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Pathology. 1982 Apr;14(2):191-5.

Placental candidiasis: report of three cases with a review of the literature.

Abstract

Three new cases of placental candidiasis are reported. Two were associated with fetal cutaneous candidiasis and one with fetal systemic candidiasis. The systemic case was associated with an intrauterine contraceptive device. Infection of the placenta results in small 'granulomata' under the surface of the cord and a diffuse chorioamnionitis of the membranes and chorionic plate. In reviewing the 24 previously reported cases it can be seen that systemic. Candida infection of the fetus results in prematurity and death, infection can occur across intact membranes, and systemic candidiasis in the fetus is likely to be associated with an intrauterine device.

PIP:

Placental candidiasis is a rare condition; only 24 cases are reported in the literature. 3 additional cases are reported, 2 were associated with fetal cutaneous candidiasis and responded to administration of oral nystatin. Maternal vaginal cultures were positive in 1 of the 2 cases. In a 3rd case, systemic candidiasis was present. The child was delivered prematurely and died 90 minutes after delivery of severe respiratory distress. The mother had continuous vaginal candidiasis unresponsive to treatment throughout the pregnancy. In addition, an IUD was present. Other researchers have determined the criteria for Candida amniotic infection as: exclusive presence of Candida albicans in the different lesions, subacute or chronic specific lesions of fetal adnexae, and clinical manifestations in the newborn. The pathology of the placenta includes microscopic granulomata and presence of filaments or spores on the cord and histological change of the membrane or chorionic plate revealing intense chorioamnionitis with occasional focal granuloma. A review of the case reports indicates that 12 of the 27 infants were delivered after the 36th week and all but 1 were normal or recovered rapidly from cutaneous candidiasis. 15 of the 27 were delivered before the 36th week and only 1 survived. 6 were stillborn, and where histology was reported, systemic candidiasis was present. The 7 infants who died shortly after birth had Candida albicans. 1 infant was anencephalic. In only 5 cases did the membrane rupture more than 12 hours prior to delivery suggesting either Candida crosses the intact membrane or the possibility of a small leaking tear in the membrane. In 7 of the cases an IUD was present and the infection tended to be more overwhelming; all infants died from infection and septicemia, not complications of prematurity. The presence of the IUD is suspect for increased infection. The association of IUDs and Candida albicans-induced septicemia and fetal death warrants careful consideration of the advisibility of attempted removal of the IUD when Candida albicans is grown from the vaginal in the antenatal period.

PMID:
7099725
DOI:
10.3109/00313028209061293
[Indexed for MEDLINE]

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