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Evaluation to determine the extent of disease in neonates with invasive Candida infection

Evaluation to determine the extent of disease in neonates with invasive Candida infection
Tests to perform Comments
Blood culture
  • Modern blood culture media can efficiently isolate the most common Candida species (ie, Candida albicans and C. parapsilosis).
  • Time to positivity is usually ≤48 hours.
Urine culture
  • The urine specimen should be collected via catheterization or suprapubic aspiration; "clean voided" bag urine samples should not be used for culture.
  • Urine culture is positive in approximately 50 to 60% of neonates with invasive candidiasis.

CSF culture

CSF cell counts, glucose, and protein
  • CNS involvement occurs in 10 to 20% of neonates with candidemia.
  • CSF parameters are variable depending on the type of CNS involvement (meningeal versus parenchymal disease).
  • Normal CSF parameters do not exclude CNS involvement.
Dilated eye examination
  • Eye involvement occurs in 3 to 5% of neonates with candidemia.
  • Classic ophthalmologic findings are focal, glistening, white, infiltrative, often mound-like lesions on the retina with indistinct borders.
Echocardiography
  • Assesses for vegetations and/or right atrial thrombi.
  • Endocarditis occurs in approximately 5% of neonates with invasive candidiasis.
Ultrasound of the kidneys and bladder
  • Assesses for kidney parenchymal infiltration, calyceal mycetoma, or fungal masses in the urinary tract; also assesses for congenital anomalies of the kidney and urinary tract.
  • Kidney involvement occurs in approximately 5 to 10% of neonates with invasive candidiasis.
Ultrasound of the liver and spleen
  • Assesses for liver and splenic abscesses, which occur in approximately 3% of neonates with invasive candidiasis.
Head ultrasound
  • Assesses for brain abscess, parenchymal involvement, hydrocephalus, and/or hemorrhage.
  • Brain abscess or ventriculitis occurs in approximately 4 to 5% of neonates with invasive candidiasis.
This table summarizes the tests to perform in neonates who are diagnosed with invasive candidiasis. All neonates with invasive Candida infections should undergo a thorough evaluation to determine the extent of systemic infection, which informs management decisions. Testing generally is not necessary in neonates with superficial mucocutaneous infections (eg, oral thrush, diaper dermatitis) unless there are other clinical concerns for systemic infection. For additional details, refer to UpToDate topics on Candida infections in neonates.
CNS: central nervous system; CSF: cerebrospinal fluid.
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