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Ji Y, Zhuo B, Jiang T, Chen M, Xu W, Shen Y, Cheng D, Ge Y. Talaromyces marneffei endocarditis initially detected by Next Generation Sequencing: A case report. Int J Med Microbiol 2024; 314:151615. [PMID: 38394877 DOI: 10.1016/j.ijmm.2024.151615] [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: 01/05/2024] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Talaromyces marneffei (T. marneffei) is a thermal dimorphic fungus, which can cause lung or blood stream infection in patients, often life-threatening. However, endocarditis caused by T. marneffei has not been reported. For elderly patients with implanted cardiac devices or artificial valves, the prevention and treatment of infective endocarditis should not be ignored. METHODS This is a descriptive study of a T. marneffei endocarditis by joint detection of cardiac ultrasound examination, peripheral blood DNA metagenomics Next Generation Sequencing (mNGS), and in vitro culture. RESULTS We describe an 80-year-old female patient with an unusual infection of T. marneffei endocarditis. After intravenous drip of 0.2 g voriconazole twice a day for antifungal treatment, the patient showed no signs of improvement and their family refused further treatment. CONCLUSION Infective endocarditis is becoming more and more common in the elderly due to the widely use of invasive surgical procedures and implantation of intracardiac devices. The diagnosis and treatment of T. marneffei endocarditis is challenging because of its rarity. Here, we discussed a case of T. marneffei endocarditis, and emphasized the role of mNGS in early diagnosis, which is of great significance for treatment and survival rate of patients.
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Affiliation(s)
- Youqi Ji
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Bingqian Zhuo
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China; School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang 310053, China
| | - Tao Jiang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Mengyuan Chen
- Department of Laboratory Medicine, the Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Wei Xu
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Yuhuan Shen
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Dongqing Cheng
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Yumei Ge
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China; School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang 310053, China; Department of Laboratory Medicine, the Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; Key Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, Zhejiang 310063, China.
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2
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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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3
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Chen W, Ji Y, Hong X, Zhu Y, Gou X, Chen M, Lv H, Ge Y. Pacemaker Associated Aspergillus fumigatus Endocarditis: A Case Report. Infect Drug Resist 2023; 16:329-335. [PMID: 36704772 PMCID: PMC9871031 DOI: 10.2147/idr.s393917] [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: 10/22/2022] [Accepted: 01/07/2023] [Indexed: 01/19/2023] Open
Abstract
Aspergillus endocarditis (AE) is a highly fatal infection that can occur in heart valve replacement, pacemaker implantation and other heart surgeries, and early recognition and sufficient diagnosis are challenging. Here, we report the case of a 68-year-old male with a history of dilated cardiomyopathy and pacemaker implantation who had a repeated fever with failed antibacterial treatment and sterile blood culture. He developed endocarditis, and the culture and biopsy of vegetation tissue showed the abundant presence of septate hyphae, which was subsequently identified as Aspergillus fumigatus by internal transcribed spacer (ITS) sequencing. Although the patient had serious side effects from voriconazole, he had a good prognosis following surgery and prolonged caspofungin antifungal therapy of 42 consecutive days. We discuss the diagnosis and treatment strategy of AE, and recommend galactomannan assays and next-generation sequencing for a timely diagnosis. Early surgical intervention combined with prompt antifungal therapy appears significant for survival.
