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Caulier T, Senneville E, Sobocinski J, Leroy O, Patoz P, Blondiaux N, Georges H, Pierre-Yves D, d'Elia P, Robineau O. Burden of Candida-related vascular graft infection: a nested-case control study. Infection 2024; 52:1153-1158. [PMID: 38329687 DOI: 10.1007/s15010-023-02172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE We aimed to assess risk factors of candida-related Vascular Graft Infections (VGIs). METHODS We did a case-control study (1:4) matched by age and year of infection, nested in a cohort of patient with a history of VGIs. Cases were defined by a positive culture for Candida spp. in biological samples and controls were defined by a positive culture for bacterial strains only in biological samples. Risk factors for Candida-related VGIs were investigated using multivariate logistic regression. Mortality were compared using survival analysis. RESULTS 16 Candida-related VGIs were matched to 64 bacterial-related VGIs. The two groups were comparable regarding medical history and clinical presentation. Candida-related VGIs were associated with bacterial strains in 88% (14/16). Gas/fluid-containing collection on abdominal CT scan and the presence of an aortic endoprosthesis were risk factors for Candida spp.-related VGIs [RRa 10.43 [1.81-60.21] p = 0.009 RRa and 6.46 [1.17-35.73] p = 0.03, respectively]. Candida-related VGIs were associated with a higher mortality when compared to bacterial-related VGIs (p = 0.002). CONCLUSIONS Candida-related VGIs are severe. Early markers of Candida spp. infection are needed to improve their outcome. The suspicion of aortic endoprosthesis infection may necessitate probabilistic treatment with antifungal agents.
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Affiliation(s)
| | - Eric Senneville
- Service Universitaire Des Maladies Infectieuses Et du Voyageur, Centre Hospitalier Gustave Dron, 59210, Tourcoing, France
- University of Lille, CHU Lille, ULR 2694, METRICS, Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | | | | | | | - Nicolas Blondiaux
- Service de Biologie, CH de Tourcoing, France
- University of Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019, UMR9017 Center for Infection and Immunity of Lille, Lille, France
| | | | | | | | - Olivier Robineau
- Service Universitaire Des Maladies Infectieuses Et du Voyageur, Centre Hospitalier Gustave Dron, 59210, Tourcoing, France.
- University of Lille, CHU Lille, ULR 2694, METRICS, Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France.
- INSERM u1136, Institut Pierre Louis de Santé Publique, Paris, France.
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2
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Combs T, Stoner BJ, McCoy P, Reda H, Sekela M, El-Dalati S. Invasive Candida Infection in Patients With Bacterial Infective Endocarditis. Open Forum Infect Dis 2024; 11:ofae179. [PMID: 38595952 PMCID: PMC11002945 DOI: 10.1093/ofid/ofae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
Over 21 months, 12 patients with invasive Candida infections detected during the course of treatment of bacterial endocarditis, including 11 with candidemia, were identified. Invasive Candida infections can occur as a complication of bacterial endocarditis and may occur more frequently in patients with injection drug use and broad-spectrum antibiotic exposure.
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Affiliation(s)
- Travis Combs
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Bobbi Jo Stoner
- Department of Pharmacy, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Parker McCoy
- Department of Pharmacy, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Hassan Reda
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Michael Sekela
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Sami El-Dalati
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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3
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Manes MT, Ritacco AR, Cassano S, Ferrò MT, Manduca B, Spaccarotella C, Musacchio D. The Heart Team during the Pandemic: A Case Report of Bio-Prosthesis Degeneration Treated with Valve in Valve Implantation. J Cardiovasc Echogr 2024; 34:77-81. [PMID: 39086702 PMCID: PMC11288296 DOI: 10.4103/jcecho.jcecho_12_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 08/02/2024] Open
Abstract
The pandemic changed the type of patients. The concept of "patient at the center" became concrete. The execution of simple consultancy was overcome to create effective collaboration and fruitful exchanges between specialists. The "Heart Team" model is on increasing affirmation. The TEAM-BASED approach in the cardiology field is successfully used in patients suffering from ischemic heart disease and valvulopathies for the choice of possible treatments. Degenerative type Sao is the most frequent valvulopathy among the valvulopathies in Western countries and its incidence is correlated with age. In high-risk patients, percutaneous valve replacement (transcatheter aortic valve implantation) is the most valid therapeutic option. The implantation of biological prostheses raises the problem of both degeneration and dysfunction of the prosthesis itself over time in subjects of advanced age and with comorbidities. In this scenario, valve-in-valve (VinV) is a valid therapeutic alternative in high-risk patients. A clinical case of aortic prosthetic degeneration, as an outcome of endocarditis, treated with VinV is presented. The therapeutic decision was made by an "Electronic Heart Team" which represents a further evolution of the treatment pathways and reduces the distance between the specialists in "Hub" Centers and the "Spoke" center.
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Affiliation(s)
| | | | - Susanna Cassano
- Department of Cardiology, Paola-Cetraro Hospital, Paola CS, Italy
| | | | - Bruno Manduca
- Department of Cardiology, Paola-Cetraro Hospital, Paola CS, Italy
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4
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Calderón-Parra J, Domínguez F, González-Rico C, Arnaiz de las Revillas F, Goenaga MÁ, Alvarez I, Muñoz P, Alonso D, Rodríguez-García R, Miró JM, De Alarcón A, Antorrena I, Goikoetxea-Agirre J, Moral-Escudero E, Ojeda-Burgos G, Ramos-Martínez A. Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort. Open Forum Infect Dis 2024; 11:ofae121. [PMID: 38500574 PMCID: PMC10946656 DOI: 10.1093/ofid/ofae121] [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: 07/14/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
Background Several aspects of the occurrence and management of mycotic aneurysm (MA) in patients with infective endocarditis (IE) have not been studied. Objectives To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA. Methods Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020. Results Of 4548 IE cases, 85 (1.9%) developed MA. Forty-six (54.1%) had intracranial MA and 39 (45.9%) extracranial MA. Rupture of MA occurred in 39 patients (45.9%). Patients with ruptured MA had higher 1-year mortality (hazard ratio, 2.33; 95% confidence interval, 1.49-3.67). Of the 55 patients with initially unruptured MA, 9 (16.4%) presented rupture after a median of 3 days (interquartile range, 1-7) after diagnosis, being more frequent in intracranial MA (32% vs 3.3%, P = .004). Of patients with initially unruptured MA, there was a trend toward better outcomes among those who received early specific intervention, including lower follow-up rupture (7.1% vs 25.0%, P = .170), higher rate of aneurysm resolution in control imaging (66.7% vs 31.3%, P = .087), lower MA-related mortality (7.1% vs 16.7%, P = .232), and lower MA-related sequalae (0% vs 27.8%, P = .045). Conclusions MA occurred in 2% of the patients with IE. Half of the Mas occurred in an intracranial location. Their rupture is frequent and associated with poor prognosis. A significant proportion of initially unruptured aneurysms result from rupture during the first several days, being more common in intracranial aneurysms. Early specific treatment could potentially lead to better outcomes.
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Affiliation(s)
- Jorge Calderón-Parra
- Infectious Diseases Unit, Department of Internal Medicine, Puerta de Hierro University Hospital, Majadahonda, Spain
- Research Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), Majadahonda, Spain
| | - Fernando Domínguez
- Research Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), Majadahonda, Spain
- Department of Cardiology, Puerta de Hierro University Hospital, Majadahonda, Spain
| | - Claudia González-Rico
- Department of Infectious Diseases, University Hospital Marqués de Valdecilla, CIBER Infectious Diseases (CIBERINFEC, CB21/13/00068). Cantabria University, Santander, Spain
| | - Francisco Arnaiz de las Revillas
- Department of Infectious Diseases, University Hospital Marqués de Valdecilla, CIBER Infectious Diseases (CIBERINFEC, CB21/13/00068). Cantabria University, Santander, Spain
| | | | - I Alvarez
- Department of Infectious Diseases, OSI Donostialdea, San Sebastian, Spain
| | - Patricia Muñoz
- Department of Microbiology and Infectious Diseases, University Hospital Gregorio Marañón, CIBER Respiratory Diseases (CIBERES, CB06/06/0058), Complutense University, Madrid, Spain
| | - David Alonso
- Department of Microbiology and Infectious Diseases, University Hospital Gregorio Marañón, CIBER Respiratory Diseases (CIBERES, CB06/06/0058), Complutense University, Madrid, Spain
| | | | - José María Miró
- Department of Infectious Diseases, Clinic Hospital—IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Arístides De Alarcón
- Infectious Diseases, Microbiology, and Parasitology Unit, University Hospital Virgen del Rocio, Seville University, Seville, Spain
| | - Isabel Antorrena
- Cardiology Department, University Hospital La Paz- IDIPAZ, Madrid, Spain
| | | | | | | | - Antonio Ramos-Martínez
- Infectious Diseases Unit, Department of Internal Medicine, Puerta de Hierro University Hospital, Majadahonda, Spain
- Research Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), Majadahonda, Spain
- Faculty of Medicine, Autónoma University of Madrid, Madrid, Spain
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5
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Al-Hashimi I, Qazi M, Hickerson S, Okon E. Late Recurrence of Prosthetic Valve Endocarditis Due to Candida albicans. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942399. [PMID: 38297824 PMCID: PMC10846750 DOI: 10.12659/ajcr.942399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/23/2023] [Accepted: 12/14/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Candida prosthetic valve endocarditis is a rare disease that is increasing in incidence with the rising rates of fungemia and increased use of intracardiac devices. Chronic antifungal prophylaxis is used after primary treatment to prevent recurrence, but the optimal duration of prophylaxis is currently unknown. This case report is of a woman with a history of mitral valve replacement due to Candida endocarditis presenting 2 years later with prosthetic valve and native aortic valve Candida albicans endocarditis. CASE REPORT A 32-year-old woman with a history of intravenous drug abuse, Staphylococcus and Candida endocarditis, and 2 mitral valve replacements 2 years ago on long-term oral fluconazole presented with fevers, weight loss, and dyspnea. She had stopped taking her oral antifungals prior to presentation. She was found to have vegetations on her prosthetic mitral valve and on her native aortic valve. She was started on ceftriaxone, vancomycin, and micafungin, and blood cultures grew C. albicans. She also developed a C. albicans metatarsal abscess and a splenic infarct. She underwent redo mitral valve replacement and aortic valve debridement successfully and was continued on intravenous micafungin for 8 weeks. CONCLUSIONS This case highlights the association between prosthetic valve endocarditis, intravenous drug abuse, and opportunistic fungal infections. Lifelong oral fluconazole can be considered for all patients with C. albicans prosthetic valve endocarditis, especially in the setting of the presence of other risk factors, such as intravenous drug abuse, as demonstrated in our case. Further studies are needed to determine differences in outcomes.
