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Koohsari P, Nakhaee A, Rahmanian M, Salahshour F, Parkhideh R, Larti F. Devastating fungal endocarditis involving ascending aorta in a patient with a history of aortic valve replacement: a case report. J Cardiothorac Surg 2024; 19:191. [PMID: 38589959 PMCID: PMC11003144 DOI: 10.1186/s13019-024-02733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Fungal endocarditis is a rare but serious condition associated with high mortality rates. Various predisposing factors contribute to its occurrence, such as underlying cardiac abnormalities, cardiac surgeries, prosthetic cardiac devices, and central venous catheters. Diagnosing fungal endocarditis, particularly Aspergillus, poses challenges, often complicated by negative blood cultures. CASE PRESENTATION This report details a case of extensive ascending aorta involvement in Aspergillus endocarditis (AE) in a 24-year-old man with a history of bioprosthesis aortic valve replacement (AVR). Three months post-AVR, he presented with pericardial effusion and aortic rupture, leading to a redo biological valved conduit aortic root replacement (Bentall surgery). Despite the intervention, the tubular graft exhibited extensive Aspergillus involvement, resulting in graft disruption and significant peri-aortic infection. A second redo procedure involving aortic homograft root replacement was performed. Unfortunately, the patient succumbed two days after the surgery. CONCLUSION A combined approach of medical and surgical therapies is recommended to manage fungal endocarditis. Despite efforts, the mortality rate associated with Aspergillus endocarditis remains unacceptably high, with no significant difference observed between combination therapy and antifungal treatment alone. Further research is essential to explore novel therapeutic strategies and improve outcomes for patients with this challenging condition.
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Affiliation(s)
- Parisa Koohsari
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Nakhaee
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrzad Rahmanian
- Cardiothoracic Surgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Faeze Salahshour
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Parkhideh
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Larti
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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Kulirankal KG, Mary A, Moni M, Pillai GS, Sathyapalan DT. Long-term survival following medical management of Aspergillus endocarditis with dissemination as a consequence of steroid therapy in severe COVID-19 pneumonia. Med Mycol Case Rep 2024; 43:100638. [PMID: 38487405 PMCID: PMC10937298 DOI: 10.1016/j.mmcr.2024.100638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
A male in his 40's with no known comorbidities developed severe COVID-19 pneumonia and received a four-week course of methylprednisolone. The patient subsequently developed disseminated Aspergillus endocarditis, manifesting as multiple organ involvement including the heart, eyes, and brain. Despite the poor prognosis generally associated with fungal endocarditis, the patient survived following aggressive medical management with a combination of liposomal amphotericin b and voriconazole therapy and is now doing well for over two years and is off antifungal therapy for a year.
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Affiliation(s)
- Kiran G. Kulirankal
- Division of Infectious Diseases, Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Ann Mary
- Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Merlin Moni
- Division of Infectious Diseases, Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Gopal S. Pillai
- Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, India
| | - Dipu T. Sathyapalan
- Division of Infectious Diseases, Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India
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Jamil Y, Akinleye A, Mirzaei M, Lempel M, Farhat K, Pan S. Candida endocarditis: Update on management considerations. World J Cardiol 2023; 15:469-478. [PMID: 37900901 PMCID: PMC10600790 DOI: 10.4330/wjc.v15.i10.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 10/24/2023] Open
Abstract
The rise in incidence rates of invasive candidiasis warrants an increase in attention and efforts toward preventing and treating this virulent infection. Cardiac involvement is one of the most feared sequelae and has a poor prognosis. Despite the introduction of several novel antifungal agents over the past quarter century, complications and mortality rates due to Candida endocarditis have remained high. Although fungal endocarditis has a mechanism similar to bacterial endocarditis, no specific diagnostic criteria or algorithm exists to help guide its management. Furthermore, recent data has questioned the current guidelines recommending a combined approach of antifungal agents with surgical valve or indwelling prostheses removal. With the emergence of multidrug-resistant Candida auris, a focus on improved prophylactic measures and management strategies is necessary.
