Case study

Treatment of bladder fungal balls in a premature infant with a combination of three antifungal agents

By Afia Manaf, MRPharmS

Bladder fungal balls are a recognised complication of septic fungal infections. This article describes an example of this complication and discusses the antifungal and antibacterial treatments that were used

This article as a FULL TEXT PDF (40K)

Afia Manaf is specialist pharmacist (paediatrics and neonates) at Central Manchester and Manchester Children’s Hospital NHS Trust

SUMMARY

Candidal infections are a significant cause of mortality (10 to 54 per cent) and morbidity (25 per cent) in neonatal intensive care units (NICUs). Invasive candidiasis in NICUs is one condition that is becoming increasingly difficult to treat, due to the emergence of resistance to antifungal drugs.

Bladder fungal balls are an unusual but recognised complication of invasive candidiasis. They can be difficult to eradicate using standard antifungal drugs and can cause urinary tract obstruction, leading to acute renal failure.

The causative pathogens are Candida spp, which produce clinical manifestations such as asymptomatic candiduria, cystitis, systemic candidiasis, primary renal candidiasis and bezoar (fungal ball) formation.

Risk factors for bladder fungal balls include

Premature birth
Treatment with broad-spectrum antibiotics or immunosuppressant drugs (eg, steroids)
Prolonged hospital stay
Iintravenous catheterisation
Endotracheal intubation