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

By Afia Manaf

Afia Manaf is specialist pharmacist (paediatricsand neonates) at Central Manchester and Manchester Children’sHospital NHS Trust


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

Bladder fungal balls are an unusual but recognised complication of invasivecandidiasis. They can be difficult to eradicate using standard antifungaldrugs and can cause urinary tract obstruction, leading to acute renalfailure.

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

Risk factorsfor bladder fungal balls include

  • Premature birth
  • Treatment with broad-spectrumantibiotics or immunosuppressant drugs (eg, steroids)
  • Prolongedhospital stay
  • Iintravenous catheterisation
  • Endotracheal intubation

Citation: Hospital Pharmacist URI: 10047312

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