIS 2018; 126:570-588. [PMID: 30129129 DOI: 10.1111/apm.12847] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/22/2018] [Indexed: 12/14/2022]
Abstract
The placenta functions as a shield against infection of the fetus. The innate and adaptive immune defenses of the developing fetus are poorly equipped to fight infections. Infection by bacteria, viruses, and protozoa may cause infertility, spontaneous abortion, stillbirth, growth retardation, anomalies of development, premature delivery, neonatal morbidity, and mortality. However, appreciation of the human microbiome and host cell-microbe interactions must be taken into consideration as we try to determine what interactions are pathologic. Infection is typically recognized histologically by the presence of inflammation. Yet, several factors make comparison of the placenta to other human organs difficult. The placenta comprises tissues from two persons, complicating the role of the immune system. The placenta is a temporary organ. It must be eventually expelled; the processes leading to partuition involve maternal inflammation. What is normal or pathologic may be a function of timing or extent of the process. We now must consider whether bacteria, and even some viruses, are useful commensals or pathogens. Still, recognizing infection of the placenta is one of the most important contributions placental pathologic examination can give to care of the mother and neonate. This review provides a brief overview of placental defense against infection, consideration of the placental microbiome, routes of infection, and the histopathology of amniotic fluid infection and TORCH infections.
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Affiliation(s)
- Amy Heerema-McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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27
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Kewley KA, Yajamanyam PK. Skin rash in a preterm infant: when to treat? Arch Dis Child Fetal Neonatal Ed 2018; 103:F177. [PMID: 29217693 DOI: 10.1136/archdischild-2017-314237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/23/2017] [Accepted: 11/24/2017] [Indexed: 11/04/2022]
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28
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Abstract
Neonatal sepsis is the cause of substantial morbidity and mortality. Precise estimates of neonatal sepsis burden vary by setting. Differing estimates of disease burden have been reported from high-income countries compared with reports from low-income and middle-income countries. The clinical manifestations range from subclinical infection to severe manifestations of focal or systemic disease. The source of the pathogen might be attributed to an in-utero infection, acquisition from maternal flora, or postnatal acquisition from the hospital or community. The timing of exposure, inoculum size, immune status of the infant, and virulence of the causative agent influence the clinical expression of neonatal sepsis. Immunological immaturity of the neonate might result in an impaired response to infectious agents. This is especially evident in premature infants whose prolonged stays in hospital and need for invasive procedures place them at increased risk for hospital-acquired infections. Clinically, there is often little difference between sepsis that is caused by an identified pathogen and sepsis that is caused by an unknown pathogen. Culture-independent diagnostics, the use of sepsis prediction scores, judicious antimicrobial use, and the development of preventive measures including maternal vaccines are ongoing efforts designed to reduce the burden of neonatal sepsis.
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Affiliation(s)
- Andi L Shane
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Pablo J Sánchez
- Divisions of Neonatology and Infectious Disease, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Barbara J Stoll
- University of Texas, Health McGovern Medical School, Houston, TX, USA
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