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Congenital cutaneous candidiasis with funisitis
  1. A K Sinha,
  2. M F Hird
  1. Neonatal Unit, Royal London Hospital, Whitechapel, London E1 1BB, UK; a.k.sinhaqmul.ac.uk

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    Congenital candidiasis is associated with increased perinatal mortality and adverse neurological outcomes, with extensive periventricular leucomalacia being common.1 This baby was the first of twins born by emergency caesarean section at 29 weeks gestation after cervical suture removal. Initial examination revealed multiple pearly white spots embedded in the umbilical cord (fig 1) and an extensive maculopapular erythematous skin eruption with some fissuring. This rapidly evolved into a dry whitish scaly rash. Congenital cutaneous candidiasis with candida funisitis was suspected and amphotericin commenced. Surface swabs and gastric aspirate grew Candida albicans and histology of the umbilical cord revealed necrotising funisitis. There was a marked polymorphonuclear leucocytosis. C reactive protein remained normal. Her subsequent respiratory course was complicated by episodic lobar collapse with excessive thick mucoid secretions. A history of repeated vaginal thrush during pregnancy was obtained.

    Figure 1

     Focal pearly lesions noted in cord (some arrowed).

    Congenital candidiasis in extremely preterm infants has been associated with: presence of an IUCD during pregnancy, characteristic chorioamnionitis and funisitis, a leucocytosis, and infective alveolitis.1 Funisitis macroscopically has small circumscribed pale yellow-white nodules with microscopic subamnionic focal lesions embedded in fibrinoid exudates surrounded by inflammatory cells.2 Rapid histology may help confirm the diagnosis.3 A marked leucocytosis with increased non-segmented granulocytes and normal C reactive protein has been described.1 Early invasive cutaneous candidiasis has also been noted in extremely premature infants: prompt recognition and treatment with amphotericin has been reported to improve outcome.4

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