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Affiliation(s)
- Yasser Jamil
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States.
| | - Akintayo Akinleye
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States
| | - Mojtaba Mirzaei
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States
| | - Matthew Lempel
- Department of Rheumatology, Yale School of Medicine, New Haven, CT 06510, United States
| | - Kassem Farhat
- Department of Internal Medicine, Yale School of Medicine, Waterbury, CT 06708, United States
| | - Samuel Pan
- Department of Infectious Disease, Yale School of Medicine, Waterbury, CT 06708, United States
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Basyal B, Clark PA, Cohen JE, Srichai MB. Rare case of infective endocarditis from invasive aspergillosis encasing the pulmonary valve: a case report. Eur Heart J Case Rep 2023; 7:ytad218. [PMID: 37181467 PMCID: PMC10170530 DOI: 10.1093/ehjcr/ytad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/20/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
Background Aspergillus endocarditis is a rare cause of infective endocarditis and requires high index of suspicion for diagnosis. Case summary We describe a case of a 50-year-old man with history of metastatic thymoma on immunosuppression (gemcitabine and capecitabine) who presented with progressive dyspnoea. Echocardiography and computed tomography (CT) of chest showed filling defect in the pulmonary artery. The initial differential diagnosis was of pulmonary embolism and metastatic disease. The mass was subsequently excised, which revealed a diagnosis of Aspergillus endocarditis of the pulmonary valve. Unfortunately, he passed away despite medical treatment with antifungal therapy after surgery. Discussion Aspergillus endocarditis should be suspected in immunosuppressed hosts with negative blood cultures and large vegetations on echocardiography. Diagnosis is made by tissue histology but may be difficult or delayed. Optimal treatment involves aggressive surgical debridement and prolonged antifungal therapy; prognosis is poor with high mortality.
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Affiliation(s)
- Binaya Basyal
- Corresponding author. Tel: 202-877-9090, Fax: 202-877-6891,
| | - Paul A Clark
- Medstar Georgetown University Hospital, Washington Hospital Center, 110 Irving St NW, Washington DC, 20010, USA
| | - Jeffrey E Cohen
- Medstar Georgetown University Hospital, Washington Hospital Center, 110 Irving St NW, Washington DC, 20010, USA
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Flores-Patiño JJ, Durán-Pacheco MJ, Cázares-Marroquín AM, Gastélum-Cano JM, Islas-Osuna MA, Arízaga-Berber JA. Endocarditis due to Candida albicans in an immunocompromised patient: A case report. Rev Iberoam Micol 2023; 40:31-34. [PMID: 37770333 DOI: 10.1016/j.riam.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Fungal endocarditis is a low-frequency disease with a challenging diagnosis, as it can be mistaken with bacterial endocarditis. Fungal endocarditis causes higher mortality rates in immunocompromised patients. In the clinical practice, the endocarditis caused by fungi represents up to 10% of all infectious endocarditis cases and has a mortality rate of nearly 50%. CASE REPORT Here we present the case of a 53-year-old woman under corticosteroid therapy with a history of rheumatic heart disease, aortic valve replacement, and rheumatoid arthritis, who presented with fungal endocarditis caused by Candida albicans. Even though the patient received 3 years of antifungal prophylaxis with fluconazole, had valve replacement surgery, and received intensive care, the patient finally worsened and died. CONCLUSIONS Comorbidities and corticosteroid therapy predisposed the patient to acquire fungal endocarditis. This case highlights the importance of implementing procedures for the isolation and identification of fungi, and for carrying out antifungal-susceptibility testing, as well as establishing surveillance programs to identify infection-causing species and drug resistance patterns in hospitals. Moreover, designing and upgrading the algorithm for infectious endocarditis is the key to future improvements in diagnosis.
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Affiliation(s)
| | | | | | - José M Gastélum-Cano
- Laboratorio de Genética y Biología Molecular de Plantas y Hongos, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico; Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Hermosillo, Mexico
| | - María A Islas-Osuna
- Laboratorio de Genética y Biología Molecular de Plantas y Hongos, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico; Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Hermosillo, Mexico
| | - José A Arízaga-Berber
- Escuela de Medicina, Universidad de Celaya, Celaya, Guanajuato, Mexico; Hospital General Zona 4 del Instituto Mexicano del Seguro Social (IMSS), Celaya, Guanajuato, Mexico.