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Affiliation(s)
- Ibrahim Al-Hashimi
- Office of Graduate Medical Education, University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - Mariam Qazi
- Department of Medicine, University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - Steven Hickerson
- Department of Infectious Diseases, UT Health East Texas, Tyler, TX, USA
| | - Emmanuel Okon
- Department of Infectious Diseases, Christus Trinity Clinic, Tyler, TX, USA
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6
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Fuller R, Jacobs SE. Candida Infectious Endocarditis and Implantable Cardiac Device Infections. Mycopathologia 2023; 188:893-905. [PMID: 37277679 DOI: 10.1007/s11046-023-00745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023]
Abstract
Intravascular diseases due to Candida species, including endocarditis and cardiac device-associated infections, are rare yet devastating manifestations of invasive candidiasis affecting an already vulnerable population. Despite their significant associated morbidity and mortality, limited prospective data exist to inform the optimal diagnostic and therapeutic approaches to these entities. Herein, we review the existing literature pertaining to the epidemiology, diagnosis, and management of infectious endocarditis, rhythm management device infections, and circulatory support device infections caused by Candida species and suggest areas for future research.
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Affiliation(s)
- Risa Fuller
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Samantha E Jacobs
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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7
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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] [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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8
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 259] [Impact Index Per Article: 259.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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9
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Weber C, Hohmann C, Lindner O, Wahlers T, Jung N. Patients with Artificial Heart Valves. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:692-702. [PMID: 37427994 PMCID: PMC10666258 DOI: 10.3238/arztebl.m2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND In Germany, a total of 38 547 heart valve procedures were performed in 2022. With a growing number of patients undergoing the surgical and interventional implantation of heart valves, the incidence of prosthetic endocarditis is also rising. METHODS We summarize the current state of the prophylaxis, diagnosis, and treatment of prosthetic endocarditis in a selective review of the literature. RESULTS Prosthetic endocarditis accounts for 10-30% of all cases of endocarditis. As its echocardiographic and microbiologic findings are often less specific than those of native endocarditis, its diagnosis now increasingly relies on alternative imaging modalities such as F-18-FDG PET-CT. Anti-infective and surgical treatment are made more difficult by biofilm formation on the prosthetic valve and the frequent formation of perivalvular abscesses. CONCLUSION Increased awareness of this clinical entity in the outpatient setting will promote the earlier initiation of appropriate diagnostic studies. Proper diagnostic evaluation is an essential prerequisite for the early detection and timely treatment of prosthetic endocarditis, with the goal of preventing progressive destruction and thus improving the outcome. Preventive and educative measures should be intensified, and certified, multidisciplinary endocarditis teams should be established. Antibiotic prophylaxis is now given much more restrictively than in earlier years; the risk of infection must be weighed against the potential development of both individual and collective resistance to antibiotic drugs.
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Affiliation(s)
- Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne
| | - Christopher Hohmann
- Department III for Internal Medicine – General and Interventional Cardiology, Electrophysiology, Angiology, Pneumology and Intensive Care Medicine, University Hospital Cologne
| | - Oliver Lindner
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital Ruhr-University Bochum, Bad Oeynhausen-Universität Bochum
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne
| | - Norma Jung
- Department I of Internal Medicine – Oncology, Hematology, Division of Infectious Diseases, Clinical Immunology, Hemostaseology and internal Intensive Care Medicine, University Hospital Cologne
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10
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Thompson GR, Jenks JD, Baddley JW, Lewis JS, Egger M, Schwartz IS, Boyer J, Patterson TF, Chen SCA, Pappas PG, Hoenigl M. Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev 2023; 36:e0001923. [PMID: 37439685 PMCID: PMC10512793 DOI: 10.1128/cmr.00019-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.
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Affiliation(s)
- George R. Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
| | - Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - John W. Baddley
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James S. Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Johannes Boyer
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter G. Pappas
- Department of Medicine Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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11
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El Hajj E, Glaser A, Yancey D, Byl A, Rahman M. Fungal Endocarditis: A Rare Cause of Left Ventricular Outflow Obstruction. Methodist Debakey Cardiovasc J 2023; 19:64-68. [PMID: 37636317 PMCID: PMC10453950 DOI: 10.14797/mdcvj.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/14/2023] [Indexed: 08/29/2023] Open
Abstract
A 53-year-old male presented with worsening fever, chest pain, and dyspnea during the past 2 weeks. He was hypoxic, tachycardic, and hypotensive on admission. Labs were notable for high-sensitivity troponin of 657 pg/mL and B-type natriuretic peptide of 1,648 pg/mL. Chest imaging was consistent with acute respiratory distress syndrome. Transthoracic echocardiography revealed an ejection fraction of 30% to 35% and a mobile 1.5 cm x 1.6 cm hyperechoic mass on the ventricular surface of the aortic valve (AV) with left ventricular outflow obstruction and mean pressure gradient of 38.7 mm Hg and maximum velocity of 3.64 m/s. The patient was initiated on empiric antibiotic and antifungal therapy. Cardiothoracic surgery was consulted for urgent AV repair. Blood cultures were positive for Candida metapsilosis, and intravenous fluconazole and micafungin were initiated. Despite aggressive and prompt medical management, the patient sustained cerebral embolic events in the middle cerebral artery territory and passed away.
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Affiliation(s)
- Elia El Hajj
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, US
| | - Alexander Glaser
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, US
| | - David Yancey
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, US
| | - Allen Byl
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, US
| | - Mehnaz Rahman
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, US
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12
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Mulè A, Rossini F, Sollima A, Lenzi A, Fumarola B, Amadasi S, Chiari E, Lorenzotti S, Saccani B, Van Hauwermeiren E, Lanza P, Matteelli A, Castelli F, Signorini L. Trichosporon asahii Infective Endocarditis of Prosthetic Valve: A Case Report and Literature Review. Antibiotics (Basel) 2023; 12:1181. [PMID: 37508277 PMCID: PMC10376831 DOI: 10.3390/antibiotics12071181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Trichosporon spp. endocarditis is a severe and hard-to-treat infection. Immunosuppressed subjects and carriers of prosthetic valves or intracardiac devices are at risk. This article presents the case of an immunocompetent 74-year-old man affected by endocarditis of the prosthetic aortic valve. After Bentall surgery, cultures of the removed valve demonstrated Trichosporon ashaii as the etiological agent. The patient was treated with amphotericin B at first and subsequently with fluconazole. Given the fragility of the patient and the aggressiveness of the pathogen, life-long prophylactic therapy with fluconazole was prescribed. After 5 years follow-up, no drug-related toxicities were reported and the patient never showed any signs of recurrence. The review of the literature illustrates that Trichosporon spp. endocarditis may present even many years after heart surgery, and it is often associated with massive valve vegetations, severe embolic complications, and unfavorable outcome. Due to the absence of international guidelines, there is no unanimous therapeutic approach, but amphotericin B and azoles are usually prescribed. Additionally, a prompt surgical intervention seems to be of paramount importance. When dealing with a life-threatening disease, such as mycotic endocarditis of prosthetic valves, it is essential to consider and treat even rare etiological agents such as Trichosporon spp.
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Affiliation(s)
- Alice Mulè
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Francesco Rossini
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Alessio Sollima
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Angelica Lenzi
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Benedetta Fumarola
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Silvia Amadasi
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Erika Chiari
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Silvia Lorenzotti
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Barbara Saccani
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Evelyn Van Hauwermeiren
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Paola Lanza
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Alberto Matteelli
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Francesco Castelli
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Liana Signorini
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
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13
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Soriano A, Honore PM, Puerta-Alcalde P, Garcia-Vidal C, Pagotto A, Gonçalves-Bradley DC, Verweij PE. Invasive candidiasis: current clinical challenges and unmet needs in adult populations. J Antimicrob Chemother 2023:7176280. [PMID: 37220664 DOI: 10.1093/jac/dkad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Invasive candidiasis (IC) is a serious infection caused by several Candida species, and the most common fungal disease in hospitals in high-income countries. Despite overall improvements in health systems and ICU care in the last few decades, as well as the development of different antifungals and microbiological techniques, mortality rates in IC have not substantially improved. The aim of this review is to summarize the main issues underlying the management of adults affected by IC, focusing on specific forms of the infection: IC developed by ICU patients, IC observed in haematological patients, breakthrough candidaemia, sanctuary site candidiasis, intra-abdominal infections and other challenging infections. Several key challenges need to be tackled to improve the clinical management and outcomes of IC patients. These include the lack of global epidemiological data for IC, the limitations of the diagnostic tests and risk scoring tools currently available, the absence of standardized effectiveness outcomes and long-term data for IC, the timing for the initiation of antifungal therapy and the limited recommendations on the optimal step-down therapy from echinocandins to azoles or the total duration of therapy. The availability of new compounds may overcome some of the challenges identified and increase the existing options for management of chronic Candida infections and ambulant patient treatments. However, early identification of patients that require antifungal therapy and treatment of sanctuary site infections remain a challenge and will require further innovations.
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Affiliation(s)
- Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | - Patrick M Honore
- CHU UCL Godinne Namur, UCL Louvain Medical School, Namur, Belgium
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | | | | | - Paul E Verweij
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
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Lourtet-Hascoët J, Valdeolmillos E, Houeijeh A, Bonnet E, Karsenty C, Sharma SR, Kempny A, Iung B, Gatzoulis MA, Fraisse A, Hascoët S. Infective endocarditis after transcatheter pulmonary valve implantation in patients with congenital heart disease: Distinctive features. Arch Cardiovasc Dis 2023; 116:159-166. [PMID: 36842868 DOI: 10.1016/j.acvd.2023.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
The introduction of transcatheter pulmonary valve implantation (TPVI) has greatly benefited the management of right ventricular outflow tract dysfunction. Infective endocarditis (IE) is a feared complication of TPVI that affects valve durability and patient outcomes. Current recommendations provide only limited guidance on the management of IE after TPVI (TPVI-IE). This article, by a group of experts in congenital heart disease in children and adults, interventional cardiology, infectious diseases including IE, and microbiology, provides a comprehensive review of the current evidence on TPVI-IE, including its incidence, risk factors, causative organisms, diagnosis, and treatment. The incidence of TPVI-IE varies from 13-91/1000 person-years for Melody valves to 8-17/1000 person-years for SAPIEN valves. Risk factors include history of IE, DiGeorge syndrome, immunosuppression, male sex, high residual transpulmonary gradient and portal of bacteria entry. Staphylococci and streptococci are the most common culprits, whereas Staphylococcus aureus is associated with the most severe disease. In addition to the modified Duke criteria, a high residual gradient warrants a strong suspicion. Imaging studies are helpful for the diagnosis. Intravenous antibiotics guided by blood culture results are the mainstay of treatment. Invasive re-intervention may be required. TPVI-IE in patients with congenital heart disease exhibits several distinctive features. Whether specific valve types are associated with a higher risk of TPVI-IE requires further investigation. Patient and parent education regarding IE prevention may have a role to play and should be offered to all patients.
