Fungal infections in the neonatal intensive care unit

Fungal pathogens, primarily Candida, cause approximately 9 percent of all late-onset infections in the neonatal intensive care unit. Candida can be acquired both vertically and horizontally, so disease in the neonate is a mixture of nosocomially and perinatally acquired infection. Systemic candidiasis predominantly affects the most immature infants with more severe underlying disease. The spectrum of diseases caused by Candida ranges from uncomplicated fungemia to multiorgan dissemination; some unusual manifestations include invasive fungal dermatitis, spontaneous intestinal perforation, and brain abscesses. Although Candida is the predominant fungal pathogen in the nursery, other organisms are implicated sporadically. Catheter-associated sepsis caused by Malassezia is seen occasionally in neonates receiving lipid infusions. Filamentous fungi, both Aspergillus and zygomycetes, cause predominantly cutaneous or gastrointestinal tract infections, often associated with breaches in the mucocutaneous barrier. Knowledge of the epidemiology and clinical presentation of fungal infections in these infants is growing, but more research is needed.