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Velazquez ID, Woo KK, Siddiqui M, Roy SK. Case Report: Culture-negative Prosthetic Valve Endocarditis. Curr Cardiol Rev 2023; 19:5-8. [PMID: 37055889 PMCID: PMC10636796 DOI: 10.2174/1573403x19666230411151214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Prosthetic valve endocarditis can be difficult to diagnose and cause significant morbidity and mortality, especially when no culture data are available to guide therapy. Transthoracic and transesophageal echocardiograms, the studies of choice for initial endocarditis evaluation, can be less reliable due to artifact and post-surgical changes. Some less common forms of endocarditis may be difficult to culture and, due to their fastidious nature, may delay the identification of causative organisms. Given the lack of directed antimicrobial treatment, culturenegative prosthetic valve endocarditis is specifically difficult. A wide differential diagnosis is critical to make a timely diagnosis and initiate treatment. CASE PRESENTATION We present a case of a patient presenting with dyspnea which was found to have culture-negative endocarditis requiring mitral and aortic valve replacement that ultimately was complicated with culture-negative prosthetic valve endocarditis. Identifying a culprit organism made appropriate and timely antimicrobial treatment difficult, ultimately resulting in the patient dying from endocarditis complications. CONCLUSION A high index of suspicion is needed when managing infective endocarditis, especially when prosthetic valves are involved. Diagnostic accuracy of cultures and echocardiography may be reduced when dealing with prosthetic valve endocarditis; thus, alternative methods of diagnosis may be required to make a timely diagnosis of causative organisms.
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Affiliation(s)
| | - Kenneth K. Woo
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mohammed Siddiqui
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Sion K. Roy
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
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Demir T, Baris A, Sigirci S, Sigirci BB, Tanriverdi ES, Koramaz I. Infective endocarditis caused by Chaetomium globosum. Cardiovasc Pathol 2023; 62:107467. [PMID: 35970486 DOI: 10.1016/j.carpath.2022.107467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 12/13/2022] Open
Abstract
Chaetomium globosum is a dematiaceous, filamentous fungus belonging to the large genus saprobic ascomycetes and is rarely involved in human infection. We present the case of a 25-year-old man undergoing tricuspid valve replacement due to recurrent prosthetic ring endocarditis. Initially, it was considered culture-negative endocarditis; however, the diagnosis of Chaetomium globosum could only be provided by DNA isolation of the mold isolate grown in culture and the valve tissue samples taken from the patient. This report describes the first documented tricuspid endocarditis caused by Chaetomium species and discusses the importance of molecular tools to enhance the diagnostic process in culture-negative endocarditis, especially for fastidious and nonculturable microorganisms.
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Hiroshima Y, Kurumisawa S, Aizawa K, Fukushima N, Kawahito K. Successful treatment of Aspergillus mural endocarditis in malignant lymphoma using a combined antifungal and surgical approach: a case report. Surg Case Rep 2020; 6:128. [PMID: 32504253 PMCID: PMC7275106 DOI: 10.1186/s40792-020-00883-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Aspergillus endocarditis (AE) is a rare and lethal cardiac infection with a high rate of mortality. AE most commonly presents in immunocompromised patients and is associated with various co-morbidities. Herein, we present a case of AE associated with lung, brain, and cervical abscesses after chemotherapy for malignant lymphoma that was successfully treated by a combination of antifungal and surgical therapy. Case presentation A 29-year-old man was admitted to our hospital with an unidentified fever. He was diagnosed with malignant lymphoma (extra-nodal NK/T cell lymphoma nasal type), and chemotherapy was administered. After chemotherapy, nodular lung shadows along with new brain, cervical, and myocardial abscesses appeared, despite anti-bacterial/fungal therapy. Gene analysis of the cervical abscess biopsy revealed the presence of Aspergillus fumigatus species, and the transesophageal echocardiogram showed a mobile mural vegetation in the left ventricle (22 × 8 mm). He underwent surgical resection of this mural vegetation. His postoperative course was uneventful. He remains healthy at 28 months after surgery with continued oral antifungal therapy. Conclusion Although AE associated with immunosuppression is a fatal clinical presentation, combined treatment with surgical resection and antifungal therapy was effective.
