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Candida septicaemia and fungal endocarditis: case report A 2-month-old boy developed Candida septicaemia and fungal endocarditis during treatment with amikacin, ampicillin and cefotaxime in the Dominican Republic [dosages not stated; not all routes stated]. The boy was born prematurely at 34 weeks of gestation. He was hospitalised. During hospitalisation, he developed tachypnoea without signs of pneumonia. His blood cultures were obtained. Owing to the high risk of infection, he was initiated on empirical antibiotic therapy consisting of IV ampicillin and amikacin, planned for 15 days. He was not treated with prophylactic anti-fungal medications. He was put on a central umbilical venous line for the first two weeks of life. At 28 days of life, he was discharged. However, at 6 weeks of life, he developed a high fever and experienced poor feeding with failure to thrive. He was re-hospitalised. His initial blood cultures were negative. He was treated with broad spectrum antibiotics including cefotaxime and amikacin. He underwent a transthoracic echocardiogram, which showed a big pedunculated heterogeneous right atrial mass, which bulged into the tricuspid annulus without tricuspid regurgitation. Blood cultures showed growth of multi-sensitive Candida albicans. He developed Candida septicaemia and fungal endocarditis. The boy was initiated on treatment with amphotericin B. At the time, he showed signs of haemodynamic instability and malnourishment, along with elevated lactate levels and metabolic acidosis, possibly due to the tricuspid valve obstruction. There were no signs of embolisation. He was transferred to another hospital and scheduled to undergo surgery. During surgery, a big, friable, purulent white mass was noted, attached at the inferior cavoatrial junction. The mass was removed and other vegetations were not found. He was successfully weaned from bypass and transferred to the ICU in stable condition. The resected specimen showed many neutrophils and signs of necrosis suggestive of abscess material. Tests for fungal and microbiological elements were negative. He was extubated two days later and was maintained on treatment with amphotericin B for one month. His cultures remained negative post-operatively. At a follow-up 3 months later, he appeared in a good clinical condition; he was eating properly and had gained weight. A recent echocardiogram did not show vegetations or cardiac abnormalities. His fungal endocarditis was thought to have resulted from Candida septicaemia, which developed secondary to use of amikacin, ampicillin and cefotaxime amongst other contributing factors. Pradegan N, et al. Giant Right Atrial Abscess in a Premature Infant With Fungal Endocarditis in a Developing Country. World Journal for Pediatric and Congenital Hearth 803507971 Surgery 11: 654-657, No. 5, Sep 2020. Available from: URL: http://doi.org/10.1177/2150135120929009

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Reactions 17 Oct 2020 No. 1826