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Affiliation(s)
- Wanyuan Chen
- Department of Pathology, Cancer Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China,Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Youqi Ji
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Xin Hong
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Yongze Zhu
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Xiaoyu Gou
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Mengyuan Chen
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Huoyang Lv
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China
| | - Yumei Ge
- Department of Pathology, Cancer Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China,Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China,Key Laboratory of Biomarkers and in vitro Diagnosis Translation of Zhejiang Province, Hangzhou, 310063, People’s Republic of China,Correspondence: Yumei Ge, Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, No. 158, Shang-Tang Road, Gong-Shu District, Hangzhou, Zhejiang, 310014, People’s Republic of China, Tel +86-0571-85893264, Email
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4
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Born T, Aruanno M, Kampouri E, Mombelli M, Monney P, Tozzi P, Lamoth F. Aspergillus tubingensis Endocarditis: A Case Report and Review of the Literature. Mycopathologia 2022; 187:249-258. [PMID: 35267153 PMCID: PMC9124170 DOI: 10.1007/s11046-022-00621-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
Aspergillus endocarditis is a rare infection that may affect immunocompetent patients following heart valve replacement or heart surgery. We report the case of a 39 year old woman with a history of intravenous drug use who developed endocarditis with direct examination of the resected valve and vegetation showing the presence of mycelia. Cultures were positive for an Aspergillus of section Nigri, which was subsequently identified as Aspergillus tubingensis by sequencing. The clinical course was favorable following surgery and prolonged antifungal therapy (8 months in total). Antifungal susceptibility testing showed good in vitro activity of amphotericin B, voriconazole and echinocandins against planktonic cells of this A. tubingensis isolate. However, only amphotericin B displayed significant activity against biofilms. In vitro combinations of voriconazole or amphotericin B with echinocandins did not meet the criteria of synergism. Our review of the literature identified 17 other cases of endocarditis attributed to Aspergillus of section Nigri with an overall mortality rate of 57% (100% in the absence of surgery). Endocarditis caused by Aspergillus niger and related cryptic species are rare events, for which surgical management appears to be crucial for outcome. While amphotericin B was the only antifungal drug displaying significant anti-biofilm activity, the type and duration of antifungal therapy remain to be determined.
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Affiliation(s)
- Tristan Born
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marion Aruanno
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Eleftheria Kampouri
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Matteo Mombelli
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Cardiology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Cardiac Surgery Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. .,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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5
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Valerio M, Camici M, Machado M, Galar A, Olmedo M, Sousa D, Antorrena I, Fariñas Alvarez MC, Hidalgo-Tenorio C, Montejo M, Vena A, Guinea J, Bouza E, Muñoz P. Aspergillus Endocarditis in the recent years, report of cases of a multicentric national cohort and literature review. Mycoses 2021; 65:362-373. [PMID: 34931375 DOI: 10.1111/myc.13415] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES 1) To describe the incidence, clinical characteristics, treatment and outcome of Aspergillus Endocarditis (AE) in a nationwide multicentric cohort (GAMES). 2) To compare the AE cases of the GAMES cohort, with the AE cases reported in the literature since 2010. 3) To identify variables related to mortality. METHODS We recruited 10 AE cases included in the GAMES cohort (January 2008-December 2018) and 51 cases from the literature published from January 2010-July 2019. RESULTS 4.528 patients with Infectious Endocarditis (IE) were included in the GAMES cohort, of them 10 (0.2%) were AE. After comparing our 10 cases with the 51 of the literature, no differences were found. Analyzing the 61 AE cases together, 55.7% were male, median age 45 years. Their main underlying conditions were: prosthetic valve surgery (34.4%) and solid organ transplant (SOT) (19.7%). Mainly affecting mitral (36.1%) and aortic valve (29.5%). Main isolated species were: A.fumigatus (47.5%) and A.flavus (24.6%). Embolisms occurred in 54%. Patients were treated with antifungals (90.2%), heart surgery (85.2%) or both (78.7%). Overall, 52.5% died. A greater mortality was observed in immunosuppressed patients (59.4% vs 24.1%, OR=4.09, 95%CI=1.26-13.19, p=0.02) and lower mortality was associated with undergoing cardiac surgery plus azole therapy (28.1% vs 65.5%, OR=0.22, 95%CI=0.07-0.72, p=0.01). CONCLUSIONS AE accounts for 0.2% of all IE episodes of a national multicentric cohort, mainly affecting patients with previous valvular surgery or SOT recipients. Mortality remains high especially in immunosuppressed hosts and azole-based treatment combined with surgical resection are related to a better outcome.