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Affiliation(s)
- Yuya Hiroshima
- Department of Cardiovascular Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Soki Kurumisawa
- Department of Cardiovascular Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kei Aizawa
- Department of Cardiovascular Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Noriyoshi Fukushima
- Department of Pathology, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Koji Kawahito
- Department of Cardiovascular Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
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Aggarwal A, Hogan K, Paez A. Aspergillus fumigatus endocarditis in a splenectomized patient with no risk factors. IDCases 2020; 19:e00694. [PMID: 32025491 PMCID: PMC6997814 DOI: 10.1016/j.idcr.2020.e00694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/28/2019] [Accepted: 12/28/2019] [Indexed: 11/01/2022] Open
Abstract
Aspergillus endocarditis is a rare cause of culture-negative fungal endocarditis, after Candida endocarditis. Typical risk factors include intravenous drug use, immunosuppression, prior cardiac surgery or presence of prosthetic heart valves, hematopoietic stem cell or solid organ transplantation. Common presentations include signs and symptoms consistent with endocarditis but with negative bacterial blood cultures. Here, we present a case report of a 49-year-old male without known risk factors for fungal endocarditis who presented with a stroke and found to have Aspergillus endocarditis. Despite surgical intervention and antifungal treatment, the outcome was fatal. This underscores the difficulty in diagnosing Aspergillus endocarditis and its poor prognosis, necessitating the need for early diagnosis and intervention.
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Affiliation(s)
- Abhimanyu Aggarwal
- Division of Infectious Diseases, Baystate Medical Center/University of, Massachusetts Medical School, Baystate, MA, USA
| | - Karen Hogan
- Division of Infectious Diseases, Baystate Medical Center/University of, Massachusetts Medical School, Baystate, MA, USA
| | - Armando Paez
- Division of Infectious Diseases, Baystate Medical Center/University of, Massachusetts Medical School, Baystate, MA, USA
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Rahmati E, Correa AJ, She RC. A budding case of infectious endocarditis: Candida lusitaniae. IDCases 2019; 19:e00679. [PMID: 31908943 PMCID: PMC6938964 DOI: 10.1016/j.idcr.2019.e00679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 11/26/2022] Open
Abstract
This is a case of recurrent Candida lusitaniae prosthetic valve endocarditis with budding yeast and pseudohyphae on the histopathology. This case illustrates the importance of keeping vigilant in recognizing some of the emerging drug resistant Candida species in our practice.
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Affiliation(s)
- Elham Rahmati
- Department of Medicine, Division of Infectious Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Adrian J Correa
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Rosemary C She
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Girod BJ, Guja KE, Davidzon G, Chan F, Zucker E, Franc BL, Moradi F, Iagaru A, Aparici CM. Fungal endocarditis resembling primary cardiac malignancy in a patient with B-cell ALL with culture confirmation. Radiol Case Rep 2019; 15:117-119. [PMID: 31768196 PMCID: PMC6872837 DOI: 10.1016/j.radcr.2019.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 11/27/2022] Open
Abstract
Fungal endocarditis is a rare subtype of infective endocarditis that often presents with nonspecific symptoms in patients with complex medical histories, making diagnosis challenging. Patients with a history of ALL may present with congestive heart failure, chemo-induced cardiomyopathy, acute coronary syndrome, cardiac lymphomatous metastasis, or infections. We present the case of a patient with a history of ALL who presented with acute coronary syndrome and imaging concerning for primary cardiac lymphoma, when in fact the patient ended up suffering from culture proven fungal endocarditis.
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Affiliation(s)
- Brad J Girod
- School of Medicine, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Kip E Guja
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Guido Davidzon
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Francis Chan
- Division of Cardiovascular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Evan Zucker
- Division of Cardiovascular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Benjamin L Franc
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Farshad Moradi
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Carina Mari Aparici
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
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Adigun RO, Baddour LM, Geske JB. A case report of Histoplasma capsulatum prosthetic valve endocarditis: an extremely rare presentation with characteristic findings. Eur Heart J Case Rep 2019; 3:ytz127. [PMID: 31660498 PMCID: PMC6764570 DOI: 10.1093/ehjcr/ytz127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/30/2018] [Accepted: 08/05/2019] [Indexed: 11/12/2022]
Abstract
Background Histoplasma capsulatum is an extremely rare cause of prosthetic valve endocarditis (PVE) and can present with non-specific symptoms leading to a delay in diagnosis with unfavourable outcomes. Case summary A 65-year-old male patient with a history of a bioprosthetic aortic valve replacement and non-obstructive coronary artery disease was admitted for altered mentation, failure to thrive, and a 20-pound unintentional weight loss over the past 4 months. Upon examination, he was lethargic but afebrile and haemodynamically stable. A late peaking ejection murmur was heard on exam. Skin exam was significant for embolic phenomenon involving the extremities. Inflammatory markers and serum calcium were elevated. A bedside echocardiogram showed severe obstruction across the aortic valve prosthesis. Two years prior, he had an echocardiogram with a normal functioning prosthesis. Routine blood cultures were negative and serologic screening was unrevealing. Urine Histoplasma antigen screen was positive on hospital day 3 and on hospital day 10, fungal blood cultures were positive for H. capsulatum. Unfortunately, the patient died shortly afterwards as a result of multiorgan failure from embolic manifestations of the infection. Discussion Based on our patient's findings and those of previously reported cases in the literature, H. capsulatum PVE should be strongly considered in patients from endemic areas with non-specific symptoms and negative routine blood cultures.
