PEDIATRICS Vol. 104 No. 5 November 1999, pp. 1126-1129
EXPERIENCE AND REASON:
Candidal Mycetoma in the Neonatal Kidney
Received Mar 3, 1999; accepted May 13, 1999.
Department of Pediatrics Duke University Medical Center Durham, NC 27710
Department of Economics Clemson University Clemson, SC 29631
Objective. To determine the natural history of renal mycetoma (fungal balls) in the neonate.
Design. Retrospective chart review of all neonatal intensive care unit patients with systemic candidiasis and sonographic evidence of renal mycetoma admitted to the Duke University Medical Center between January 1, 1993, and July 1, 1998.
Results. Fourteen patients were reviewed. Three died from
fungemia, and 3 died from other causes months after completing
treatment. Ten patients had urine cultures obtained within 1 week of
diagnosis; each had a positive routine or fungal urine culture for
candida. The rate of improvement of renal mycetoma by ultrasound was
variable, ranging from 10 days to 4 months and was not predictive of
survival or long-term renal function. All patients who were discharged from the hospital had creatinine 
0.5 mg/dL on discharge. Only 1 patient had surgical intervention (nephrostomy tube placement). Of the
11 patients who survived fungemia, 7 were treated for 3 weeks from the
time negative cultures were obtained, while 4 were treated for 5 weeks
or more after negative cultures. A declining platelet count was
suggestive of fungemia in the patients we reviewed.
Conclusions. For our patients with renal mycetoma without complete obstruction (patients continued to have urine output) surgical intervention was rarely necessary, the rate of sonographic improvement neither correlated with clinical course nor necessitated longer therapy, and long-term creatinine levels were normal. Sustained declines in platelet count of 10% per day or more in a neonate on broad-spectrum antibiotics for suspected sepsis may be indicative of fungemia. Key words: candida, fungal balls, renal mycetomata, neonate, sepsis, platelets, amphotericin, ultrasound, kidney.
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