Fungal Chorioamnionitis by Candida Albicans in a Low-risk Pregnant Woman: Case Report
Year: 2026
Type: article
Study design: Case Report
Abstract: Chorioamnionitis is an inflammation of the fetal membranes, usually resulting from an ascending infection and with polymicrobial bacterial etiology, occurring in 1–6% of term pregnancies. The main risk factors are rupture of fetal membranes and prolonged labor. Treatment must be initiated immediately upon clinical suspicion due to the risk of maternal and fetal complications. We report the case of a 37-year-old otherwise healthy pregnant woman at 23 weeks’ gestation who underwent emergency cerclage due to cervical insufficiency and received ceftriaxone and metronidazole for 3 days. She had a history of two episodes of genital candidiasis during pregnancy, both treated with topical therapy. At 26 weeks of gestation, she presented with preterm labor, leukocytosis (20,859/mm³), elevated C-reactive protein (98.4 mg/L) and yellow leukorrhea. Therapy with amoxicillin-clavulanate was initiated, and an attempt was made to inhibit labor with nifedipine, without success. Cesarean section was indicated, and purulent secretion was observed in the abdominal cavity, confirming clinical suspicion of chorioamnionitis. After delivery, antibiotic therapy was escalated to piperacillin-tazobactam following collection of urine and blood cultures. Amniotic fluid culture showed the presence of yeasts, and intravenous micafungin was initiated based on the preliminary result. Blood and urine cultures were negative. Amniotic fluid culture subsequently identified multisensitive Candida albicans by MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization – Time of Flight), allowing de-escalation to fluconazole and completion of therapy on an outpatient basis. As bacterial chorioamnionitis could not be excluded, the antibiotic regimen was maintained for seven days. Placental histopathology showed severe diffuse acute neutrophilic chorioamnionitis associated with deciduitis and funisitis. The patient remained asymptomatic and completed 14 days of oral fluconazole. On follow-up, abdominal ultrasound excluded local complications and laboratory tests normalized. Chorioamnionitis is the main cause of maternal and neonatal sepsis. Its diagnosis can be clinical, histological or microbiological. Fungal etiology is rare, more frequent in pregnant women using intrauterine devices, and may occur without fever. To date, there are no clinical trials on fungal chorioamnionitis to define the best treatment. In this case, we report a successful outcome with 14 days of oral azole therapy.
Institution: Hospital Nossa Senhora das Graças
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,600
OpenAlex ID: W7135379179