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Affiliation(s)
- Rosalyn O Adigun
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Larry M Baddour
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.,Division of Infectious Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Jeffrey B Geske
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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Nakajima T, Oba Y, Takashima J, Ueno K, Kikuchi A, Yamada T, Fukunami M. Cryptococcus endocarditis: A case report and review of the literature. J Infect Chemother 2019; 25:901-905. [PMID: 31182330 DOI: 10.1016/j.jiac.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/23/2019] [Accepted: 05/07/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Cryptococcus neoformans is known to be a cause of meningitis. However, as cryptococcal endocarditis is rare, it is not well understood. Here, we describe a case with Implantable Cardioverter Defibrillator associated endocarditis and meningitis caused by Cryptococcus neoformans and we review the literature associated cryptococcal endocarditis. CASE PRESENTATION A 72 years old Japanese male presented in emergency department with non-productive cough and respiratory discomfort. His past medical history was ischemic heart disease four years ago and ICD was implanted. Physical examination was unremarkable. Chest computer tomography revealed ground glass opacity in the right lung. He received a diagnosis of amiodarone-induced interstitial pneumonitis and high dose steroid pulse therapy. Septic shock and acute respiratory failure occurred after steroid therapy. Cryptococcus neoformans was identified by blood culture and cerebral spinal fluid. Intravenous liposomal Amphotericin B and oral flucytosine were initiated. Transesophageal echocardiography revealed vegetation on the lead of the ICD. Diagnosis of cryptococcal endocarditis was made. The patient died despite antifungal therapy was continued. DISCUSSION We analyzed our case and 8 cases of cryptococcal endocarditis in the literature for 40 years. Almost all of the patients had previous valve replacement surgery or immunocompromised state. Three cases had meningitis. Surgery performed in 3 cases. The overall mortality rate were 44.4%. CONCLUSIONS Cryptococcal endocarditis is rare and carries a high mortality. Almost all of the patients had underlying diseases. Diagnosis needs repeating blood culture and echocardiogram, sometimes. Cryptococcal endocarditis needs lumber puncture for rule out meningitis.
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Affiliation(s)
- Takahiro Nakajima
- Division of General Internal Medicine, Akashi Medical Center, 743-33, Okubocho-Yagi, Akashi City, Hyogo, 674-0063, Japan.
| | - Yuichirou Oba
- Department of General Internal Medicine, Osaka General Medical Center, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Junpei Takashima
- Department of Respiratory Medicine, Sakai City Medical Center, 1-1-1, Eharaji, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Kiyonobu Ueno
- Department of Respiratory Medicine, Osaka General Medical Center 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Atsushi Kikuchi
- Department of Cardiology, Osaka General Medical Center, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Takahisa Yamada
- Department of Cardiology, Osaka General Medical Center, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Masatake Fukunami
- Department of Cardiology, Osaka General Medical Center, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
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14
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Morioka H, Tokuda Y, Oshima H, Iguchi M, Tomita Y, Usui A, Yagi T. Fungal endocarditis after transcatheter aortic valve replacement (TAVR): Case report and review of literature. J Infect Chemother 2019; 25:215-7. [PMID: 30243901 DOI: 10.1016/j.jiac.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/15/2018] [Accepted: 08/25/2018] [Indexed: 01/05/2023]
Abstract
The reported number of transcatheter aortic valve replacement-associated infective endocarditis (TAVR-IE) cases has been increasing worldwide, but information about the incidence and clinical features of fungal TAVR-IE is quite limited. We present a patient who acquired TAVR-IE caused by Candida parapsilosis four month after TAVR, who was successfully treated redo-aortic valve replacement and prolonged antifungal therapy.
