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Caroselli C, Suardi LR, Besola L, Fiocco A, Colli A, Falcone M. Native-Valve Aspergillus Endocarditis: Case Report and Literature Review. Antibiotics (Basel) 2023; 12:1190. [PMID: 37508286 PMCID: PMC10376027 DOI: 10.3390/antibiotics12071190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Aspergillus endocarditis represents the second etiological cause of prosthetic endocarditis following Candida spp. On the other hand, native-valve endocarditis due to Aspergillus are anecdotally reported with increasing numbers in the last decade due to new diagnostic technologies such as polymerase chain reaction (PCR) on samples like valve tissue or entire blood. We performed a review of the literature presenting one case report observed at Pisa University Hospital. Seventy-four case reports have been included in a period between 1950-2022. Immunocompromised status (patients with solid tumor/oncohematological cancer or transplanted patients) was confirmed to be the main risk factor for this rare opportunistic infection with a high rate of metastatic infection (above all, central nervous system) and mortality. Diagnosis relies on serum galactomannan and culture with PCR on valve tissue or whole blood. Cardiac surgery was revealed to be a life-saving priority as well as appropriate antifungal therapy including b-liposomal amphotericin or new triazoles (isavuconazole). The endocarditis team, facing negative blood culture endocarditis affecting an immunocompromised patient, should investigate this difficult-to-treat pathogen.
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Affiliation(s)
- Claudio Caroselli
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Roberto Suardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
| | - Laura Besola
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
| | - Alessandro Fiocco
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
| | - Andrea Colli
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
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Menu E, Filori Q, Dufour JC, Ranque S, L’Ollivier C. A Repertoire of Clinical Non-Dermatophytes Moulds. J Fungi (Basel) 2023; 9:jof9040433. [PMID: 37108888 PMCID: PMC10146755 DOI: 10.3390/jof9040433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Humans are constantly exposed to micromycetes, especially filamentous fungi that are ubiquitous in the environment. In the presence of risk factors, mostly related to an alteration of immunity, the non-dermatophyte fungi can then become opportunistic pathogens, causing superficial, deep or disseminated infections. With new molecular tools applied to medical mycology and revisions in taxonomy, the number of fungi described in humans is rising. Some rare species are emerging, and others more frequent are increasing. The aim of this review is to (i) inventory the filamentous fungi found in humans and (ii) provide details on the anatomical sites where they have been identified and the semiology of infections. Among the 239,890 fungi taxa and corresponding synonyms, if any, retrieved from the Mycobank and NCBI Taxonomy databases, we were able to identify 565 moulds in humans. These filamentous fungi were identified in one or more anatomical sites. From a clinical point of view, this review allows us to realize that some uncommon fungi isolated in non-sterile sites may be involved in invasive infections. It may present a first step in the understanding of the pathogenicity of filamentous fungi and the interpretation of the results obtained with the new molecular diagnostic tools.
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Affiliation(s)
- Estelle Menu
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerra-néennes, Aix Marseille Université, 13385 Marseille, France
| | - Quentin Filori
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, 13385 Marseille, France
| | - Jean-Charles Dufour
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, 13385 Marseille, France
- APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l’Information et de la Communication, 13385 Marseille, France
| | - Stéphane Ranque
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerra-néennes, Aix Marseille Université, 13385 Marseille, France
| | - Coralie L’Ollivier
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerra-néennes, Aix Marseille Université, 13385 Marseille, France
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3
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Skibba AA, West MR, Evans JR, Hopkins SP, Maltais S, Rush DS. Aspergillus thromboembolism from a mycotic ascending aortic pseudoaneurysm. J Vasc Surg Cases 2015; 1:94-96. [PMID: 31724580 PMCID: PMC6849891 DOI: 10.1016/j.jvsc.2015.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/01/2015] [Indexed: 11/29/2022] Open
Abstract
This case report describes an immune-competent patient with acute upper extremity ischemia caused by thromboembolism from an Aspergillus-infected ascending aortic pseudoaneurysm. Efforts to identify the source of an acute arterial thromboembolic occlusion should be made, and a high index of suspicion for mycotic infection should be maintained in patients with an atypical presentation, such as fevers of unknown origin. Additional measures, such as pathologic examination of thromboembolic debris, blood cultures, and positron emission tomography, should be performed to identify the etiology in these unexplained situations.
