Treatment of Candida glabrata intraamniotic infection with an antifungal agent in preterm pre-labor rupture of the membranes

Intraamniotic infection, a major cause of preterm pre-labor rupture of membranes (PPROM), is a risk factor for neonatal morbidity and mortality as well as long-term handicap. We presented a patient with PPROM at 25 +2 weeks of gestation with Candida glabrata intraamniotic infection, for which amniotic fluid culture and 18S rRNA sequencing consistently demonstrated Candida glabrata . After extensive counseling, expectant management with intravenous liposomal amphotericin B was performed. A repeat amniocentesis (2 nd amniocentesis) was performed after 14 days of anti-fungal treatment (at 27 +5 weeks of gestation). The results of the 2 nd amniotic fluid fungal culture and 18S rRNA sequencing continued to demonstrate a Candida glabrata infection. However, a treatment response was observed, as evidenced by a decrease in the number of Candida colonies in the fungal culture, as determined by visual inspection, and by a normalized interleukin-6 (IL-6) concentration, a proxy for intraamniotic inflammation. Therefore, we plan to continue amphotericin B for one more week and reassess the amniotic fluid. The third amniocentesis was performed at 29 weeks of gestation (a total of 21 days of liposomal amphotericin B treatment), and the results of fungal culture and 18S rRNA analysis still showed Candida glabrata intraamniotic infection. Subsequently, the patient developed a spontaneous onset of preterm labor at 29 +3 weeks of gestation. Placental histologic examination revealed acute chorioamnionitis, stage 1, grade 1, without funisitis. The neonate had no fetal inflammatory response syndrome and no Candida glabata septicemia. We hereby report the successful treatment of intraamniotic Candida glabrata infection, aiming to prevent fetal inflammatory response syndrome, in a patient with PPROM at 25 +2 weeks of gestation.