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15
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Seki A, Yoshida A, Matsuda Y, Kawata M, Nishimura T, Tanaka J, Misawa Y, Nakano Y, Asami R, Chida K, Kikuchi K, Arai T. Fatal fungal endocarditis by Aspergillus udagawae: an emerging cause of invasive aspergillosis. Cardiovasc Pathol 2017; 28:14-17. [PMID: 28259839 DOI: 10.1016/j.carpath.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/30/2017] [Accepted: 02/03/2017] [Indexed: 11/26/2022] Open
Abstract
Aspergillus udagawae has morphological similarities to Aspergillusfumigatus; however, it shows a low susceptibility to common antifungal drugs and poor in vitro sporulation. We present the first reported case of infectious endocarditis caused by A. udagawae. An awareness of this newly described Aspergillus species is vital for further clarification.
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Affiliation(s)
- Atsuko Seki
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.
| | - Atsushi Yoshida
- Department of Infectious Diseases, Tokyo Women's Medical Hospital, Tokyo, Japan
| | - Yoko Matsuda
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Mitsuhiro Kawata
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Takashi Nishimura
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Jun Tanaka
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | | | - Yuta Nakano
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Ryoko Asami
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Koji Chida
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Ken Kikuchi
- Department of Infectious Diseases, Tokyo Women's Medical Hospital, Tokyo, Japan
| | - Tomio Arai
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
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16
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Waheed S, Baig MA, Khan MW, Sheikh FA, Khan NU. Fungal endocarditis presenting with right lumbar pain and femoral artery ischemia - An unusual case report. Turk J Emerg Med 2016; 16:173-5. [PMID: 27995211 DOI: 10.1016/j.tjem.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/30/2016] [Indexed: 11/20/2022] Open
Abstract
Fungal endocarditis is a rare entity which has a poor outcome. Our case reports an atypical presentation of similar pathology now presenting with femoral artery ischemia in an immune competent individual. A 62-year Asian male presented with sudden onset of right sided lumbar pain. Initial clinical exam was consistent with right sided renal colic. Intravenous analgesia did not relieve the pain. Repeat clinical examination revealed absent right femoral artery pulsation. The patient underwent a Computerized tomography angiography of right lower extremity. Echocardiogram revealed valvular vegetations that were later revealed to be because of Aspergillus Terreus. This case highlights the atypical presentation of a rare fungal endocarditis in an immune competent individual presenting with right sided lumbar pain. This case is of particular interest for emergency physicians who are at the forefront and may require to deal with such presentations.
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17
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Brandão M, Almeida J, Ferraz R, Santos L, Pinho P, Casanova J. Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report. Rev Port Cardiol 2016; 35:495.e1-4. [PMID: 27493128 DOI: 10.1016/j.repc.2015.11.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022] Open
Abstract
Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality despite treatment. Candida albicans is the most common etiological agent for this rare but increasingly frequent condition. We present a case of fungal prosthetic valve endocarditis due to C. albicans following aortic and pulmonary valve replacement in a 38-year-old woman with a history of surgically corrected tetralogy of Fallot, prior infective endocarditis and acute renal failure with need for catheter-based hemodialysis. Antifungal therapy with liposomal amphotericin B was initiated prior to cardiac surgery, in which the bioprostheses were replaced by homografts, providing greater resistance to recurrent infection. During hospitalization, a mycotic aneurysm was diagnosed following an episode of acute arterial ischemia, requiring two vascular surgical interventions. Despite the complications, the patient's outcome was good and she was discharged on suppressive antifungal therapy with oral fluconazole for at least a year. The reported case illustrates multiple risk factors for fungal endocarditis, as well as complications and predictors of poor prognosis, demonstrating its complexity.
