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Born T, Aruanno M, Kampouri E, Mombelli M, Monney P, Tozzi P, Lamoth F. Aspergillus tubingensis Endocarditis: A Case Report and Review of the Literature. Mycopathologia 2022; 187:249-258. [PMID: 35267153 PMCID: PMC9124170 DOI: 10.1007/s11046-022-00621-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
Aspergillus endocarditis is a rare infection that may affect immunocompetent patients following heart valve replacement or heart surgery. We report the case of a 39 year old woman with a history of intravenous drug use who developed endocarditis with direct examination of the resected valve and vegetation showing the presence of mycelia. Cultures were positive for an Aspergillus of section Nigri, which was subsequently identified as Aspergillus tubingensis by sequencing. The clinical course was favorable following surgery and prolonged antifungal therapy (8 months in total). Antifungal susceptibility testing showed good in vitro activity of amphotericin B, voriconazole and echinocandins against planktonic cells of this A. tubingensis isolate. However, only amphotericin B displayed significant activity against biofilms. In vitro combinations of voriconazole or amphotericin B with echinocandins did not meet the criteria of synergism. Our review of the literature identified 17 other cases of endocarditis attributed to Aspergillus of section Nigri with an overall mortality rate of 57% (100% in the absence of surgery). Endocarditis caused by Aspergillus niger and related cryptic species are rare events, for which surgical management appears to be crucial for outcome. While amphotericin B was the only antifungal drug displaying significant anti-biofilm activity, the type and duration of antifungal therapy remain to be determined.
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Affiliation(s)
- Tristan Born
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marion Aruanno
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Eleftheria Kampouri
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Matteo Mombelli
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Cardiology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Cardiac Surgery Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. .,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Marro M, Atzeni F, La Torre MW, Attisani M, Belloro S, De Rosa FG, Rinaldi M. Insidious postoperative Aspergillus niger graft aortitis. IDCases 2020; 21:e00823. [PMID: 32489875 PMCID: PMC7256640 DOI: 10.1016/j.idcr.2020.e00823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 11/26/2022] Open
Abstract
Fungal endocarditis/aortitis is an uncommon yet emerging entity accounting for 2% to 4% of all cases of infective endocarditis and continues to be associated with a poor prognosis. We present the first case of polyethylene-terephthalate (PETE) graft aortitis caused by A. niger, a rare fungal agent. Early diagnosis with frequent transoesophageal echocardiography (TEE) and a prompt surgical intervention coupled with optimal antifungal therapy are still the only option to reduce the exceedingly high mortality and morbidity.
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Affiliation(s)
- Matteo Marro
- Città della Salute e della Scienza di Torino, University of Turin, Department of Surgical Sciences, Division of Cardiac Surgery, Italy
| | - Francesco Atzeni
- Città della Salute e della Scienza di Torino, University of Turin, Department of Surgical Sciences, Division of Cardiac Surgery, Italy
| | - Michele William La Torre
- Città della Salute e della Scienza di Torino, University of Turin, Department of Surgical Sciences, Division of Cardiac Surgery, Italy
| | - Matteo Attisani
- Città della Salute e della Scienza di Torino, University of Turin, Department of Surgical Sciences, Division of Cardiac Surgery, Italy
| | - Stefania Belloro
- Città della Salute e della Scienza di Torino, University of Turin, Department of Medical Sciences, Division of Infectious Diseases, Italy
| | - Francesco Giuseppe De Rosa
- Città della Salute e della Scienza di Torino, University of Turin, Department of Medical Sciences, Division of Infectious Diseases, Italy
| | - Mauro Rinaldi
- Città della Salute e della Scienza di Torino, University of Turin, Department of Surgical Sciences, Division of Cardiac Surgery, Italy
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Spadea L, Giannico MI. Diagnostic and Management Strategies of Aspergillus Endophthalmitis: Current Insights. Clin Ophthalmol 2019; 13:2573-2582. [PMID: 31920280 PMCID: PMC6939405 DOI: 10.2147/opth.s219264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
Fungal endophthalmitis is subsequent to endogenous or exogenous infection and represents an important complication of ocular surgery which may lead to significant visual loss and blindness. The prognosis is poor because of delayed diagnosis and limited availability of effective antifungal drugs with good ocular penetration. Furthermore, the critical issue in diagnosing fungal infection of the eye is microbiological identification of the etiologic agent in clinical samples. Aspergillus is among the most frequent isolated organisms in fungal endophthalmitis. Early diagnosis is essential to prevent severe complications and blindness. Treatments include local, systemic and surgical therapeutic strategies. The purpose of the present review is the analysis of the current procedures adopted to promptly diagnose and treat Aspergillus endophthalmitis.
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Affiliation(s)
- Leopoldo Spadea
- University “La Sapienza”, Department of Sense Organs, Eye Clinic, Rome, Italy
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Rocco JM, Benson MK. Aspergillus aortitis in an immunocompetent patient presenting with acute endophthalmitis. Infect Dis Rep 2018; 10:7750. [PMID: 30344969 PMCID: PMC6176472 DOI: 10.4081/idr.2018.7750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/23/2022] Open
Abstract
Aspergillus is a common environmental mold most often recognized as an infectious agent in patients with severe immune compromise. We present a case of an immunocompetent patient presenting with endogenous endophthalmitis in the absence of other infectious symptoms. The search for a systemic source revealed an ascending aortic pseudoaneurysm. Surgical resection and pathology revealed angioinvasive aspergillus aortitis. Recent cardiac surgery has been noted to be a risk factor for angioinvasive aspergillosis. Diagnosis is difficult as symptoms are mild and laboratory studies are often normal. To our knowledge this is the first case of aspergillus aortitis presenting as endogenous endophthalmitis without systemic signs of inflammation. These patients have a high mortality rate therefore early recognition is essential. It is important to consider angioinvasive aspergillus infections in patients with prior cardiac surgery presenting with occult embolic phenomena. Only with early diagnosis and prompt treatment can we improve outcomes of this disease process.
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Affiliation(s)
- Joseph M. Rocco
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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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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Jamieson RW, Wallace WA, Din JN, Raza Z. Acute aortic occlusion with sudden paraplegia secondary to Aspergillus niger embolism from Aspergillus niger aortitis. J Vasc Surg 2011; 54:1472-4. [PMID: 21715126 DOI: 10.1016/j.jvs.2011.04.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/28/2011] [Accepted: 03/29/2011] [Indexed: 11/28/2022]
Abstract
Acute aortic occlusion caused by a saddle embolus is a rare vascular emergency. Associated sudden paraplegia secondary to spinal cord ischemia is even more uncommon. Aspergillus surgical site infection is typically linked to cardiac surgery but is exceptional. Here we present a case that combines all of these factors. A 67-year-old man presented with sudden paraplegia from acute aortic occlusion with a saddle embolus from Aspergillus niger aortitis 4 months after aortic valve replacement and aortoplasty. We believe this to be the second reported case of Aspergillus niger aortitis and the first presenting as aortic occlusion with paraplegia.
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Affiliation(s)
- Russell W Jamieson
- Vascular Surgical Service, Royal Infirmary of Edinburgh, Little France, Edinburgh, United Kingdom.
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