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Affiliation(s)
- Julie Lourtet-Hascoët
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK; Clinical Microbiology Laboratory, Hôpital Saint Joseph, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Estibaliz Valdeolmillos
- Pôle des cardiopathies congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes-réseau M3C, Faculté de Médecine, Université Paris-Saclay, INSERM UMR-S999, BME Lab, 92350 Le Plessis-Robinson, France
| | - Ali Houeijeh
- Department of Congenital Heart Disease, Lille University Hospital, 59000 Lille, France
| | - Eric Bonnet
- Infectious Diseases Mobile Unit, Clinique Pasteur, 31000 Toulouse, France
| | - Clément Karsenty
- Cardiologie pédiatrie, Hôpital des enfants, Centre de Compétence Cardiopathies Congénitales Complexes-réseau M3C- CHU Toulouse, 31000 Toulouse, France
| | - Shiv-Raj Sharma
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK
| | - Aleksander Kempny
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK
| | - Bernard Iung
- Service de Cardiologie, Hôpital Bichat, AP-HP, Université Paris-Cité, 75018 Paris, France
| | - Michael A Gatzoulis
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK; National Heart and Lung Institute, Imperial College, SW3 6LY London, UK
| | - Alain Fraisse
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK
| | - Sébastien Hascoët
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK; Pôle des cardiopathies congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes-réseau M3C, Faculté de Médecine, Université Paris-Saclay, INSERM UMR-S999, BME Lab, 92350 Le Plessis-Robinson, France.
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15
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De Bels D, Maillart E, Van Bambeke F, Redant S, Honoré PM. Existing and emerging therapies for the treatment of invasive candidiasis and candidemia. Expert Opin Emerg Drugs 2022; 27:405-416. [PMID: 36317695 DOI: 10.1080/14728214.2022.2142207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Invasive candidiasis or candidemia is a severe infection affecting more than 250,000 people worldwide every year. It is present in up to 16% of ICU patients. The prognosis of these infections is unfavorable, with global death estimated around 50,000 per year, which corresponds to up to 40% depending on patient severity and comorbidities. Therapeutic failure is not rare due to the emergence of multiresistant strains and of new species poorly responsive to current therapies like Candida auris. AREAS COVERED We first review the positioning of antifungal drugs used to treat candidiasis, namely polyenes, azoles, echinocandins and pyrimidine analogues. We then discuss the progresses brought by new formulations, new derivatives within these classes, compounds acting on new targets or repurposed drugs in terms of pharmacokinetic profile, spectrum of activity, potency, safety or risk of drug-drug interactions. EXPERT OPINION While new formulations (amphotericin B cochleate) improve oral bioavailability of the corresponding drugs, new azoles or echinocandins offer higher potency including against strains resistant to former generations of drugs. Repurposed drugs show synergism with current therapies in vitro. Results from ongoing and future clinical trials will be decisive to establish the interest for these drugs in our arsenal.
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Affiliation(s)
- David De Bels
- Intensive Care Department, Brugmann University Hospital, Brussels, Belgium
| | - Evelyne Maillart
- Department of Infectious Disease, Brugmann University Hospital, Brussels, Belgium
| | - Françoise Van Bambeke
- Louvain Drug Research Institute, Department of Pharmacology, Université Catholique de Louvain, Brussels, Belgium
| | - Sebastien Redant
- Intensive Care Department, Brugmann University Hospital, Brussels, Belgium
| | - Patrick M Honoré
- Intensive Care Department, Brugmann University Hospital, Brussels, Belgium.,Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of ICU, CHU UCL Godinne-Namur, UCL Louvain Medical School
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16
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Infective Endocarditis in High-Income Countries. Metabolites 2022; 12:metabo12080682. [PMID: 35893249 PMCID: PMC9329978 DOI: 10.3390/metabo12080682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.
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17
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Evaluation for Metastatic Candida Focus and Mortality at Candida-associated Catheter-related Bloodstream Infections at the Pediatric Hematology-oncology Patients. J Pediatr Hematol Oncol 2022; 44:e643-e648. [PMID: 34486572 DOI: 10.1097/mph.0000000000002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Candidemia and Candida-associated catheter-related bloodstream infections (CRBSIs) are the significant cause of mortality and morbidity in patients with malignancy. METHODS A retrospective analysis including all pediatric hematologic/oncologic malignancies patients with CRBSIs treated in Dr. Behçet Uz Children Diseases and Surgery Training and Research Hospital between the period of 2009 and 2020. RESULTS During the study period, 53 children with CRBSIs associated with Candida species were included. The most common malignancy was acute lymphoblastic leukemia (45.3%) and acute myeloid leukemia (15.1%). A total of 56 Candida isolates were present including non-albicans Candida species (80.4%) and Candida albicans (19.6%). The most common isolated Candida species was Candida parapsilosis (42.9%) and followed by C. albicans (19.6%). The ratio of azole prophylaxis was significantly higher in patients with the non-albicans Candida group (P=0.031). Candida-related endocarditis (vegetation) was present in 2 (3.8%) patients, and the overall rate of hepatosplenic candidiasis was 3.8%. Seven days Candida attributable mortality was 7.5% (4 patients) and 30 days Candida attributable mortality was 11.3% (6 patients). The Candida species responsible for the Candida-related deaths were as following: Candida tropicalis (n=3), C. parapsilosis (n=2), and C. lusitanae (n=1). CONCLUSION In pediatric cancer patients with Candida-associated CRBSIs, evaluation of the patient for organ involvement including liver and spleen ultrasonography and cardiac involvement with echocardiography are essential regardless of the patients' clinical picture.
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18
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Zakhem AE, Istambouli R, Jabbour JF, Hindy JR, Gharamti A, Kanj SS. Diagnosis and Management of Invasive Candida Infections in Critically Ill Patients. Semin Respir Crit Care Med 2022; 43:46-59. [PMID: 35172358 DOI: 10.1055/s-0041-1741009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Invasive candidiasis (IC) has become a serious problem in the intensive care unit patients with an attributable mortality rate that can reach up to 51%. Multiple global surveillance studies have shown an increasing incidence of candidemia. Despite their limited sensitivity (21-71%), cultures remain the gold standard for the diagnosis of IC associated with candidemia. Many adjunct laboratory tests exist to support or rule out the diagnosis, each with its indications and limitations, including procalcitonin, 1,3-β-D-glucan, mannan and anti-mannan antibodies, and Candida albicans germ tube antibody. In addition, polymerase chain reaction-based methods could expedite species identification in positive blood cultures, helping in guiding early empirical antifungal therapy. The management of IC in critically ill patients can be classified into prophylactic, preemptive, empiric, and directed/targeted therapy of a documented infection. There is no consensus concerning the benefit of prophylactic therapy in critically ill patients. While early initiation of appropriate therapy in confirmed IC is an important determinant of survival, the selection of candidates and drug of choice for empirical systemic antifungal therapy is more controversial. The choice of antifungal agents is determined by many factors, including the host, the site of infection, the species of the isolated Candida, and its susceptibility profile. Echinocandins are considered initial first-line therapy agents. Due to the conflicting results of the various studies on the benefit of preemptive therapy for critically ill patients and the lack of robust evidence, the Infectious Diseases Society of America (IDSA) omitted this category from its updated guidelines and the European Society of Intensive Care Medicine (ESICM) and the Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) do not recommend it.
