A term newborn with adequate weight for gestational age, without relevant perineal defects.
At birth, a generalized erythema affecting the palms and soles was observed on physical examination, respecting the posterior region of the trunk and mucous membranes.
At 24 h of life the presence of papules and pustules on erythema prevailed over the clinical picture.
The patient was in good general condition, with no signs of systemic toxoinfection at any time.
Routine laboratory studies, direct immunofluorescence (DIF) for herpes, blood and urine cultures, direct examination and culture of pustule content, and cytomegalovirus (EBV) serology were performed.
Direct mycological examination of the pustules revealed yeast-like elements and Candida albicans grew in culture.
Bacteriological examination and Giemsa staining of the pustule contents were negative, as well as monoclonal antibodies for herpesvirus 1, 2, zoster, serology and cultures.
The patient had a very good clinical evolution and was treated with oral fluconazole at doses of 6 mg/kg/day for 7 days.
Signaling was observed at 7 days and tegument restitution at 14 days of life.
Congenital cutaneous candidiasis
Congenital cutaneous candidiasis is a very rare disease that occurs at birth or in the first 24 hours of life, almost always as a diffuse maculopapular rash that evolves to vesicles and pustules with blistering.
The exanthema is widespread, as in the case of the patient, characteristically affects the palms and soles, and usually respects the mucous membranes and diaper area.
Nail involvement may sometimes occur, manifesting as onixis and perionixis.1-3
Congenital cutaneous candidiasis rarely spreads; when it occurs, it is a serious disease that causes high morbidity and mortality.
There are factors that increase the risk of dissemination, such as respiratory distress or other clinical or laboratory signs of sepsis in the neonatal period, broad-spectrum antibiotic treatment during the first days of life, invasive maneuvers at birth 1500 g.
Congenital cutaneous candidiasis is considered an intrauterine infection acquired by vertical transmission from the vagina colonized by Candida.
Other factors associated with congenital cutaneous candidiasis are the use of intrauterine devices, sutures, cervical cerclage or foreign bodies.2
The diagnosis is based on a compatible clinical picture and the isolation of Candida from skin lesions.
Cytology of the material obtained from the lesions would demonstrate the presence of spores or pseudohyphae, and the culture of the aspirate of the lesions would reveal the growth of microorganisms belonging to the genus Candida, of which C. albicans is more frequent.
With respect to the treatment of cutaneous candidiasis, although the disease usually presents a course and does not usually appear as a case of congenital candidiasis, topical imidazole treatment is advised;2,4,5 some authors suggest that oral antifungal treatment should be reduced.
Systemic antifungal treatment is recommended for newborns who have a risk factor for the spread of infection or signs of sepsis.
Intravenous amphotericin B is recommended.2
Differential diagnoses should be made with other papulopustular eruptions in the neonatal period, such as congenital syphilis, neonatal undisseminated lesions, recent peptic infection, staphylotoxic papules sterile aspiration of childhood, among others.
In herpesvirus 2 infection, skin lesions appear as vesicles that may be racing or follow a zosteriform arrangement.
The vesicular lesions appear between the first and second week of life.
For its diagnosis, viral culture is the method of choice, but direct immunofluorescence (DIF) or polymerase chain reaction (PCR) can be performed, as well as intranuclear giant Tzank test, which shows epithelial cells.
In congenital syphilis symptoms may be from birth or appear between 6 and 8 weeks of life.
Serological tests and dark field microscopy are performed for diagnosis.1
In staphylococcal infection, the most common manifestation is neonatal imprinting, which appears as rapidly growing blisters, easily ruptured and cause erosions.
Since the skin of the newborn is sterile at birth, a period of approximately two weeks is needed for the production of these lesions.
The diagnosis is made by culture of the lesions.1
Neonatal toxic erythema is characterized by macules, vesicles, papules and pustules of 1 to 3 mm in diameter surrounded by an erythematous halo that appear within 48 to 72 h.
It presents a self-involutive course.
The diagnosis is clinical, but if there is diagnostic doubt, the Tzank test shows abundant eosinophils.1
Among these differential diagnoses, herpes virus infection should be ruled out with greater urgency, as in this case intravenous antiviral treatment should be promptly established.
