congenital candidiasis ( cc ) is rare and usually caused by intrauterine candidial infection and manifests within first 6 days of life .
it may be localized involving only skin or generalized resulting in respiratory distress , meningitis , sepsis , and death .
a total of 10 - 35% of the women suffer from candidial vagintis during pregnancy , but less than 1% of them develop candidial chorioamnionitis that can affect the fetus .
this is why cc is so rare and only 100 cases have been reported in the literature so far .
a preterm ( 36 weeks ) , baby boy weighing 2.5 kg delivered by lower segment caesarean section ( lscs ) was brought to the dermatology department with pustular lesions all over the body on the second day of life .
the attendant noticed erythema in both groins and over face within few hours after birth , followed by the appearance of pustular lesions on it in next 12 - 16 h. scalp , back of trunk , extremities , and palms were involved by the second day .
mother was 31-year - old , gravida 6 , para 3 , live born 2 , abortions 3 , death 1[g6p3l2a3d1 ] with gestational hypertension .
there was a history of cervical incompetence and cervical encirclage was done at 16 week of pregnancy .
cutaneous examination revealed multiple , superficial , small pustules some coalescing to form lakes of pus over an erythematous back ground in groins , scalp , forehead , back , extremities , and palms .
based on the history of vaginitis and cervical suture in the mother , whitish plaques on cord during delivery , pustular lesions on an erythematous background with in 24 h after birth , a clinical diagnosis of cc was considered .
pustular lesions in groins pustules coalescing to form lakes of pus on the back hemogram revealed leucocytosis ( 24,900 cells / mm ) .
koh mount from the pustular lesions revealed pseudohyphae suggestive of candidiasis [ figure 3 ] .
culture on sabourauds dextrose agar showed candida species , further confirming the diagnosis [ figure 4 ] .
the baby was given topical 2% ketaconazole cream twice daily along with fluconazole 6 mg / kg intravenously once daily for 3 days as there was leucocytosis .
pustules began to dry by 3 day and desquamated completely by 5 day [ figure 5 ] .
oral fluconazole ( 6 mg / kg / week ) and topical ketoconazole were continued for 1 week and there was no recurrence at 3 months of follow - up .
cc is a very rare condition which presents at birth or with in first 6 - 7 days after birth and generally represents maternal chorioamnionitis occurring either from birth canal as an ascending infection or as transplacental infection .
ascending infection may occur either from subclinical rupture of membranes or even through intact membranes resulting in whitish plaques on the membranes and umbilical cord along with skin lesions , described classically as 
various risk factors like < 27 weeks of gestation age , wt < 1000 g , intrauterine device , cervical sutures , invasive procedures , and extensive instrumentation have been reported .
the role of maternal steroids or immunodeficiency in the infant is controversial . in the present case ,
cervical encirclage was done for cervical incompetence by mcdonold 's method at 16 weeks of pregnancy .
cc manifest at birth or within a few hours of birth as extensive erythematous maculopapular eruption on head , trunk , and extremities that progress to vesicles and pustules on erythematous base in 1 - 3 days .
palmar and plantar pustules are considered as hallmark of the disease , but mucosae and napkin area are spared .
onychia and paronychia may occur and rarely cc may be limited to nails . scalded or burn - like appearance of skin lesions may herald systemic involvement . severe involvement of gastrointestinal and respiratory tract can occur due to aspiration of infected amniotic fluid that culminates in candidial septicemia manifesting as bronchopneumonia , meningitis , arthritis , endocarditis with microabcess in liver , brain , kidneys , or spleen . features like respiratory distress , leucocytosis with left shift , persistent hyperglycemia , glycosuria , positive cultures from blood , urine , cerebrospinal fluid ( csf ) , and burn - like skin lesions suggest systemic involvement .
neonatal candidiasis typically manifests after 6 days of life and differs clinically from cc [ table 1 ] .
cc should be differentiated from various other diseases presenting with pustules in the newborn [ table 2 ] .
comparision of congenital and neonatal candidiasis causes of neonatal pustular disorders diagnosis was established by koh mount of skin lesions showing budding yeasts and pseudohyphae and culture revealing candidial growth .
blood , urine , and csf cultures should be obtained to rule out systemic involvement if there is clinical suspicion .
amphotercin b is the first line agent given in doses of 0.5 - 1 mg / kg / day and liposomal amphotericin b is less toxic and preferred if there is preexisting renal insufficiency .
fluconazole at 6 - 12 mg / kg / day dose is effective alternative if organism is susceptible .
topical therapy is given till the resolution of skin lesions and systemic therapy continued for minimum of 21 - 28 days if systemic involvement is present .
cc is very rare and needs to be differentiated from various diseases presenting with generalized maculopapular or pustular lesions at birth in order to avoid complications .
 congenital candidiasis ( cc ) is a rare disease with less than 100 cases being reported in the literature . 
 it presents within six days of life with manifestations ranging from localized skin disease to systemic involvement in the form of respiratory distress , sepsis , and death . 
 we report a neonate who presented with diffuse pustular eruption on erythematous background involving face , trunk , and palms within 24 h after birth . 
 candida albicans was identified in 10% potassium hydroxide ( koh ) smear and culture from the pustules . 
 intravenous fluconazole and topical ketoconazole were given and the condition improved completely in two weeks . 
 cc is rare and needs to be differentiated from other conditions presenting with pustular lesions at birth in order to avoid complications . 
 early diagnosis and prompt treatment of this condition is important as untreated cases carry a mortality rate of 8 - 40% . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION