Systemic candidiasis in the pediatric field

We studied 5 clinical cases, incluiding 3 infants with sepsis due to mycetes with respect to antibiotics used prior to the onset of the disease, background factors and clinical course We also discuss the early diagnosis, treatment and prevention of mycosis. Two of three infants were minimal premature infants weighing 1, 500 g or less at birth, and all three cases had received intratracheal intubation. Some broad spectrum antibiotics had been administered in all the cases and an indwelling catheter (e. g. umbilical or intravenous) was used in 4 of the 5 cases. Our results agreed with previous reports on the background factors of this disease. As to the pathogenic mechanism of mycosis, it is thought that, due to the changes in bacterial flora during administration of antibiotics, mycetes proliferate in the intestinal canal, eventually leading to the development of mycosis. Consequently, mycetes tend to be found earlier in fecal than in urine and blood cultures. Hence the fecal culture is useful in the early diagnosis of mycosis. Furthermore, as a method of preventing mycosis due to a change in intestinal flora, it is neccesary to select antibiotics with the least influence on this flora. Miconazole (MCZ), a new anti-mycotic agent which is an imidazole derivative, was used in 4 of 5 cases, all of which responded well whithout adverse reactions. Especially the fact that MCZ was effective in premature infants suffering from side effects due to combination therapy with amphotericin B and 5-fluorocytosine suggests that MCZ is a safe and useful drug in pediatrics.