Multifocal osteoarthritis due to Candida albicans in a neonate: serum level monitoring of liposomal amphotericin B and literature review

Abstract

A 32-week neonate weighing 2,300 g at birth with fungemia due to Candida albicans subsequently developed multifocal osteoarthritis of the lower extremities due to the same organism during therapy with amphotericin B (0.5 mg/kg/day) and flucytosine (100 mg/kg/day) to which the isolates were susceptible. Liposomal amphotericin B (3.5 mg/kg/day) was substituted for conventional amphotericin B and complete clinical and radiologic recovery as well as sterilization of affected joints were achieved with a 38-day-course (144.5 mg/kg total). Adequate drug concentrations in serum and synovial fluid were attained with liposomal amphotericin B. Nine neonates (< or = 28 days of age) with bone and/or joint infections due to Candida spp. had previously been reported in the English-language literature. To our knowledge, the present case is the first reported cure with liposomal amphotericin B. Previous cases are reviewed and the potential role of liposomal amphotericin B in this serious neonatal infection is discussed.