CANDIDA INFECTION OF CENTRAL NERVOUS SYSTEM IN INFANTS SUFFERING FROM NECROTIZING ENTEROCOLITIS

Kowalewska-Kantecka B.,SidorB.

Institute of Mother and Child, Institute of Neurology and Psychiatry - Neuropathology Department. Warsaw, Poland

OBJECTIVE: Necrotizing enterocolitis (NEC) is one of the life threatening diseases of newborns and infants. Babies with very low (VLBW) and extremely low birth weight (ELBW)heve a particulary risk. Among multifactorial pathogenesis prematurity, hypoxic insults, improper feeding practices as well as infection are of great importance. Many kinds of pathogenes - bacterial, viral, fungal or its toxins - may be considered as etiologic agents in NEC. Immaturity of immunological responses, labile metabolic homeostasis in VLBW and ELBW babies may by responsible for their special susceptibility to fungal infections.

PATIENTS: In group of 144 cases of NEC treated in the Institute of Mother and Child between 1986-96. there were 127 preterm infants born between 27-36 weeks - (mean 31.4 g.a.) with b.w. 720-2520g - (mean 1840g). ELBW group consisted of 21 babies. There were 17 full term newborns. Died 47 infants (34%).

RESULTS: Typical ischemic - necrotic NEC changes in the gut were seen in all autopies. Candida infection of central nervous system (c.n.s.) was confirmed by autopsy in 9 cases, five of them was ELBW babies. Only one full term newborn was affected. Neuropathological examinations revealed multifocal Candida abscesses in brain tissue. changes in the blood vassels, hemorrhagiae and symptoms of meningitis. In five babies disseminated fungal abscesses in such organs as gut, heart, kidneys, spleen and liver were also observed. Despite this morfological changes in post mortem examination in 6 of those 9 babies, fungal infection was not clinically confirmed. The lack of correlation between Candida infection and its magnitude, with positive results of cultures was suprising.

CONCLUSION: Severe fungal infection of c.n.s. during NEC. particulary in ELBW group may be asymptomatic. This indicates the necessity of repetitive, consequnent antifungal control.