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Affiliation(s)
- Mariana Brandão
- Escola de Ciências da Saúde, Universidade do Minho, Braga, Portugal.
| | - Jorge Almeida
- Centro de Cirurgia Cardiotorácica, Hospital de São João, Porto, Portugal
| | - Rita Ferraz
- Serviço de Doenças Infecciosas, Hospital de São João, Porto, Portugal
| | - Lurdes Santos
- Serviço de Doenças Infecciosas, Hospital de São João, Porto, Portugal
| | - Paulo Pinho
- Centro de Cirurgia Cardiotorácica, Hospital de São João, Porto, Portugal
| | - Jorge Casanova
- Centro de Cirurgia Cardiotorácica, Hospital de São João, Porto, Portugal
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18
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Bouabdallaoui N, Demondion P, Lebreton G, Leprince P. Fungal native pulmonary valve endocarditis: facing both medical and surgical challenges. Eur J Cardiothorac Surg 2016; 51:184-185. [PMID: 27354256 DOI: 10.1093/ejcts/ezw219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/19/2016] [Accepted: 05/25/2016] [Indexed: 11/14/2022] Open
Abstract
Fungal isolated native pulmonary valve endocarditis is extremely uncommon. Data are scarce and report high mortality and recurrence rates. Recommended management combines both medical and surgical approaches. We report herein a rare case of isolated pulmonary valve endocarditis caused by Candida albicans The patient did not display prior heart disease. Medical management was unsuccessful. Pulmonary valve replacement allowed rapid improvement.
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Affiliation(s)
- Nadia Bouabdallaoui
- Department of Thoracic and Cardiovascular Surgery, Pierre et Marie Curie University, Paris VI, Assistance Publique des Hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France
| | - Pierre Demondion
- Department of Thoracic and Cardiovascular Surgery, Pierre et Marie Curie University, Paris VI, Assistance Publique des Hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France
| | - Guillaume Lebreton
- Department of Thoracic and Cardiovascular Surgery, Pierre et Marie Curie University, Paris VI, Assistance Publique des Hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery, Pierre et Marie Curie University, Paris VI, Assistance Publique des Hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France
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19
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Tsugu T, Murata M, Iwanaga S, Kitamura Y, Inoue S, Fukuda K. A rare case of fungal endocarditis caused by Candida glabrata after completion of antibiotic therapy for Streptococcus endocarditis. J Med Ultrason (2001) 2015; 42:243-6. [PMID: 26576579 DOI: 10.1007/s10396-014-0580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 09/09/2014] [Indexed: 11/26/2022]
Abstract
We present the rare case of a 76-year-old female with infective endocarditis (IE) caused by Candida glabrata. Immediately before developing the present infection, she developed IE with vegetation on the mitral annular calcification, which was caused by Streptococcus mitis and successfully treated with penicillin-G and gentamicin. However, her fever recurred, and she developed disseminated intravascular coagulation. Blood culture revealed C. glabrata, and echocardiography revealed new vegetation on the mitral valve. After 4 weeks of treatment with micafungin, prosthetic valve replacement was performed, followed by additional administration of micafungin for 4 weeks (total of 8 weeks). No relapse at 9 months after surgery has been observed. C. glabrata endocarditis is extremely rare and difficult to manage. Our case and review of past reported cases suggest that early diagnosis and initiation of treatment contribute to good prognosis of C. glabrata endocarditis.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
- Department of Cardiology, Hino Municipal Hospital, 4-3-1, Tamadaira, Hino, Tokyo, 191-0062, Japan.
| | - Mitsushige Murata
- Department of Laboratory Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Shiro Iwanaga
- Department of Cardiology, Saitama International Medical Center, Saitama, Japan
| | - Yohei Kitamura
- Department of Neurosurgery, Hino Municipal Hospital, Tokyo, Japan
| | - Soushin Inoue
- Department of Cardiology, Hino Municipal Hospital, 4-3-1, Tamadaira, Hino, Tokyo, 191-0062, Japan
| | - Keiichi Fukuda
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
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20
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Clement ME, Maziarz EK, Schroder JN, Patel CB, Perfect JR. Scedosporium apiosermum infection of the "Native" valve: Fungal endocarditis in an orthotopic heart transplant recipient. Med Mycol Case Rep 2015; 9:34-6. [PMID: 26288748 PMCID: PMC4534754 DOI: 10.1016/j.mmcr.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/17/2022] Open
Abstract
Scedosporium apiospermum is an increasingly appreciated pathogen in immunosuppressed patients. We present a case of S. apiospermum endocarditis in a 70-year-old male who had undergone orthotopic heart transplant. Echocardiogram demonstrated a 1.4 cm tricuspid valve vegetation. He underwent valve replacement, complicated by fatal massive post-operative haemorrhage. Valve cultures grew S. apiospermum. To our knowledge, our case is the first reported instance of endocarditis caused by S. apiospermum in a recipient of a cardiac transplant.