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Affiliation(s)
- Afshin A Skibba
- Division of Vascular Surgery, East Tennessee State University, Johnson City, Tenn
| | - Michael R West
- Division of Vascular Surgery, East Tennessee State University, Johnson City, Tenn
| | - James R Evans
- Division of Vascular Surgery, East Tennessee State University, Johnson City, Tenn
| | - Steven P Hopkins
- Division of Vascular Surgery, East Tennessee State University, Johnson City, Tenn
| | - Simon Maltais
- Department of Cardiac Surgery, Vanderbilt Heart and Vascular Institute, Nashville, Tenn
| | - Daniel S Rush
- Division of Vascular Surgery, East Tennessee State University, Johnson City, Tenn
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Venugopal V, Ramachandran M. Do not blame the arterial catheter: a case report of intraoperative acute Leriche syndrome. J Cardiothorac Vasc Anesth 2011; 26:462-4. [PMID: 21441040 DOI: 10.1053/j.jvca.2011.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Indexed: 11/11/2022]
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Hope WW, Walsh TJ, Denning DW. The invasive and saprophytic syndromes due to Aspergillus spp. Med Mycol 2005; 43 Suppl 1:S207-38. [PMID: 16110814 DOI: 10.1080/13693780400025179] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Aspergillus spp. produce a wide range of invasive and sapropytic syndromes which may involve any tissue. Within a given tissue or organ the pathology and pathogenesis varies enormously, ranging from angioinvasive disease to noninvasive saprophytic disease. The individual invasive and saprophytic syndromes in which a causative role can be attributed to Aspergillus spp. are detailed specifically with reference to the underlying pathology and pathogenesis, the clinical setting and features, and the manner in which a diagnosis can be established.
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Affiliation(s)
- W W Hope
- University of Manchester and Wythenshawe Hospital, Manchester UK
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7
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Büttner A, Weis S. Central Nervous System Alterations in Drug Abuse. FORENSIC PATHOLOGY REVIEWS 2004. [DOI: 10.1007/978-1-59259-786-4_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Petrosillo N, Pellicelli AM, Cicalini S, Conte A, Goletti D, Palmieri F. Endocarditis caused by Aspergillus species in injection drug users. Clin Infect Dis 2001; 33:e97-9. [PMID: 11565094 DOI: 10.1086/323564] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2001] [Revised: 05/09/2001] [Indexed: 11/04/2022] Open
Abstract
Aspergillus endocarditis is a rare event; a very few cases have been reported in injection drug users (IDUs) and patients infected with human immunodeficiency virus (HIV). We report 2 proven cases and 1 highly suggestive case of Aspergillus endocarditis in IDUs, 2 of whom were infected with HIV, and discuss some related clinical and pathogenic aspects.
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Affiliation(s)
- N Petrosillo
- Second Infectious Diseases Unit, Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, Rome, Italy.
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Veraldi GF, Guglielmi A, Genna M, Bertolini P, Pasetto E, Dusi R, Cordiano C. Occlusion of the common iliac artery secondary of fungal endocarditis: report of a case. Surg Today 2001; 30:291-3. [PMID: 10752786 DOI: 10.1007/s005950050062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Fungal endocarditis becomes complicated by peripheral arterial embolization of the lower limbs in 33%-75% of cases. Although the prognosis of patients with fungal endocarditis has improved somewhat over recent years, it remains poor, especially when the disease is associated with peripheral arterial embolization. We report herein our experience of treating a patient in whom occlusion of the right common iliac artery developed secondary to endocarditis caused by Candida parapsilosis, and review the literature on this subject.
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Affiliation(s)
- G F Veraldi
- First Department of General Surgery, Second Postgraduate School of General Surgery, University of Verona School of Medicine, Ospedale Civile Maggiore di Verona, Italy
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Abstract
A broad spectrum of neuropathologic changes are encountered in the brains of heroin abusers. The main findings are due to infections, either due to bacterial spread from bacterial endocarditis, mycoses, or from HIV-1 infection. Other complications include hypoxic-ischemic changes with cerebral edema, ischemic neuronal damage and neuronal loss, which are assumed to occur under conditions of prolonged heroin-induced respiratory depression, stroke due to, for example, thromboembolism, vasculitis, septic emboli, hypotension, and positional vascular compression. Myelopathy is believed to be the result of an isolated vascular accident within the spinal cord due to an as yet unknown mechanism. A distinct entity, spongiform leukoencephalopathy, has been described mainly after inhalation of pre-heated heroin. A lipophilic toxin-induced process was considered to be due to contaminants and to be induced or enhanced by cerebral hypoxia, but a definite toxin could not be identified. At the cellular level, abnormalities in signal transduction systems and changes of various receptor densities have been reported. The exact etiology of the different neuropathological alterations associated with heroin abuse is still unclear, but may also be related to additional substances used as adulterants.
