Guerra AB, Marques MIN, Antunes S, Serrano A (2021) Candida Albicans Brain Microabscesses in a Preterm Neonate. Clin Med Img Lib 7:192.

Image Article | OPEN ACCESS DOI: 10.23937/2474-3682/1510192

Candida Albicans Brain Microabscesses in a Preterm Neonate

António Bento Guerra*, M Inês Nunes Marques, Sónia Antunes and Ana Serrano

Neonatal Intensive Care Unit, Department of Pediatrics, Hospital do Espírito Santo de Évora, Portugal

We report the case of a male preterm at 27 weeks of gestational age, born by emergency cesarean section with 1195 g, of an untreated HIV-infected mother, with an unsupervised pregnancy. After immediate resuscitation, he was admitted to the neonatal intensive care unit (NICU). He was started on standard neonatal antiretroviral HIV prophylaxis and completed seven days of ampicillin and gentamicin. Due to Staphylococcus epidermidis late sepsis, he completed 21 days of cefotaxime and vancomycin, but on day 14 of antibiotics, there was clinical and analytical worsening. Candida albicans was isolated in blood and cerebrospinal fluid cultures. Brain imaging identified several microabscesses which evolved to microcalcifications, as shown in Figure 1 and Figure 2. The patient completed six weeks of amphotericin B with clinical improvement. A multidisciplinary approach and follow-up including electroencephalogram, echocardiogram, abdominal and renal ultrasound, and ophthalmological exam were unremarkable, and HIV antibody tests were negative at 18 months of age.

Candida spp. is a relevant cause of neonatal infection, especially in very low birth weight (VLBW) infants, with significant morbidity and mortality [1,2]. The most frequent complication from hematogenous spread of candidiasis to the central nervous system is meningitis, while brain abscesses are uncommon [1].

Facing late-onset neonatal sepsis, particularly in VLBW neonates without antifungal prophylaxis, it's crucial to recognize an invasive Candida as a possible cause of infection while timely adjusting antimicrobic therapy. Another risk factor for a Candida infection was the possibility of a vertical transmission HIV infection but ruled out afterward.

We highlight the importance of sequential cranial ultrasounds for diagnosing and following preterm neonates [3]. Also, brain magnetic resonance imaging is required, especially when central nervous system complications are present, as reported in this case.

A multidisciplinary approach and long-term follow-up are required to evaluate possible neurological sequelae [3].

Funding Support

None declared.


The authors declare no conflict of interest.

All authors have given their input and approved the final manuscript.


Figure 1: Coronal view of neonatal transfontanellar ultrasound- multiple echogenic frontoparietal and basal ganglia lesions (A) which progressed to microcalcifications after 2 weeks (B).

Figure 2: Brain magnetic resonance T1 sagittal image after 4 weeks of amphotericin B - multiple rounded and punctate infectious lesions in different stages of evolution, mainly in periventricular white matter.


  1. Pahud BA, Greenhow TL, Piecuch B, Weintrub PS (2009) Preterm neonates with candidal brain microabscesses: A case series. J Perinatol 29: 323-326.
  2. Barton M, O'Brien K, Robinson JL, Davies DH, Simpson K, et al. (2014) Invasive candidiasis in low birth weight preterm infants: Risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls. BMC Infect Dis 14: 1-10.
  3. Friedman S, Richardson SE, Jacobs SE, O'Brien K (2000) Systemic Candida infection in extremely low birth weight infants: Short term morbidity and long term neurodevelopmental outcome. Pediatr Infect Dis J 19: 499-504.


Guerra AB, Marques MIN, Antunes S, Serrano A (2021) Candida Albicans Brain Microabscesses in a Preterm Neonate. Clin Med Img Lib 7:192.