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Affiliation(s)
- Aline El Zakhem
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rachid Istambouli
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Jean-Francois Jabbour
- Department of Internal Medicine, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Joya-Rita Hindy
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Amal Gharamti
- Department of Internal Medicine, Yale School of Medicine, Waterbury Hospital, Waterbury, Connecticut
| | - Souha S Kanj
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
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19
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Handa K, Suhara H, Ohata T, Sakamoto T, Ito Y, Yanagino Y, Masai T. Successful surgical treatment of delayed left ventricular pseudoaneurysm related to Candida albicans infection after repair of ventricular septal rupture complicating acute myocardial infarction. J Cardiol Cases 2022; 25:87-90. [PMID: 35079305 PMCID: PMC8766318 DOI: 10.1016/j.jccase.2021.07.004] [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: 12/04/2020] [Revised: 06/13/2021] [Accepted: 07/03/2021] [Indexed: 11/08/2022] Open
Abstract
Left ventricular (LV) pseudoaneurysm is a rare complication after postinfarction repair of ventricular septal rupture (VSR), and surgical treatment of this condition due to mycosis has rarely been reported. We report a rare case of successful surgical treatment of delayed LV pseudoaneurysm related to Candida albicans infection after repair of VSR due to myocardial infarction. A 75-year-old woman was admitted for fever and severe inflammatory reaction. Two and a half years previously, she had undergone postinfarct VSR repair and was treated for mycotic infective endocarditis due to C. albicans. Transthoracic echocardiography and computed tomography revealed a LV pseudoaneurysm (maximum transverse diameter 6.2 cm). The cause of the LV pseudoaneurysm was suspected to be infectious, and broad-spectrum antibiotic treatment was started. Fourteen days after admission, she developed acute abdominal pain and an elevated β-D-glucan level because the LV pseudoaneurysm ruptured. Emergency surgical treatment was performed with antimycotic drug therapy. The LV wall defect was reconstructed using bovine pericardium under cardiopulmonary support. Her postoperative course was good, and she was discharged to home. Echocardiography revealed no recurrence of the LV pseudoaneurysm at 4 months postoperatively. During 1 year of follow-up, the patient had been doing well without any infection or adverse event. <Learning objective: The development of a left ventricular (LV) pseudoaneurysm after repair of postinfarction ventricular septal rupture (VSR) is rare, and the cause of this condition is often unknown. Moreover, LV pseudoaneurysm due to mycosis has rarely been reported and is thought to have a poor prognosis. We report a rare case of successful surgical treatment of delayed LV pseudoaneurysm related to Candida albicans infection after repair of VSR complicating acute myocardial infarction.>
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Affiliation(s)
- Kazuma Handa
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Hitoshi Suhara
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Toshihiro Ohata
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Tomohiko Sakamoto
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Yoshito Ito
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Yusuke Yanagino
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
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20
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Keighley C, Cooley L, Morris AJ, Ritchie D, Clark JE, Boan P, Worth LJ. Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings, 2021. Intern Med J 2021; 51 Suppl 7:89-117. [DOI: 10.1111/imj.15589] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Caitlin Keighley
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney Camperdown New South Wales Australia
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology Westmead New South Wales Australia
- Southern IML Pathology, Sonic Healthcare Coniston New South Wales Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases Royal Hobart Hospital Hobart Tasmania Australia
- University of Tasmania Hobart Tasmania Australia
| | - Arthur J. Morris
- LabPLUS, Clinical Microbiology Laboratory Auckland City Hospital Auckland New Zealand
| | - David Ritchie
- Department of Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Victoria Australia
| | - Julia E. Clark
- Department of Infection Management Queensland Children's Hospital, Children's Health Queensland Brisbane Queensland Australia
- Child Health Research Centre The University of Queensland Brisbane Queensland Australia
| | - Peter Boan
- PathWest Laboratory Medicine WA, Department of Microbiology Fiona Stanley Fremantle Hospitals Group Murdoch Western Australia Australia
- Department of Infectious Diseases Fiona Stanley Fremantle Hospitals Group Murdoch Western Australia Australia
| | - Leon J. Worth
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
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21
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Interplay between Candida albicans and Lactic Acid Bacteria in the Gastrointestinal Tract: Impact on Colonization Resistance, Microbial Carriage, Opportunistic Infection, and Host Immunity. Clin Microbiol Rev 2021; 34:e0032320. [PMID: 34259567 PMCID: PMC8404691 DOI: 10.1128/cmr.00323-20] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Emerging studies have highlighted the disproportionate role of Candida albicans in influencing both early community assembly of the bacterial microbiome and dysbiosis during allergic diseases and intestinal inflammation. Nonpathogenic colonization of the human gastrointestinal (GI) tract by C. albicans is common, and the role of this single fungal species in modulating bacterial community reassembly after broad-spectrum antibiotics can be readily recapitulated in mouse studies. One of the most notable features of C. albicans-associated dysbiotic states is a marked change in the levels of lactic acid bacteria (LAB). C. albicans and LAB share metabolic niches throughout the GI tract, and in vitro studies have identified various interactions between these microbes. The two predominant LAB affected are Lactobacillus species and Enterococcus species. Lactobacilli can antagonize enterococci and C. albicans, while Enterococcus faecalis and C. albicans have been reported to exhibit a mutualistic relationship. E. faecalis and C. albicans are also causative agents of a variety of life-threatening infections, are frequently isolated together from mixed-species infections, and share certain similarities in clinical presentation-most notably their emergence as opportunistic pathogens following disruption of the microbiota. In this review, we discuss and model the mechanisms used by Lactobacillus species, E. faecalis, and C. albicans to modulate each other's growth and virulence in the GI tract. With multidrug-resistant E. faecalis and C. albicans strains becoming increasingly common in hospital settings, examining the interplay between these three microbes may provide novel insights for enhancing the efficacy of existing antimicrobial therapies.
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22
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Fungal endocarditis after type a dissection, a positive outcome from Candida parapsilosis prosthetic aortic valve endocarditis and aortic graft infection: A testament to multidisciplinary practice. CLINICAL INFECTION IN PRACTICE 2021. [DOI: 10.1016/j.clinpr.2021.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Chaussade H, Cazals X, Desoubeaux G, Jouvion G, Bougnoux ME, Lefort A, Rivoisy C, Desnos-Ollivier M, Chretien F, Chouaki T, Gruson B, Bernard L, Lortholary O, Lanternier F. Central nervous system candidiasis beyond neonates: Lessons from a nationwide study. Med Mycol 2021; 59:266-277. [PMID: 32577733 DOI: 10.1093/mmy/myaa051] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
Though candidiasis is the most frequent invasive fungal infection, Candida spp. central nervous system (CNS) infections are rare but severe. To further describe clinico-patho-radiological presentations of this entity, we report a retrospective study from January 2005 to December 2018 including patients aged ≥ 28 days with proven or probable CNS candidiasis in France. Twenty-four patients were included. Seventeen patients (70%) had CNS localization secondary to disseminated candidiasis (10 with hematologic malignancies [HM]; the seven other patients had infective endocarditis [IE]). Among patients with HM, seven previously had lumbar puncture for intrathecal chemotherapy, the three others had IE. Among patients with disseminated infection, magnetic resonance imaging (MRI) evidenced meningitis (17%), micro-abscesses (58%), or vascular complications (67%). Seven patients (30%) had isolated CNS involvement related to neurosurgery (n = 2), CARD9 deficiency (n = 2), intravenous drug use, diabetes mellitus, or no identified predisposing condition (n = 1 each). All evaluated patients with isolated CNS involvement had meningitis on cerebrospinal fluid (CSF) and intracranial hypertension. For the latter patients, MRI evidenced meningitis (71%) or abscesses (57%). Among all patients, cerebrospinal fluid (CSF) culture grew Candida spp. in 31% of cases. CSF βDGlucan or mannan Ag were positive in respectively 86% and 80% of cases. Mortality attributed to CNS candidiasis was 42%: 53% in case of disseminated infection (70% for HM) and 14% in case of localized infection. CNS candidiasis are isolated or occur during disseminated infection in patients with HM and lumbar puncture for intrathecal chemotherapy or during IE. Clinical, radiological finding and outcome highly vary according to CNS localized versus disseminated candidiasis. LAY SUMMARY Candida is a yeast and is the most common cause of fungal infections worldwide. Candida central nervous system (CNS) infections are rare, severe, and poorly described. We report a retrospective study from January 2005 to December 2018 including patients aged ≥ 28 days with proven or probable CNS candidiasis in France. Twenty-four patients were included (14 men, median age 51 years). Seventeen patients had CNS localization secondary to disseminated candidiasis from blood to CNS (10 with hematologic malignancies [HM], the seven other patients had infective endocarditis [IE]). Seven patients had isolated CNS involvement related to neurosurgery (n = 2), CARD9 deficiency (n = 2), intravenous drug use (n = 1), diabetes mellitus (n = 1), or no identified risk factor (n = 1).During Candida CNS infections, brain lesions were meningitis abscesses or vascular complications. Cerebrospinal fluid (CSF) culture grew Candida spp. in 31% of cases. Forty-two percent of patients died from infection: 53% in case of disseminated infection (70% for HM) and 14% in case of localized infection.
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Affiliation(s)
- Hélène Chaussade
- Université de Paris, Service de maladies infectieuses, hôpital Universitaire Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris, IHU Imagine, Paris, France.,Service de médecine interne et maladies infectieuses, Tours, France
| | | | | | - Gregory Jouvion
- Unité histopathologie humaine et modèles animaux, Institut Pasteur, Paris, France.,Université de la Sorbonne, INSERM, Maladies génétiques d'expression pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, UF Génétique moléculaire, Paris, France
| | | | - Agnes Lefort
- Service de médecine interne, Hôpital Beaujon, Clichy, France
| | - Claire Rivoisy
- Université de Paris, Service de maladies infectieuses, hôpital Universitaire Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris, IHU Imagine, Paris, France
| | - Marie Desnos-Ollivier
- Institut Pasteur, Unité de Mycologie Moléculaire, UMR 2000, CNR des Mycoses Invasives et antifongiques, Paris, France
| | - Fabrice Chretien
- Unité histopathologie humaine et modèles animaux, Institut Pasteur, Paris, France
| | - Taieb Chouaki
- Laboratoire de mycologie et parasitologie, Amiens, France
| | | | - Louis Bernard
- Service de médecine interne et maladies infectieuses, Tours, France
| | - Olivier Lortholary
- Université de Paris, Service de maladies infectieuses, hôpital Universitaire Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris, IHU Imagine, Paris, France.,Institut Pasteur, Unité de Mycologie Moléculaire, UMR 2000, CNR des Mycoses Invasives et antifongiques, Paris, France
| | - Fanny Lanternier
- Université de Paris, Service de maladies infectieuses, hôpital Universitaire Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris, IHU Imagine, Paris, France.,Institut Pasteur, Unité de Mycologie Moléculaire, UMR 2000, CNR des Mycoses Invasives et antifongiques, Paris, France
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The New Challenge for Heart Endocarditis: From Conventional Prosthesis to New Devices and Platforms for the Treatment of Structural Heart Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7302165. [PMID: 34222484 PMCID: PMC8219429 DOI: 10.1155/2021/7302165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/02/2021] [Indexed: 01/07/2023]
Abstract
Infective endocarditis is a sinister condition with considerable morbidity and mortality. Its relevance in the current era is compounded by the increased use of implanted devices such as replacement valves or cardiac implantable electronic devices. These infections are caused by multiple different bacteria with different virulence, pathogenicity, and antimicrobial resistance. Unlike in native endocarditis, the presence of foreign tissue permits sustenance by inflammatory and thrombotic processes as the artificial surfaces promote inflammatory responses and hypercoagulability. Prevention of these infections has been suggested with the use of homografts in combination with antibiotics. Others have attempted to use "low fouling coats" with little clinical success thus far. The use of antibiotic prophylaxis plays a pivotal part in reducing the incidence of prosthesis-related endocarditis. This remains especially crucial with the increasing use of transcatheter heart valve therapies. The widespread use of cardiac implantable electronic devices such as permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices has also heralded a noticeable increase in cases of infectious endocarditis affecting complex equipment which can be difficult to treat. Multimodality strategies are needed with input from surgeons and cardiologists to ensure treatment is both prompt and successful, tailored to the individual needs of the patients.