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Affiliation(s)
- Maricela Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Marta Camici
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Alicia Galar
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Maria Olmedo
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Dolores Sousa
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario La Coruña, La Coruña
| | | | | | - Carmen Hidalgo-Tenorio
- Servicio de Enfermedades Infecciosas. Hospital Universitario Virgen de las Nieves. Complejo Hospitalario de Granada, Granada
| | - Miguel Montejo
- Servicio de Enfermedades Infecciosas. Hospital de Cruces, Bilbao
| | - Antonio Vena
- Infectious Diseases Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, 16132, Genoa, Italy
| | - Jesús Guinea
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain.,CIBERES (CB06/06/0058), Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain.,CIBERES (CB06/06/0058), Madrid, Spain
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6
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Karangelis D, Tzifa A, Mylonas KS, Gatzoulis MA, Kavvouras C, Mitropoulos F. Aspergillus Endocarditis of Pulmonary Homograft in a Congenital Heart Disease Patient. World J Pediatr Congenit Heart Surg 2021; 13:99-101. [PMID: 33956543 DOI: 10.1177/2150135120988640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aspergillus endocarditis (AE) is a life-threatening condition with mortality rates approximating 80%. Herein, we describe the case of a 19-year-old patient with congenitally corrected transposition of great arteries, ventricular septal defect, and pulmonary atresia, who underwent seven cardiac surgical procedures in the past. The patient was operated for AE of a previously implanted pulmonary valve homograft associated with septic pulmonary embolism and right heart failure but succumbed to multi-organ failure three months later. To our knowledge, this is one of two reported cases of Aspergillus infection of a pulmonary homograft, indicating the rarity of the disease.
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Affiliation(s)
| | - Aphrodite Tzifa
- Department of Congenital Cardiology, Mitera Hospital, Marousi, Athens, Greece.,School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | | | - Michael A Gatzoulis
- Adult and Congenital Heart Disease, Royal Brompton, Syndney Street, London, United Kingdom
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7
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Talha KM, DeSimone DC, Sohail MR, Baddour LM. Pathogen influence on epidemiology, diagnostic evaluation and management of infective endocarditis. Heart 2020; 106:1878-1882. [PMID: 32847941 DOI: 10.1136/heartjnl-2020-317034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022] Open
Abstract
Infective endocarditis (IE) is uncommon and has, in the past, been most often caused by viridans group streptococci (VGS). Due to the indolent nature of these organisms, the phrase 'subacute bacterial endocarditis', so-called 'SBE', was routinely used as it characterised the clinical course of most patients that extended for weeks to months. However, in more recent years, there has been a significant shift in the microbiology of IE with the emergence of staphylococci as the most frequent pathogens, and for IE due to Staphylococcus aureus, the clinical course is acute and can be associated with sepsis. Moreover, increases in IE due to enterococci have occurred and have been characterised by treatment-related complications and worse outcomes. These changes in pathogen distribution have been attributed to a diversification in the target population at risk of IE. While prosthetic valve endocarditis and history of IE remain at highest risk of IE, the rise in prevalence of injection drug use, intracardiac device implantations and other healthcare exposures have heavily contributed to the existing pool of at-risk patients. This review focuses on common IE pathogens and their impact on the clinical profile of IE.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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8
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Museedi AS, Nashawi M, Ghali A, Alshami A, Chakravorty R. Prosthetic mitral valve Aspergillus fumigatus endocarditis. IDCases 2020; 21:e00891. [PMID: 32642437 PMCID: PMC7332524 DOI: 10.1016/j.idcr.2020.e00891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
Aspergillus endocarditis is a fatal source of valvular infection with a near 100 % mortality rate if pharmacotherapy and valve-replacement surgery are not initiated swiftly after diagnosis. Complicating its diagnosis is the low yield for growth on standard blood culture and time requirements for molecular diagnostic tools to return a result. Aspergillus endocarditis of the mitral valve presents as valvular vegetations that reduce the caliber of the mitral valve and can cause syncope as in the case of mitral stenosis with subsequent valve failure, left atrial enlargement, and prospective cardiovascular failure. Reports of the management of Aspergillus endocarditis after serial mitral valve replacement are not prominent in the literature. We report the case of a 41-year-old female with previous mitral valve prosthesis who received a second prosthetic mitral valve after a syncopal episode. Vegetations resembling thrombi were noted on transesophageal echocardiogram, diagnosed as Aspergillus fumigatus endocarditis, and successfully treated with antifungal therapy in conjunction with removal of her dysfunctional prosthesis.
