Voriconazole Treatment for an Infant With Intractable Candida glabrata Meningitis.

We report voriconazole levels in an infant with disseminated Candida glabrata infection who received combination antifungal therapy and rescue voriconazole treatment. Serum and cerebrospinal fluid voriconazole levels were higher than anticipated and above target. Dose reduction did not lead to a reduction in the blood or cerebrospinal fluid levels. The patient did not exhibit identifiable drug toxicity.

Cranial Asymmetry Versus Microcephaly: Implications for Practice During the Zika Virus Epidemic.

Congenital microcephaly can be the result of genetic, teratogenic, mechanical, infectious, and other factors affecting the fetal brain. Transient craniofacial asymmetries and cranial molding can mimic congenital microcephaly caused by brain abnormalities or neurotropic infectious pathogens, including Zika. We present two neonates who were born with head circumference at or below the 3rd percentile for gestational age, and had improving head measurements at discharge from the nursery and resolution of the microcephaly by the second month of life. The diagnostic workup of the first patient revealed congenital cranial bone asymmetry and molding, and the second patient's workup revealed cranial molding. Other etiologies for their microcephaly were excluded. These two cases highlight the importance of standardized serial head circumference measurements as part of the workup for neonatal microcephaly. Clinical exclusion of transient congenital craniofacial asymmetries and cranial molding could be a cost-effective first step in the diagnostic workup of microcephaly.

First Neonatal Demise with Travel-Associated Zika Virus Infection in the United States of America.

Zika virus is increasingly recognized as a fetal pathogen worldwide. We describe the first case of neonatal demise with travel-associated Zika virus infection in the United States of America, including a novel prenatal ultrasound finding. A young Latina presented to our health care system in Southeast Texas for prenatal care at 23 weeks of gestation. Fetal Dandy-Walker malformation, asymmetric cerebral ventriculomegaly, single umbilical artery, hypoechoic fetal knee, dorsal foot edema, and mild polyhydramnios were noted upon initial screening prenatal sonography at 26 weeks. A growth-restricted, microcephalic, and arthrogrypotic infant was delivered alive at 36 weeks but died within an hour despite resuscitation. The neonatal karyotype was normal. Flavivirus IgM antibodies were identified in the serum of the puerpera, once she disclosed that she had traveled from El Salvador to Texas in the early second trimester. Zika virus was identified in the umbilical cord and neonatal brain. Fetal arthritis may precede congenital arthrogryposis in cases of Zika virus infection and may be detectable by prenatal sonography. Physician and health care system vigilance is required to optimally address the significant and enduring Zika virus global health threat.

Atypical Meigs' syndrome in a neonate with ovarian torsion associated with an ovarian dermoid cyst.

We describe a female neonate with ovarian torsion, ovarian follicular and dermoid cysts, congenital ascites, pleural effusions, and respiratory distress. Her symptoms were consistent with atypical Meigs' syndrome and resolved after unilateral oophorectomy. This is the first report in a neonate of this syndrome in association with congenital ovarian disease.