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Talapko J, Juzbašić M, Matijević T, Pustijanac E, Bekić S, Kotris I, Škrlec I. Candida albicans-The Virulence Factors and Clinical Manifestations of Infection. J Fungi (Basel) 2021; 7:79. [PMID: 33499276 PMCID: PMC7912069 DOI: 10.3390/jof7020079] [Citation(s) in RCA: 188] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
Candida albicans is a common commensal fungus that colonizes the oropharyngeal cavity, gastrointestinal and vaginal tract, and healthy individuals' skin. In 50% of the population, C. albicans is part of the normal flora of the microbiota. The various clinical manifestations of Candida species range from localized, superficial mucocutaneous disorders to invasive diseases that involve multiple organ systems and are life-threatening. From systemic and local to hereditary and environmental, diverse factors lead to disturbances in Candida's normal homeostasis, resulting in a transition from normal flora to pathogenic and opportunistic infections. The transition in the pathophysiology of the onset and progression of infection is also influenced by Candida's virulence traits that lead to the development of candidiasis. Oral candidiasis has a wide range of clinical manifestations, divided into primary and secondary candidiasis. The main supply of C. albicans in the body is located in the gastrointestinal tract, and the development of infections occurs due to dysbiosis of the residential microbiota, immune dysfunction, and damage to the muco-intestinal barrier. The presence of C. albicans in the blood is associated with candidemia-invasive Candida infections. The commensal relationship exists as long as there is a balance between the host immune system and the virulence factors of C. albicans. This paper presents the virulence traits of Candida albicans and clinical manifestations of specific candidiasis.
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Affiliation(s)
- Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (M.J.)
| | - Martina Juzbašić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (M.J.)
| | - Tatjana Matijević
- Department of Dermatology and Venereology, Clinical Hospital Center Osijek, HR-31000 Osijek, Croatia;
| | - Emina Pustijanac
- Faculty of Natural Sciences, Juraj Dobrila University of Pula, HR-52100 Pula, Croatia;
| | - Sanja Bekić
- Family Medicine Practice, HR-31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
| | - Ivan Kotris
- Department of Internal Medicine, General County Hospital Vukovar, HR-3200 Vukovar, Croatia;
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (M.J.)
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26
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Huggins JP, Hohmann S, David MZ. Candida Infective Endocarditis: A Retrospective Study of Patient Characteristics and Risk Factors for Death in 703 United States Cases, 2015-2019. Open Forum Infect Dis 2020; 8:ofaa628. [PMID: 33614813 PMCID: PMC7881760 DOI: 10.1093/ofid/ofaa628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/16/2020] [Indexed: 12/02/2022] Open
Abstract
Background Candida endocarditis is a rare, sometimes fatal complication of candidemia. Past investigations of this condition are limited by small sample sizes. We used the Vizient clinical database to report on characteristics of patients with Candida endocarditis and to examine risk factors for in-hospital mortality. Methods This was a multicenter, retrospective cohort study of 703 inpatients admitted to 179 US hospitals between October 2015 and April 2019. We reviewed demographic, diagnostic, medication administration, and procedural data from each patient’s initial encounter. Univariate and multivariate logistic regression analyses were used to identify predictors of in-hospital mortality. Results Of 703 patients, 114 (16.2%) died during the index encounter. One hundred fifty-eight (22.5%) underwent an intervention on a cardiac valve. On multivariate analysis, acute and subacute liver failure was the strongest predictor of death (odds ratio [OR], 9.2; 95% confidence interval [CI], 4.8 –17.7). Female sex (OR, 1.9; 95% CI, 1.2–3.0), transfer from an outside medical facility (OR, 1.8; 95% CI, 1.1–2.8), aortic valve pathology (OR, 2.7; 95% CI, 1.5–4.9), hemodialysis (OR, 2.1; 95% CI, 1.1–4.0), cerebrovascular disease (OR, 2.2; 95% CI, 1.2–3.8), neutropenia (OR, 2.5; 95% CI, 1.3–4.8), and alcohol abuse (OR, 2.9; 95% CI, 1.3–6.7) were also associated with death on adjusted analysis, whereas opiate abuse was associated with a lower odds of death (OR, 0.5; 95% CI, 0.2–0.9). Conclusions We found that the inpatient mortality rate was 16.2% among patients with Candida endocarditis. Acute and subacute liver failure was associated with a high risk of death, whereas opiate abuse was associated with a lower risk of death.
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Affiliation(s)
- Jonathan P Huggins
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Samuel Hohmann
- Department of Health Systems Management, Rush University, Chicago, Illinois, USA.,Vizient, Chicago, Illinois, USA
| | - Michael Z David
- Department of Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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27
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Benedetto U, Spadaccio C, Gentile F, Moon MR, Nappi F. A narrative review of early surgery versus conventional treatment for infective endocarditis: do we have an answer? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1626. [PMID: 33437825 PMCID: PMC7791236 DOI: 10.21037/atm-20-3880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The most appropriate strategy and timing for surgery in infective endocarditis (IE) remains an argument of debate. Despite some authors promote the adoption of an early surgical approach (within 48 hours) to limit mortality and complications, no robust randomized trials are available on this argument and the evidence on this subject remain at the "expert opinion" level. Additionally, the different messages promulgated by the American and European guidelines contributed to fuel confusion regarding the relative priority of the surgical over medical therapy in IE. The European Society of Cardiology (ESC) guidelines individuates three level of urgency: emergency surgery, to be performed within 24 hours; urgent surgery, recommended within a few days; elective surgery to be performed after 1-2 weeks of antibiotic therapy. Urgent surgery is recommended for most cases of IE. In the American Heart Association (AHA)'s guidelines define early surgery as "during the initial hospitalization and before completion of a full course of antibiotics." Some of the available evidences showed that are no proven benefits in delaying surgery if a definite diagnosis of IE has been established. However, this argument is controversial across the literature and several factors including the center specific experience can play a role in decision-making. In this review the latest evidences on IE clinical and surgical characteristics along with the current studies on the adoption of an early surgical approach are analyzed to clarify whether enough evidence is available to inform an update of the guidelines.
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Affiliation(s)
- Umberto Benedetto
- Department of Cardiothoracic Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | | | - Marc R Moon
- Department of Cardiac Thoracic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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28
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Ioannou P, Volosyraki M, Mavrikaki V, Papakitsou I, Mathioudaki A, Samonis G, Kofteridis DP. Candida parapsilosis endocarditis. Report of cases and review of the literature. Germs 2020; 10:254-259. [PMID: 33134205 DOI: 10.18683/germs.2020.1214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/04/2020] [Accepted: 07/11/2020] [Indexed: 12/15/2022]
Abstract
Introduction Infective endocarditis (IE) due to Candida species is a rare disease representing about 1-2% of all IE cases and carries a high mortality rate. Given the rarity of the disease, there are no clear guidelines on the type and duration of antifungal therapy. Thus, long-term or even life-long antifungal treatment is commonly used. Case report We report two patients with prosthetic valve C. parapsilosis IE and persistent candidemia that failed conservative treatment and ultimately developed heart failure. They underwent prosthetic valve replacement and prolonged antifungal treatment with favorable outcome. Discussion Candida IE commonly occurs in the setting of underlying malignancy, chronic liver disease, previous endocarditis, previous antimicrobial exposure, previous abdominal surgery, intravenous drug use, presence of a central venous catheter, and previous cardiac surgery. Both present patients had undergone a cardiac surgery and had a prosthetic heart valve, while one patient had an underlying autoimmune disease that could be associated with higher risk of IE. In both patients transthoracic ultrasound failed to diagnose IE. In our patients, conservative treatment alone was not enough to control the infection, thus, both patients underwent valve replacement and were subsequently treated with antifungals for 6 weeks. Furthermore, both patients were put on long-term antifungal suppression treatment. Conclusions Given the absence of controlled randomized trials, the treatment of Candida endocarditis mostly relies on experts' opinion, and, thus, future studies focusing on the type and duration of antifungal treatment are required.
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Affiliation(s)
- Petros Ioannou
- MD, MSc, PhD, Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes crossroad, Heraklion, PC 71110, Crete, Greece
| | - Maria Volosyraki
- MD, Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes crossroad, Heraklion, PC 71110, Crete, Greece
| | - Vasiliki Mavrikaki
- MD, Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes crossroad, Heraklion, PC 71110, Crete, Greece
| | - Ioanna Papakitsou
- MD, Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes crossroad, Heraklion, PC 71110, Crete, Greece
| | - Anna Mathioudaki
- MD, Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes crossroad, Heraklion, PC 71110, Crete, Greece
| | - George Samonis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes crossroad, Heraklion, PC 71110, Crete, Greece
| | - Diamantis P Kofteridis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes crossroad, Heraklion, PC 71110, Crete, Greece
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Mansour J, Zulfiqar M, Umer A, Zurcher KS, Heeger A, Menias CO. Abdominal Imaging Manifestations of Recreational Drug Use. Radiographics 2020; 40:1895-1915. [PMID: 33064622 DOI: 10.1148/rg.2020200048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Recreational drug use is a burgeoning health issue worldwide, with a variety of presenting symptoms and complications. These complications can be secondary to the toxic effects of the drug itself, drug impurities, and nonsterile injection. The abdominal radiologist is likely to encounter patients who use drugs recreationally and may be responsible for recognizing and reporting these acute conditions, which in some cases can be life threatening. Because these patients often present with an altered mental state and may deny or withhold information on drug use, the underlying cause may be difficult to determine. The most commonly used drugs worldwide include cocaine, cannabinoids, opioids, and amphetamines and their derivatives. Complications of use of these drugs that can be seen at abdominopelvic CT can involve multiple organ systems, including the soft tissue and gastrointestinal, genitourinary, vascular, and musculoskeletal systems. A diverse range of abdominal complications associated with these drugs can be seen at imaging, including disseminated infections, gastrointestinal ischemia, and visceral infarction. Radiologists should be familiar with the imaging findings of these complications to accurately diagnose these entities and help guide workup and patient treatment. ©RSNA, 2020.