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Affiliation(s)
- Abdulrahman S Museedi
- Department of Internal Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mouhamed Nashawi
- Department of Internal Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abdullah Ghali
- Department of Internal Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Ripa Chakravorty
- Department of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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9
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Tabandeh M, Bahramali E, Savand Roomi Z, Salari S, Radpey M, Shamsolvaezin N. Intra-cardiac aspergilloma in a normally structured heart: A case report. J Cardiol Cases 2020; 21:165-168. [PMID: 32373238 DOI: 10.1016/j.jccase.2019.12.006] [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: 04/03/2019] [Revised: 12/03/2019] [Accepted: 12/14/2019] [Indexed: 11/26/2022] Open
Abstract
Fungal endocarditis is a relatively rare condition which mostly complicates those with intra-cardiac devices and those whose immune system is compromised. Here we present a 63-year-old diabetic man with two-weeks history of weakness and fatigue plus low-grade fever. Transesophageal echocardiography showed a mobile mass attached to the left coronary cusp of the aortic valve which protruded into the left ventricular (LV) outflow tract. Cardiac magnetic resonance further confirmed the presence of a large broad base 18 × 20 × 18 mm mass without gadolinium enhancement suggestive for fungal infection. Voriconazole was administered on the same day after which distal embolization of the mass to distal abdominal aorta ensued shortly. Echocardiography documented the disappearance of the mass from LV outflow tract. Vascular surgeon removed the mass from abdominal aorta immediately and pathology revealed the aspergilloma which was later confirmed by culture. After embolization the patient had become unstable and signs of septic shock occurred which ultimately led to his death in 72 h. Presence of Aspergillus infection in apparently normal cardiac chambers without presence of any intra-cardiac device is extremely rare and the presented case study reports such a scenario. Rapid initiation of anti-fungal agents and early surgery are of paramount importance in patient survival. <Learning objective: Cardiac aspergillosis is a rare condition and delayed diagnosis and treatment can be fatal. Cardiac imaging though helps differentiate the intra cardiac mass etiology, must not hinder early surgical removal especially when the location of the mass is critical.>.
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Affiliation(s)
- Mahmoud Tabandeh
- Non-communicable Diseases Research Center, Kowsar Hospital, Fars Heart Foundation, Shiraz, Iran
| | - Eshan Bahramali
- Interventional Cardiology Section, Non-communicable Diseases Research Center, Kowsar Hospital, Fars Heart Foundation, Shiraz, Iran.,Digestive Disease Research Center, Digestive Disease Research Institute, Shahriati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Savand Roomi
- Non-communicable Diseases Research Center, Kowsar Hospital, Fars Heart Foundation, Shiraz, Iran
| | - Soheila Salari
- Non-communicable Diseases Research Center, Kowsar Hospital, Fars Heart Foundation, Shiraz, Iran
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10
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Aspergillus fumigatus endocarditis in an indigenous Australian male without classic risk factors. Med Mycol Case Rep 2018; 22:61-64. [PMID: 30271705 PMCID: PMC6159333 DOI: 10.1016/j.mmcr.2018.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022] Open
Abstract
Aspergillus endocarditis is rare with most cases occurring in immunosuppressed patients. We present the case of an “immunocompetent” Indigenous Australian male with culture confirmed Aspergillus brain abscesses complicating bilateral endocarditis. The reported mortality rate for Aspergillus endocarditis approaches 100%. Despite sub-optimal therapy this patient survived beyond expectation.