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Affiliation(s)
- A Büttner
- Institute of Legal Medicine, University of Munich, Frauenlobstrasse 7a, 80337, Munich, Germany
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Gumbo T, Taege AJ, Mawhorter S, McHenry MC, Lytle BH, Cosgrove DM, Gordon SM. Aspergillus valve endocarditis in patients without prior cardiac surgery. Medicine (Baltimore) 2000; 79:261-8. [PMID: 10941355 DOI: 10.1097/00005792-200007000-00007] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aspergillus native valve endocarditis in patients who have not had cardiac surgery is uncommon. We report 3 cases and review 58 other adult patients reported in the English-language literature. Sixty-seven percent of the patients had underlying immunosuppression. The clinical features were fever (74%), embolic episodes (69%), a new or changing heart murmur (41%), and sudden visual loss (13%). Patients with mural endocarditis were more often immunosuppressed, especially due to solid organ transplants, but had lower frequency of heart murmurs and embolic episodes. Echocardiography revealed a vegetation in 78% of all the cases in which it was performed. Examination and culture of biopsy material often helped to establish a diagnosis of Aspergillus infection. Twenty-five patients had an antemortem diagnosis. These patients received a mean cumulative amphotericin B dose of 27 mg/kg. Twenty percent (3/15) of patients who received combined surgical and medical therapy survived, compared to none of those who received medical therapy alone (p = 0.08). Patients who survived were not immunosuppressed. We conclude that native valve aspergillus infective endocarditis is uniformly fatal without surgical intervention and antifungal therapy.
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Affiliation(s)
- T Gumbo
- Department of Infectious Disease, Cleveland Clinic Foundation, OH 44195, USA
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Chim CS, Ho PL, Yuen ST, Yuen KY. Fungal endocarditis in bone marrow transplantation: case report and review of literature. J Infect 1998; 37:287-91. [PMID: 9892534 DOI: 10.1016/s0163-4453(98)92169-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report a case of fungal endocarditis due to Aspergillus terreus in a leukaemia patient who received a bone marrow allograft from a matched unrelated donor. He presented with persistent fever. microangiopathic haemolytic anaemia but there was no cardiac signs and symptoms. He died despite intravenous amphotericin B. Review of the English literature showed five other patients with fungal endocarditis in the setting of bone marrow transplantation and revealed the same features of difficult diagnosis and poor outcome.
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Affiliation(s)
- C S Chim
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
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Abstract
We report the case of an intramyocardial abscess caused by mucormycosis that arose after cardiac operation. Several causes of immunosuppression in a 71-year-old woman were exacerbated after she underwent coronary revascularization. Before she died of multiple organ system dysfunction, a variety of supraventricular and ventricular arrhythmias, as well as complete heart block, developed, but the cause was not clear until autopsy revealed a large septal myocardial abscess due to mucormycosis.
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Affiliation(s)
- J M Balaguer
- Department of Pathology, St. Vincent Hospital, Worcester, Massachusetts
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14
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Lozano P, Flores D, Blanes I, Rimbau E, Corominas C, Julia J, Garcia de la Torre A. Acute lower limb ischemia complicating endocarditis due to Candida parapsilosis in a drug abuser. Ann Vasc Surg 1994; 8:591-4. [PMID: 7865399 DOI: 10.1007/bf02017417] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Acute ischemia due to arterial embolism occurred in the right leg of a male drug abuser who had developed fungal endocarditis as a result of Candida parapsilosis. Transesophageal echocardiography aided in the diagnosis. The patient was successfully treated with fibrinolysis and surgery. The clinical features and management of this serious condition have been reviewed in the literature.
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Affiliation(s)
- P Lozano
- Division of Angiology and Vascular Surgery, Hospital Son Dureta, Palma de Mallorca, Spain
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