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Affiliation(s)
- Joseph Mansour
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Maria Zulfiqar
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Affan Umer
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Kenneth S Zurcher
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Allen Heeger
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Christine O Menias
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
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30
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Singh SP, Singh D. Infective Endocarditis: A Case Series. JOURNAL OF CARDIAC CRITICAL CARE TSS 2020. [DOI: 10.1055/s-0040-1716610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractInfective endocarditis (IE) is an infection of the endocardial surface of the heart. The incidence of IE worldwide is approximately 3 to 10 per 100,000 people annually. Twenty percent of patients die during the hospital stay, and the mortality may reach 25 to 30% six months postinfection. We hereby present our experience of six patients, of whom five survived. The cause of one death was late presentation and lack of coverage for Burkholderia in the prescribed empirical antibiotic therapy. One of our patients, with culture-negative endocarditis, responded to doxycycline and did not require any surgery. Five out of six patients who underwent surgery had vegetations more than 10 mm in size, and one patient had an aortic valve abscess (caused by Staphylococcus haemolyticus). Both prosthetic endocarditis and native valve endocarditis can be treated successfully with antimicrobial agents and surgery (when indicated). A high index of suspicion is required to diagnose IE caused by fungus and atypical bacteria.
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Affiliation(s)
- Sarvesh Pal Singh
- Department of Cardio-Thoracic and Vascular Surgery, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Dharmraj Singh
- Department of Cardio-Thoracic and Vascular Surgery, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
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31
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Wong MKH, Rocha BA, Au TWK. Intracardiac foreign body: A rare cause of recurrent fungemia. J Card Surg 2020; 35:2844-2846. [PMID: 32678970 DOI: 10.1111/jocs.14875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND An intracardiac foreign body causing recurrent fungemia is a rare clinical situation. Clinicians should be that aware of rare sources of sepsis despite a thorough history and examination. RESULTS The authors describe a 63 year-old man, with unremarkable past medical history, who presented with a fever for 2 weeks. Blood cultures persistently grew Candida albicans and Streptococcus constellatus. Echocardiogram assessment showed a suspected vegetation over the tricuspid valve. Surgical exploration with median sternotomy and cardiopulmonary bypass revealed a tooth-pick impacted within the right atrium surrounded by vegetation. The authors postulate accidental ingestion of the foreign body and translocation into the right atrium via the esophagus and thoracic cavity. CONCLUSION Surgical removal of symptomatic intracardiac foreign bodies is highly recommended.
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Affiliation(s)
- Max K H Wong
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong
| | - Barnabe A Rocha
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong
| | - Timmy W K Au
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong
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32
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Foong KS, Sung A, Burnham JP, Kronen R, Lian Q, Salazar Zetina A, Hsueh K, Lin C, Powderly WG, Spec A. Risk factors predicting Candida infective endocarditis in patients with candidemia. Med Mycol 2020; 58:593-599. [PMID: 31613365 PMCID: PMC7326586 DOI: 10.1093/mmy/myz104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/19/2019] [Accepted: 10/01/2019] [Indexed: 12/15/2022] Open
Abstract
Candida infective endocarditis (CIE) is a rare but serious complication of candidemia. Incidence and risk factors associated with CIE among candidemic patients are poorly defined from small cohorts. Identification of clinical predictors associated with this entity may guide more judicious use of cardiac imaging. We conducted a retrospective analysis of all inpatients aged ≥18 years diagnosed with candidemia at our institution. CIE was diagnosed by fulfilling two of the major Duke criteria: specifically a vegetation(s) on echocardiogram and positive blood cultures for Candida spp. We used univariable and multivariable regression analyses to identify risk factors associated with CIE. Of 1,873 patients with candidemia, 47 (2.5%) were identified to have CIE. In our multivariable logistic model, existing valvular heart disease was associated with a higher risk for CIE (adjusted odds ratio [aOR], 7.66; 95% confidence interval [CI], 2.95-19.84). Predictors that demonstrated a decreased risk of CIE included infection with C. glabrata (aOR, 0.17; 95% CI, 0.04-0.69), hematologic malignancy (aOR, 0.09; 95% CI, 0.01-0.68), and receipt of total parenteral nutrition (aOR, 0.38; 95% CI, 0.16-0.91). The 90-day crude mortality for CIE was 48.9%, similar to the overall non-CIE mortality of 41.9% (P = .338). We identified a set of clinical factors that can predict the presence of CIE among patient with candidemia. These findings may reduce the need for unnecessary expensive and invasive imaging studies in a subset of patients with a lower risk profile for endocarditis and alternative infection source.
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Affiliation(s)
- Kap Sum Foong
- Section of Infectious Diseases, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Abby Sung
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jason P Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan Kronen
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Qinghua Lian
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Ana Salazar Zetina
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Kevin Hsueh
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
| | - Charlotte Lin
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - William G Powderly
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
| | - Andrej Spec
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
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Cuervo G, Garcia-Vidal C, Puig-Asensio M, Merino P, Vena A, Martín-Peña A, Montejo JM, Ruiz A, Lázaro-Perona F, Fortún J, Fernández-Ruiz M, Suarez AI, Castro C, Cardozo C, Gudiol C, Aguado JM, Paño JR, Pemán J, Salavert M, Garnacho-Montero J, Cisneros JM, Soriano A, Muñoz P, Almirante B, Carratalà J. Usefulness of guideline recommendations for prognosis in patients with candidemia. Med Mycol 2020; 57:659-667. [PMID: 30418567 DOI: 10.1093/mmy/myy118] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/05/2018] [Accepted: 10/26/2018] [Indexed: 01/05/2023] Open
Abstract
We aimed to analyze whether the lack of inclusion of specific recommendations for the management of candidemia is an independent risk factor for early and overall mortality. Multicenter study of adult patients with candidemia in 13 hospitals. We assessed the proportion of patients on whom nine specific ESCMID and IDSA guidelines recommendations had been applied, and analyzed its impact on mortality. 455 episodes of candidemia were documented. Patients who died within the first 48 hours were excluded. Sixty-two percent of patients received an appropriate antifungal treatment. Either echinocandin or amphotericin B therapy were administered in 43% of patients presenting septic shock and in 71% of those with neutropenia. Sixty-one percent of patients with breakthrough candidemia underwent a change in antifungal drug class. Venous catheters were removed in 79% of cases. Follow-up blood cultures were performed in 72% of cases. Ophthalmoscopy and echocardiogram were performed in 48% and 50% of patients, respectively. Length of treatment was appropriate in 78% of cases. Early (2-7 days) and overall (2-30 days) mortality were 8% and 27.7%, respectively. Inclusion of less than 50% of the specific recommendations was independently associated with a higher early (HR = 7.02, 95% CI: 2.97-16.57; P < .001) and overall mortality (HR = 3.55, 95% CI: 2.24-5.64; P < .001). In conclusion, ESCMID and IDSA guideline recommendations were not performed on a significant number of patients. Lack of inclusion of these recommendations proved to be an independent risk factor for early and overall mortality.
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Affiliation(s)
- Guillermo Cuervo
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | | | - Mireia Puig-Asensio
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Antonio Vena
- Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Alba Ruiz
- Hospital Universitari i Politecnic "La Fe", Valencia, Spain
| | | | | | - Mario Fernández-Ruiz
- Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Celia Cardozo
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Carlota Gudiol
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | - José María Aguado
- Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense de Madrid, Madrid, Spain
| | | | - Javier Pemán
- Hospital Universitari i Politecnic "La Fe", Valencia, Spain
| | | | | | | | - Alex Soriano
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Benito Almirante
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Carratalà
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
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34
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Portillo-Miño JD, Cerón-Muñoz E, Toro-Zapata C, Chaucanez-Bastidas Y. Endocarditis infecciosa debida a candida lusitaniae en un lactante menor: Reporte de caso. INFECTIO 2020. [DOI: 10.22354/in.v24i4.888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introducción: La endocarditis fúngica es una enfermedad infecciosa agresiva e infrecuente, considerada una emergencia en los servicios hospitalarios. Se ha evidenciado una incidencia de 0-12% del total de las admisiones pediátricas por endocarditis infecciosa. La mortalidad por Candida spp se encuentra alrededor del 50-80% en todos los casos. La Candida lusitaniae afecta principalmente a pacientes inmunocomprometidos, con uso de dispositivos intravasculares y el empleo de antibióticos de amplio espectro. Reporte de caso: Se presenta el caso de un lactante menor quien es diagnosticado con fungemia y endocarditis infecciosa por Candida lusitaniae en válvula nativa posterior a cirugía de corrección por transposición de grandes vasos. Discusión y Conclusiones: La endocarditis infecciosa por Candida lusitaniae es una entidad poco frecuente, con una prevalencia menor al 2% constituyéndose un escenario desafiante en la práctica clínica. Se describen las características de un lactante menor quien presentó endocarditis fúngica ya definidas en la literatura mundial. Es imprescindible la detección temprana y una intervención terapéutica vertiginosa; puesto que, la persistencia del inoculo, la resistencia antimicótica y el retraso en el diagnóstico conllevan a una condición amenazante para la vida del paciente.
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Sankar NP, Thakarar K, Rokas KE. Candida Infective Endocarditis During the Infectious Diseases and Substance Use Disorder Syndemic: A Six-Year Case Series. Open Forum Infect Dis 2020; 7:ofaa142. [PMID: 32494579 PMCID: PMC7252282 DOI: 10.1093/ofid/ofaa142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/21/2020] [Indexed: 12/16/2022] Open
Abstract
Treatment for Candida infective endocarditis (IE) has not been extensively studied in the setting of rising injection drug use. There were 12 cases of Candida IE at the Maine Medical Center between 2013 and 2018. The patient characteristics, treatment regimens, and outcomes were retrospectively analyzed.
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Affiliation(s)
- N P Sankar
- University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
| | - K Thakarar
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA.,Division of Infectious Diseases, Maine Medical Center, Portland, Maine, USA
| | - Kristina E Rokas
- Department of Pharmacy Maine Medical Center, Portland, Maine, USA
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Shin SU, Yu YH, Kim SS, Oh TH, Kim SE, Kim UJ, Kang SJ, Jang HC, Park KH, Jung SI. Clinical characteristics and risk factors for complications of candidaemia in adults: Focus on endophthalmitis, endocarditis, and osteoarticular infections. Int J Infect Dis 2020; 93:126-132. [PMID: 32007642 DOI: 10.1016/j.ijid.2020.01.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study evaluated the incidence, risk factors, and clinical characteristics of complications of candidaemia in adults, with a focus on endophthalmitis, endocarditis, and osteoarticular infections. METHODS All patients ≥18 years old with candidaemia in two Korean tertiary hospitals from 2007 to 2016 were investigated. Complications of candidaemia were defined as the presence of endophthalmitis, endocarditis, or osteoarticular infections documented in patients with candidaemia. The clinical characteristics and risk factors for candidaemia with complications were analysed in the patients who underwent ophthalmological examinations. RESULTS Of 765 adult patients with candidaemia, 34 (4.4%) met the definition of complications, including endophthalmitis in 29 (3.8%), endocarditis in 4 (0.5%), and osteoarticular infections in 3 (0.4%). Of the 225 patients who underwent ophthalmological examinations, 29 (12.9%) had endophthalmitis. Candida albicans was an independent risk factor for complicated candidaemia (OR, 5.12; 95% CI, 2.17-12.09; P < 0.001). Although the mortality rate was no higher in complicated candidaemia, the duration of antifungal therapy was longer (23.1 ± 17.6 vs. 16.4 ± 10.8 days, P = 0.042), and 13 patients (39.3%) underwent additional procedures or surgery. CONCLUSIONS Complications of candidaemia occurred in 4.4% of adult patients. C. albicans was an independent risk factor for complicated candidaemia in adults. Complications of candidaemia might need prolonged treatment and additional procedures or surgery. Therefore, careful evaluation and active treatment of candidaemia with complications should be encouraged.