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Affiliation(s)
- Meredith E Clement
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC USA
| | - Eileen K Maziarz
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC USA
| | - Jacob N Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Chetan B Patel
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - John R Perfect
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC USA
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21
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Minhas HS, Jain G, Mangukia C, Goyal M. Pulmonary endarterectomy for saddling pulmonary embolism by Aspergillus fungus in an immunocompetent patient. Indian Heart J 2014; 66:539-42. [PMID: 25443609 DOI: 10.1016/j.ihj.2014.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 05/28/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022] Open
Abstract
We present a case of tricuspid valve Aspergillus endocarditis with saddle shaped massive pulmonary embolism occurring in an immunocompetent host. The patient was managed uniquely by pulmonary endarterectomy (PEA) and combination antifungal chemotherapy with Liposomal amphotericin-B + caspofungin.
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Affiliation(s)
- Harpreet Singh Minhas
- Professor, Department of Cardio-thoracic Surgery, G B Pant Hospital, New Delhi 110002, India
| | - Gagan Jain
- Ex-Assistant Professor, Department of Cardiology, G B Pant Hospital, New Delhi 110002, India.
| | - Chirantan Mangukia
- Senior Resident, Department of Cardio-thoracic Surgery, G B Pant Hospital, New Delhi 110002, India
| | - Mayank Goyal
- Senior Resident, Department of Cardiology, G B Pant Hospital, New Delhi 110002, India
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22
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El Alami S, Handor N, Moutaki Allah Y, Bouchrik M, El Mellouki W, Boulahya A, Lmimouni B. [Candida albicans endocarditis after treatment of complete atrioventricular canal]. J Mycol Med 2013; 23:185-8. [PMID: 23896621 DOI: 10.1016/j.mycmed.2013.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
Abstract
Infective endocarditis is rare in children, it is rarer after a surgical treatment of atrioventricular canal, and it is exceptional that Candida albicans is the etiologic agent. This is a serious infection found in congenital heart disease with or without surgery. It is potentially lethal, despite diagnostic and therapeutic advances. We report a case of infective endocarditis due to C. albicans after the treatment of a congenital systemic atrioventricular canal in a child with trisomy 21. The diagnosis was suspected on clinical manifestations and cardiac auscultation. Confirmation was provided by positive blood cultures and echocardiography. The large size of the vegetation in the patient was in favor of a fungal etiology, blood cultures allowed to identify the fungus. This observation illustrates a poorly understood disease, with very poor prognosis and which is a potential complication of heart surgery. The improved prognosis should be achieved by shortening the time to diagnosis and optimizing the therapeutic support.
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Affiliation(s)
- S El Alami
- Service de parasitologie mycologie, hôpital militaire d'instruction Mohammed V, Rabat, Morocco
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23
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Azhar A. Successful management of fungal pericarditis and endocarditis in a neonate: A case report. J Saudi Heart Assoc 2012; 24:195-9. [PMID: 23960695 DOI: 10.1016/j.jsha.2012.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 02/29/2012] [Accepted: 03/26/2012] [Indexed: 11/30/2022] Open
Abstract
Neonatal fungal endocarditis is a rare but serious infection, which does not have a well-accepted management method. This is the second report of this condition in Saudi Arabia. A preterm, very low birth weight, female neonate presented with fever and shortness of breath. An echocardiogram showed moderate pericardial effusion and two masses in the heart, one in the right ventricle and the other in the inferior portion of the posterior mitral valve of the left ventricle. Blood and pericardial fluid cultures revealed an infection with Candida albicans. The patient received a 60 days course of intravenous fluconazole and amphotericin B lipid complex. At the conclusion of treatment, she was discharged in good condition with no echocardiographic evidence of pericardial effusion or fungal vegetations. Thus, a successful outcome to a serious case of fungal endocarditis was achieved through aggressive antifungal therapy with intravenous fluconazole and amphotericin B lipid complex.
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Affiliation(s)
- Ahmad Azhar
- Division of Pediatric Cardiology, Department of Pediatrics, King Abdulaziz University, Jeddah
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