Obstructive Bilateral Renal Fungal Bezoars in an Extremely Premature Neonate Treated With Antifungals and Urokinase Irrigation: A Case Report and Review of the Literature.

Autor:	Davis K; From the Department of Infection and Immunity.; General Paediatrics Department., Yap N; From the Department of Infection and Immunity.; General Paediatrics Department., Clark M; Pharmacy Department.; Faculty of Pharmacy and Pharmaceutical Science, Monash University, Parkville, VIC, Australia., Bhatia R; Monash Newborn.; Department of Paediatrics, Monash University, Monash Children's Hospital, Clayton, VIC, Australia., Johnstone L; Department of Nephrology.; Department of Paediatrics, Monash University, Monash Children's Hospital, Clayton, VIC, Australia., Taghavi K; Department of Paediatric Urology, Monash Children's Hospital, Clayton, VIC, Australia.; Department of Paediatrics, Monash University, Monash Children's Hospital, Clayton, VIC, Australia., O'Brien M; From the Department of Infection and Immunity.; General Paediatrics Department., Ching N; From the Department of Infection and Immunity.; General Paediatrics Department., Carr J; From the Department of Infection and Immunity.; Department of Paediatrics, Monash University, Monash Children's Hospital, Clayton, VIC, Australia.
Jazyk:	angličtina
Zdroj:	The Pediatric infectious disease journal [Pediatr Infect Dis J] 2024 Aug 07. Date of Electronic Publication: 2024 Aug 07.
DOI:	10.1097/INF.0000000000004505
Abstrakt:	Background: An ex-27-week gestation female infant developed bilateral forearm nodules at 4 weeks of life during treatment for methicillin-sensitive Staphylococcus aureus bacteremia. A pure growth of Candida albicans was isolated on culture of both sterile aspiration of the forearm abscess and urine without evidence of methicillin-sensitive Staphylococcus aureus. The patient went on to develop bilateral obstructive renal fungal bezoars at 11 weeks of life. Results: Bilateral nephrostomies were required to alleviate obstruction with the addition of local irrigation with amphotericin B deoxycholate. Two weeks later, urokinase via the nephrostomy tubes was added due to an unchanged appearance on ultrasound (US) and ongoing candiduria. A significant reduction in the size of bezoars was seen on US after 3 days. Sterilization of urine culture was achieved 7 weeks into treatment, and resolution of bezoars on US was seen 9 weeks after treatment began. No adverse events occurred from the use of local urokinase. Conclusions: Urokinase irrigation via nephrostomy is an effective and safe adjunctive treatment in refractory obstructive renal candidiasis in neonates. Competing Interests: The authors have no funding or conflicts of interest to disclose. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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