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11
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Sabir N, Ikram A, Gardezi A, Zaman G, Satti L, Ahmed A, Khadim T. Native valve dual pathogen endocarditis caused by Burkholderia cepacia and Aspergillus flavus - a case report. JMM Case Rep 2018; 5:e005143. [PMID: 30425834 PMCID: PMC6230757 DOI: 10.1099/jmmcr.0.005143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/26/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Infective endocarditis (IE) is an important clinical condition with significant morbidity and mortality among the affected population. A single etiological agent is identifiable in more than 90 % of the cases, however, polymicrobial endocarditis (PE) is a rare find, with a poor clinical outcome. Here we report a case of native valve dual pathogen endocarditis caused by Burkholderia cepacia and Aspergillus flavus in an immunocompetent individual. It is among unique occurrences of simultaneous bacterial and fungal etiology in IE. Case presentation A 30-year-old male was admitted to a cardiology institute with complaints of low grade intermittent fever and progressive shortness of breath for last two months. He was a known case of rheumatic heart disease and had suffered an episode of IE three years ago. On the basis of clinical presentation and the results of radiological investigations, a diagnosis of infective endocarditis was made. Paired blood samples for culture and sensitivity, sampled before the commencement of antimicrobial therapy, yielded growth of Burkholderia cepacia which was highly drug resistant. Sensitivity results-directed therapy consisting of tablet Trimethoprim–Sulfamethoxazole, two double-strength tablets 12 hourly, and Meropenem, 1 g IV every 8 h, was commenced. Despite mild relief of fever intensity, overall clinical condition did not improve and double valve replacement therapy was carried out. Excised valves were sent for microbiological analysis. Burkholderia cepacia was grown on tissue culture with a similar antibiogram to that previously reported from the blood culture of this patient. Direct microscopy of section of valvular tissue with 10 % KOH revealed abundant fungal hyphae. Patient serum galactomannan antigen assay was also positive. Histopathological examination of vegetations also revealed hyphae typical of species of the genus Aspergillus. The patient was successfully treated with meropenem, trimethoprim–sulfamethoxazole and voriconazole. Conclusion The hallmark of successful treatment in this case was exact identification of pathogens, antibiogram-directed therapy and good liaison between laboratory experts and treating clinicians.
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Affiliation(s)
- Nargis Sabir
- Armed Forces Institute of Pathology, National University of Medical Sciences, Islamabad, Pakistan
| | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan
| | - Adeel Gardezi
- Armed Forces Institute of Pathology, National University of Medical Sciences, Islamabad, Pakistan
| | - Gohar Zaman
- Armed Forces Institute of Pathology, National University of Medical Sciences, Islamabad, Pakistan
| | - Luqman Satti
- Armed Forces Institute of Pathology, National University of Medical Sciences, Islamabad, Pakistan
| | - Abeera Ahmed
- Armed Forces Institute of Pathology, National University of Medical Sciences, Islamabad, Pakistan
| | - Tahir Khadim
- Armed Forces Institute of Pathology, National University of Medical Sciences, Islamabad, Pakistan
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Ortega-Loubon C, Fernández-Molina M, Tobar-Ruiz J, Arce-Ramos N, Fulquet-Carreras E. Rapid Fulminant Case of Aspergillus Prosthetic Valve Endocarditis. Cureus 2017; 9:e1652. [PMID: 29142800 PMCID: PMC5669520 DOI: 10.7759/cureus.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 74-year-old male presented to the emergency department 46 days after undergoing an aortic valve replacement. He presented with nonspecific symptoms developed over the previous 15 days, with a new onset of a systolic panfocal murmur. Echocardiography revealed a great vegetation measuring 15 mm by 23 mm causing a severe obstruction of the bioprosthesis. The patient underwent an emergency surgical procedure due to his hemodynamic unsteadiness. During the procedure, we noted an obstruction of the left ventricle outflow tract with pseudoaneurysm of the aortomitral continuity. We debrided the aortic annulus, reconstructed the aortomitral continuity, and replaced the prosthesis, but the patient died. We present a rare fulminant case of Aspergillus endocarditis.
