Drug resistant tachycardia and fever in a neonate: a case of systemic candidiasis

Introduction

Invasive fungal infection is a known cause of morbidity and mortality in the neonates especially in immunocompromised children. Demonstration of organisms by culture remains the gold standard for mycological diagnosis.

 

Case report

A neonate delivered at 34 weeks of gestation with a birth weight of 1800g was admitted to a premature baby unit with breathing difficulty on day 05 after delivery. On examination, the child was febrile and had tachyarrhythmia. Blood culture showed a mixed growth of organisms and the echocardiogram was suggestive of a cardiac tumor. The condition of the neonate deteriorated in spite of treatment with antibiotics and supportive therapy and the child died 20 days after admission. At autopsy, a large vegetation was found on the tricuspid valve.

 

Conclusion

Fungal endocarditis should have been considered as a possible cause especially in the presence of large vegetations in the right side of the heart in neonates. The presence of fungal abscesses in the kidneys supported the systemic nature of the infection. Tachyarrhythmias may have been due to the involvement of the conduction system of the heart as vegetations were found in the area of AV node.