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Affiliation(s)
- Sung Un Shin
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Yo Han Yu
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Soo Sung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Tae Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Seong Eun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Uh Jin Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Seung-Ji Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Hee-Chang Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Kyung-Hwa Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Sook In Jung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
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Mamtani S, Aljanabi NM, Gupta Rauniyar RP, Acharya A, Malik BH. Candida Endocarditis: A Review of the Pathogenesis, Morphology, Risk Factors, and Management of an Emerging and Serious Condition. Cureus 2020; 12:e6695. [PMID: 32104631 PMCID: PMC7026878 DOI: 10.7759/cureus.6695] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Infective endocarditis is a significant healthcare burden due to the associated high mortality and complications. Endocarditis caused by both Candida albicans (C. albicans) and non-Candida albicans Candida (NCAC) species has been associated with a substantial rise in in-hospital morbidity and mortality. We used the Pubmed database to identify 47 out of 101 articles that had met our inclusion and exclusion criteria. We had put in place a broad inclusion criterion with no age or gender restrictions. These 47 articles included abstracts, 11 review articles, 13 case reports, 10 research articles, 1 clinical trial report, 1 meta-analysis, and other research articles. And they comprehensively cover the pathogenesis, risk factors, and management of infections caused by C. albicans and NCAC species in the past 26 years. The articles we scanned provided us with information on different associations in correlation to multiple types of Candida species. Here, we discuss the association between Candida and endocarditis, a major cause of morbidity and mortality in both C. albicans and NCAC. We also present our understanding regarding this interesting association and attempt to address some of the recurring questions.
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Affiliation(s)
- Sahil Mamtani
- Infectious Diseases Research, Veterans Affairs Medical Center, Lebanon, USA
| | - Nawar Muneer Aljanabi
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | - Ashu Acharya
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Bays DJ, Thompson GR. Fungal Infections of the Stem Cell Transplant Recipient and Hematologic Malignancy Patients. Infect Dis Clin North Am 2019; 33:545-566. [PMID: 31005138 DOI: 10.1016/j.idc.2019.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Despite advances in chemotherapy and supportive care, morbidity and mortality remain high for patients with hematologic malignancies (HMs). Those who require hematopoietic stem cell transplantation (HSCT) often require significant immunosuppression and are subject to a variety of complications. These patients carry multiple risk factors for infectious complications, including the development of invasive fungal infections, compared with the general population. Because antifungal prophylaxis has been widely adopted, there has been a shift away from invasive candidiasis toward invasive mold infections, including breakthrough infections. For patients with HM and HSCT, we outline the epidemiology, manifestations, diagnosis, and treatment of invasive fungal infections.
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Affiliation(s)
- Derek J Bays
- Department of Internal Medicine, University of California Davis Medical Center, 4150 V Street, Suite 3100, Sacramento, CA 95817, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, Suite G500, Sacramento, CA 96817, USA; Department of Medical Microbiology and Immunology, University of California - Davis, One Shields Avenue, Tupper Hall, Davis, CA 95616, USA.
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Cardozo C, Cuervo G, Salavert M, Merino P, Gioia F, Fernández-Ruiz M, López-Cortés LE, Escolá-Vergé L, Montejo M, Muñoz P, Aguilar-Guisado M, Puerta-Alcalde P, Tasias M, Ruiz-Gaitán A, González F, Puig-Asensio M, Vena A, Marco F, Pemán J, Fortún J, Aguado JM, Almirante B, Soriano A, Carratalá J, Garcia-Vidal C, Martínez JA, Morata L, Rodríguez-Nuñez O, Guerrero MA, Ayats J, Grau I, Calabuig E, Castro I, Cuéllar S, Martín-Dávila P, Gómez-García de la Pedrosa E, Pérez-Ayala A, Losada I, Navarro MD, Suarez AI, Martin-Gomez MT, Rodríguez-Alvarez R, López-Soira L, Bouza E, Guinea J, Martín C. An evidence-based bundle improves the quality of care and outcomes of patients with candidaemia. J Antimicrob Chemother 2019; 75:730-737. [DOI: 10.1093/jac/dkz491] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/05/2019] [Accepted: 10/25/2019] [Indexed: 12/31/2022] Open
Abstract
AbstractBackgroundCandidaemia is a leading cause of bloodstream infections in hospitalized patients all over the world. It remains associated with high mortality.ObjectivesTo assess the impact of implementing an evidence-based package of measures (bundle) on the quality of care and outcomes of candidaemia.MethodsA systematic review of the literature was performed to identify measures related to better outcomes in candidaemia. Eight quality-of-care indicators (QCIs) were identified and a set of written recommendations (early treatment, echinocandins in septic shock, source control, follow-up blood culture, ophthalmoscopy, echocardiography, de-escalation, length of treatment) was prospectively implemented. The study was performed in 11 tertiary hospitals in Spain. A quasi-experimental design before and during bundle implementation (September 2016 to February 2018) was used. For the pre-intervention period, data from the prospective national surveillance were used (May 2010 to April 2011).ResultsA total of 385 and 263 episodes were included in the pre-intervention and intervention groups, respectively. Adherence to all QCIs improved in the intervention group. The intervention group had a decrease in early (OR 0.46; 95% CI 0.23–0.89; P = 0.022) and overall (OR 0.61; 95% CI 0.4–0.94; P = 0.023) mortality after controlling for potential confounders.ConclusionsImplementing a structured, evidence-based intervention bundle significantly improved patient care and early and overall mortality in patients with candidaemia. Institutions should embrace this objective strategy and use the bundle as a means to measure high-quality medical care of patients.
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Affiliation(s)
- Celia Cardozo
- Hospital Clínic, IDIBAPS (Institut d’Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Hospital Universitari de Bellvitge, IDIBELL (Institut D’Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | | | - Paloma Merino
- Hospital Universitario Clínico ‘San Carlos’, Madrid, Spain
| | | | - Mario Fernández-Ruiz
- Hospital Universitario ‘12 de Octubre’, Instituto de Investigación Hospital ‘12 de Octubre’ (i+12), Universidad Complutense de Madrid, Madrid, Spain
| | - Luis E López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena/Instituto de Biomedicina de Sevilla (IBiS)/Universidad de Sevilla/Centro Superior de Investigaciones Científicas, Sevilla, Spain
| | - Laura Escolá-Vergé
- Hospital Universitari Vall d’Hebron, VHIR (Vall d’Hebron Institut de Recerca), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Pedro Puerta-Alcalde
- Hospital Clínic, IDIBAPS (Institut d’Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Mariona Tasias
- Hospital Universitari I Politecnic ‘La Fe’, Valencia, Spain
| | | | | | - Mireia Puig-Asensio
- Hospital Universitari Vall d’Hebron, VHIR (Vall d’Hebron Institut de Recerca), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Vena
- Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Francesc Marco
- Hospital Clínic, IDIBAPS (Institut d’Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Javier Pemán
- Hospital Universitari I Politecnic ‘La Fe’, Valencia, Spain
| | - Jesús Fortún
- Hospital Universitario ‘Ramón y Cajal’, Madrid, Spain
| | - José María Aguado
- Hospital Universitario ‘12 de Octubre’, Instituto de Investigación Hospital ‘12 de Octubre’ (i+12), Universidad Complutense de Madrid, Madrid, Spain
| | - Benito Almirante
- Hospital Universitari Vall d’Hebron, VHIR (Vall d’Hebron Institut de Recerca), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Soriano
- Hospital Clínic, IDIBAPS (Institut d’Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Jordi Carratalá
- Hospital Universitari de Bellvitge, IDIBELL (Institut D’Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Hospital Clínic, IDIBAPS (Institut d’Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
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Kowatari R, Suzuki Y, Daitoku K, Fukuda I. Cryptococcal infective endocarditis in a child with acute lymphocytic leukaemia. Interact Cardiovasc Thorac Surg 2019; 28:642-644. [PMID: 30376048 DOI: 10.1093/icvts/ivy291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/28/2018] [Accepted: 09/16/2018] [Indexed: 11/13/2022] Open
Abstract
A 4-year-old boy with acute lymphocytic leukaemia presented with left hemiplegia during chemotherapy. Computed tomography revealed cerebral infarction, and an echocardiogram showed vegetation in the right and left ventricles. Despite antifungal therapy, he experienced another stroke; and 9 days after the first stroke, he underwent total extirpation of the vegetative nodules and fragile vegetation. The postoperative course was unremarkable with no recurrence of infective endocarditis. Although a bacterial culture of the vegetation could not identify the presence of any organism, a pathological specimen examination revealed Cryptococcus with a round and mucinous capsule.
