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Doença invasiva por fungos no recém-nascido pré-termo
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A doença invasiva por fungos (DIF), mais especificamente a candidíase invasiva, é a 3ª causa mais comum de sépsis tardia em recém-nascidos pré-termo (RN PT). Quanto menor a idade gestacional e o peso ao nascer, maior a incidência de DIF.
A apresentação clínica da DIF é inespecífica e as hemoculturas têm uma baixa sensibilidade para o isolamento de fungos, pelo que um elevado nível de suspeição é importante para um diagnóstico precoce.
Os fármacos de primeira linha para o tratamento da DIF têm sido a anfotericina B e o fluconazol. No entanto, novas classes de antifúngicos, como as equinocandinas, têm sido cada vez mais utilizadas no tratamento destes RN.
Apesar do tratamento antifúngico, a DIF nos RN PT está associada a um mau prognóstico em termos de mortalidade e alterações do neurodesenvolvimento. É de extrema importância a prevenção, nomeadamente através da profilaxia antifúngica em RN com maior risco de DIF, especialmente em Unidades de Cuidados Intensivos Neonatais (UCIN) com elevada incidência desta infeção. O fluconazol por via endovenosa é o agente mais utlizado, mas agentes orais não absorvíveis como a nistatina e o miconazol, têm vindo a ganhar importância.
Invasive fungal infections, specifically invasive candidiasis, are the third most common cause of late onset sepsis in preterm infants. Lower gestational age and lower weight at birth are associated with higher incidence of invasive fungal infections. The clinical presentation of invasive fungal infections is unspecific and blood cultures have a low sensibility for the isolation of fungus, so an elevated level of suspicion is very important for a successful premature diagnostic. The first line treatment for invasive fungal infections has been amphotericin B and fluconazol. However, new classes of antifungals, such as echinocandins, have been increasingly used in treating these infants. Even with antifungal treatment, invasive fungal infections in preterm newborns are associated with a bad prognosis in terms of mortality and neurodevelopment outcomes. This makes prevention extremely important, which can be achieved by using prophylactic antifungal drugs in preterm infants at a bigger risk of developing invasive fungal infection, especially in NICUs with a high incidence of such infections. Intravenous fluconazol is the most commonly used agent, but oral and topic non- absorbed agents like nystatin and miconazol have been gaining importance.
Invasive fungal infections, specifically invasive candidiasis, are the third most common cause of late onset sepsis in preterm infants. Lower gestational age and lower weight at birth are associated with higher incidence of invasive fungal infections. The clinical presentation of invasive fungal infections is unspecific and blood cultures have a low sensibility for the isolation of fungus, so an elevated level of suspicion is very important for a successful premature diagnostic. The first line treatment for invasive fungal infections has been amphotericin B and fluconazol. However, new classes of antifungals, such as echinocandins, have been increasingly used in treating these infants. Even with antifungal treatment, invasive fungal infections in preterm newborns are associated with a bad prognosis in terms of mortality and neurodevelopment outcomes. This makes prevention extremely important, which can be achieved by using prophylactic antifungal drugs in preterm infants at a bigger risk of developing invasive fungal infection, especially in NICUs with a high incidence of such infections. Intravenous fluconazol is the most commonly used agent, but oral and topic non- absorbed agents like nystatin and miconazol have been gaining importance.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Doença invasiva por fungos Recém-nascido pré-termo Unidade de cuidados intensivos neonatais Sépsis tardia