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Affiliation(s)
- Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yasuyuki Suzuki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
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Nakatani S, Ohara T, Ashihara K, Izumi C, Iwanaga S, Eishi K, Okita Y, Daimon M, Kimura T, Toyoda K, Nakase H, Nakano K, Higashi M, Mitsutake K, Murakami T, Yasukochi S, Okazaki S, Sakamoto H, Tanaka H, Nakagawa I, Nomura R, Fujiu K, Miura T, Morizane T. JCS 2017 Guideline on Prevention and Treatment of Infective Endocarditis. Circ J 2019; 83:1767-1809. [PMID: 31281136 DOI: 10.1253/circj.cj-19-0549] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, the University of Tokyo
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Kazuhiko Nakano
- Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization, Osaka National Hospital
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center
| | | | | | - Shuhei Okazaki
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Haruo Sakamoto
- Department of Oral and Maxicillofacial Surgery, Tokai University Hachioji Hospital
| | - Hiroshi Tanaka
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University
| | | | - Ryota Nomura
- Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, the University of Tokyo
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
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Candida tropicalis defibrillator endocarditis: A case report and review of current literature. Med Mycol Case Rep 2019; 25:1-9. [PMID: 31245269 PMCID: PMC6582067 DOI: 10.1016/j.mmcr.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/29/2019] [Accepted: 06/07/2019] [Indexed: 11/20/2022] Open
Abstract
We provide a review of current literature and report on a case of electronic device infective endocarditis with C. tropicalis. A 64-year-old man presented for revision of his implantable cardioverter defibrillator. Echocardiography revealed extensive vegetations attached to the Eustachian valve and in the right ventricular apex. Microbiological findings presented C. tropicalis on the explanted material. The patient refused additional surgical intervention. We successfully treated the patient with liposomal Amphotericin B and Flucytosine for 8 weeks.
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Agnelli C, Guinea J, Valerio M, Escribano P, Bouza E, Muñoz P. Infectious endocarditis caused by Candida glabrata: evidence of in vivo development of echinocandin resistance. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:395-397. [PMID: 31327188 PMCID: PMC6719648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Caroline Agnelli
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,Correspondence: Caroline Agnelli Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Calle Doctor Esquerdo 46, 28007, Madrid, Spain. Phone: +34 915868453. - Fax: +34 915044906. E-mail:
| | - Jesus Guinea
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,CIBER de Enfermedades Respiratórias (CIBERES CB06/06/0058), Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0, 28029, Madrid, Spain.,Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Plaza Ramón y Cajal, s/n. Ciudad Universitaria, 28040, Madrid, Spain
| | - Maricela Valerio
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Pilar Escribano
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Plaza Ramón y Cajal, s/n. Ciudad Universitaria, 28040, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,CIBER de Enfermedades Respiratórias (CIBERES CB06/06/0058), Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0, 28029, Madrid, Spain.,Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Plaza Ramón y Cajal, s/n. Ciudad Universitaria, 28040, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Doctor Esquerdo, 46, 28007, Madrid, Spain.,CIBER de Enfermedades Respiratórias (CIBERES CB06/06/0058), Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0, 28029, Madrid, Spain.,Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Plaza Ramón y Cajal, s/n. Ciudad Universitaria, 28040, Madrid, Spain
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Černáková L, Light C, Salehi B, Rogel-Castillo C, Victoriano M, Martorell M, Sharifi-Rad J, Martins N, Rodrigues CF. Novel Therapies for Biofilm-Based Candida spp. Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1214:93-123. [DOI: 10.1007/5584_2019_400] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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45
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Carneiro H, Rasalingam R. Fungal prosthetic aortic valve endocarditis and endarteritis: An unusual cause of aortic root vegetations. Echocardiography 2018; 36:401-405. [PMID: 30592783 DOI: 10.1111/echo.14233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/23/2018] [Accepted: 11/27/2018] [Indexed: 11/28/2022] Open
Abstract
Fungal endocarditis is a relatively rare occurrence with high morbidity and mortality. Patients may have an indolent and non-specific course requiring a high index of suspicion to make a diagnosis. Here, we present the case of a 33-year-old patient who presented with fevers and acute lower limb ischemia requiring a 4-compartment fasciotomy caused by septic emboli from Candida albicans endocarditis. The patient had a large vegetation in the ascending aorta associated with a mycotic aneurysm, which is an exceedingly rare location for a vegetation. We also review the literature and summarize the typical echocardiographic appearance and vegetation locations in fungal endocarditis.
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Affiliation(s)
- Herman Carneiro
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.,Department of Cardiology, VA Boston Healthcare System, West Roxbury, Massachusetts
| | - Ravi Rasalingam
- Department of Cardiology, VA Boston Healthcare System, West Roxbury, Massachusetts
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46
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Kara A, Devrim İ, Meşe T, Bayram N, Yılmazer M, Gülfidan G. The Frequency of Infective Endocarditis in Candida Bloodstream Infections: a Retrospective Study in a Child Hospital. Braz J Cardiovasc Surg 2018; 33:54-58. [PMID: 29617502 PMCID: PMC5873774 DOI: 10.21470/1678-9741-2017-0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/21/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Fungal endocarditis is reported less frequently than bacterial endocarditis,
with an incidence of 0-12% of the total pediatric infective
endocarditis. Objective In this study, the incidence of infective endocarditis in
Candida bloodstream infections in a tertiary hospital
during the periods of 2007 and 2016 was reviewed. Methods Patients with positive blood or catheter cultures in terms of Candida
spp. during the study period of January 2007 and January 2016
were analyzed in terms of Candida infective endocarditis.
Infective endocarditis was defined according to the modified Duke criteria.
The outcome, possible associated predisposing factors for
Candida endocarditis were determined. Results 221 patients and 256 attacks with positive blood or catheter cultures in
terms of Candida were included in the study. The most
common Candida species was Candida
parapsilosis, isolated in 157 (61.3%) attacks, followed by
Candida albicans in 70 (27.3%). Neurological diseases
(23%), hemato-oncological diseases (12.1%), previously known heart diseases
(8.2%), inborn errors of metabolism (9%) were common comorbidities. Twelve
(5.4%) patients had a previous history of cardiac surgery. Among the 221
patients, Candida endocarditis was present in only two
(0.9%) of them. Conclusion Although Candida infective endocarditis is an uncommon but
frequently fatal infection in pediatrics, echocardiography should be
performed routinely for patients with positive blood or catheter cultures in
terms of Candida. Prompt and effective antimicrobial
therapy might prevent cardiac surgery in selected cases, however this could
not be a general rule for all patients.
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Affiliation(s)
- Ahu Kara
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - İlker Devrim
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Timur Meşe
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Nuri Bayram
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Murat Yılmazer
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Gamze Gülfidan
- Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
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47
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Ahmadi NA, Davodi L. Candidemia after cardiac surgery in Tehran, Iran: A retrospective analysis of 424 cases at two medical centers. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Nayeb Ali Ahmadi
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Davodi
- Medical Diagnostic Laboratory, Lavasani hospital, Tehran, Iran
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48
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Outcomes in patients with fungal endocarditis: A multicenter observational cohort study. Int J Infect Dis 2018; 77:48-52. [DOI: 10.1016/j.ijid.2018.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 12/13/2022] Open
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49
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Massa N, Cantamessa S, Novello G, Ranzato E, Martinotti S, Pavan M, Rocchetti A, Berta G, Gamalero E, Bona E. Antifungal activity of essential oils against azole-resistant and azole-susceptible vaginal Candida glabrata strains. Can J Microbiol 2018; 64:647-663. [DOI: 10.1139/cjm-2018-0082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Candida glabrata is an opportunistic pathogen, associated with endocarditis, meningitis, and disseminated disease, and also with complicated vaginitis. Essential oils derived from aromatic plants are known in traditional medicine as antimicrobial agents and have antifungal properties. The aim of this work was to evaluate whether 12 tested essential oils (tea tree, laurel, anise, basil, bergamot, lavender, mint, oregano, grapefruit, rosemary, winter savory, and ginger) could have a transverse effect on C. glabrata sensitive strains but above all on strains resistant to the three main azole antifungals used (clotrimazole, fluconazole, itraconazole). For this reason, different strains of C. glabrata, vaginal isolated, were characterized (disk diffusion assay, minimal inhibitory concentration) with respect to their response to such antifungals. Electron microscopy analyses were performed to examine cellular damages in depth. Subsequently, we wanted to evaluate the effect of the oils on human cells to estimate their potential cytotoxicity. Oregano and winter savory were the two most effective essential oils, inducing growth inhibition, cell damage of C. glabrata strains (both sensitive and resistant to azole antifungal drugs), and medium–high level of toxicity against human keratinocytes. The results of this work support the research for new alternatives or complementary therapies against vaginal candidiasis.
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Affiliation(s)
- N. Massa
- Dipartimento di Scienze ed Innovazione Tecnologica, Università del Piemonte Orientale, Viale Teresa Michel, 11, 15121 Alessandria, Italy
| | - S. Cantamessa
- Dipartimento di Scienze ed Innovazione Tecnologica, Università del Piemonte Orientale, Viale Teresa Michel, 11, 15121 Alessandria, Italy
| | - G. Novello
- Dipartimento di Scienze ed Innovazione Tecnologica, Università del Piemonte Orientale, Viale Teresa Michel, 11, 15121 Alessandria, Italy
| | - E. Ranzato
- Dipartimento di Scienze ed Innovazione Tecnologica, Università del Piemonte Orientale, Piazza San Eusebio 5, 13100 Vercelli, Italy
| | - S. Martinotti
- Dipartimento di Scienze ed Innovazione Tecnologica, Università del Piemonte Orientale, Viale Teresa Michel, 11, 15121 Alessandria, Italy
| | - M. Pavan
- Dipartimento di Scienze ed Innovazione Tecnologica, Università del Piemonte Orientale, Viale Teresa Michel, 11, 15121 Alessandria, Italy
| | - A. Rocchetti
- Azienda Sanitaria Santi Antonio, Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy
| | - G. Berta
- Dipartimento di Scienze ed Innovazione Tecnologica, Università del Piemonte Orientale, Viale Teresa Michel, 11, 15121 Alessandria, Italy
| | - E. Gamalero
- Dipartimento di Scienze ed Innovazione Tecnologica, Università del Piemonte Orientale, Viale Teresa Michel, 11, 15121 Alessandria, Italy
| | - E. Bona
- Dipartimento di Scienze ed Innovazione Tecnologica, Università del Piemonte Orientale, Piazza San Eusebio 5, 13100 Vercelli, Italy
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50
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Kubota K, Soma K, Uehara M, Inaba T, Saito A, Takeda N, Hatano M, Morita H, Inuzuka R, Hirata Y, Yao A, Komuro I. Combined Surgical and Medical Therapy for Candida Prosthetic Endocarditis in a Patient with Repaired Tetralogy of Fallot. Int Heart J 2018; 59:877-880. [DOI: 10.1536/ihj.17-314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kana Kubota
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsura Soma
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Akihito Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Norihiko Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masaru Hatano
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Ryo Inuzuka
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo
| | - Yasutaka Hirata
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Atsushi Yao
- Division of Health Service Promotion, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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