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13
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Angioinvasive Aspergillus-associated Stroke in an Immunocompetent Host Following Cardiac Surgery and ECMO. Neurologist 2017; 22:92-94. [DOI: 10.1097/nrl.0000000000000119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Fungal endocarditis presenting with right lumbar pain and femoral artery ischemia - An unusual case report. Turk J Emerg Med 2016; 16:173-175. [PMID: 27995211 PMCID: PMC5154577 DOI: 10.1016/j.tjem.2016.03.002] [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: 02/24/2016] [Accepted: 03/30/2016] [Indexed: 11/20/2022] Open
Abstract
Fungal endocarditis is a rare entity which has a poor outcome. Our case reports an atypical presentation of similar pathology now presenting with femoral artery ischemia in an immune competent individual. A 62-year Asian male presented with sudden onset of right sided lumbar pain. Initial clinical exam was consistent with right sided renal colic. Intravenous analgesia did not relieve the pain. Repeat clinical examination revealed absent right femoral artery pulsation. The patient underwent a Computerized tomography angiography of right lower extremity. Echocardiogram revealed valvular vegetations that were later revealed to be because of Aspergillus Terreus. This case highlights the atypical presentation of a rare fungal endocarditis in an immune competent individual presenting with right sided lumbar pain. This case is of particular interest for emergency physicians who are at the forefront and may require to deal with such presentations.
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15
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Rofaiel R, Turkistani Y, McCarty D, Hosseini-Moghaddam SM. Fungal mobile mass on echocardiogram: native mitral valve Aspergillus fumigatus endocarditis. BMJ Case Rep 2016; 2016:bcr-2016-217281. [PMID: 27932432 DOI: 10.1136/bcr-2016-217281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The most common type of infective endocarditis is bacterial endocarditis. However, fungal infections have been seen more frequently, mostly in the immunocompromised population. We report a case of invasive Aspergillus fumigatus native mitral valve endocarditis. The patient received appropriate empiric antifungal treatment with a combination of liposomal amphotericin B and flucytosine, associated with surgical debridement, valve replacement and chordae tendineae repair. Despite receiving the standard treatment of Aspergillus endocarditis, and susceptibility of the microorganism to the antifungal regimen, the patient, unexpectedly, developed early-onset septic emboli. It is surprising to see that the patient had developed such complications early, despite attempts to eliminate the source of infection with surgical intervention.
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Affiliation(s)
- Rymon Rofaiel
- Department of Medicine, Western University, London, Ontario, Canada
| | - Yosra Turkistani
- Department of Cardiology, Western University, London, Ontario, Canada
| | - David McCarty
- Department of Cardiology, Western University, London, Ontario, Canada
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16
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Uhrin GB, Jensen RH, Korup E, Grønlund J, Hjort U, Moser C, Arendrup MC, Schønheyder HC. Recurrent prosthetic valve endocarditis caused by Aspergillus delacroxii (formerly Aspergillus nidulans var. echinulatus). Med Mycol Case Rep 2015; 10:21-3. [PMID: 26909244 PMCID: PMC4731950 DOI: 10.1016/j.mmcr.2015.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 11/25/2022] Open
Abstract
We report Aspergillus delacroxii (formerly Aspergillus nidulans var. echinulatus) causing recurrent prosthetic valve endocarditis. The fungus was the sole agent detected during replacement of a mechanical aortic valve conduit due to abscess formation. Despite extensive surgery and anti-fungal treatment, the patient had a cerebral hemorrhage 4 months post-surgery prompting a diagnosis of recurrent prosthetic valve endocarditis and fungemia.
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Affiliation(s)
- Gábor Balázs Uhrin
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
| | - Rasmus Hare Jensen
- Unit of Mycology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Eva Korup
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
| | - Jens Grønlund
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000 Aalborg, Denmark
| | - Ulla Hjort
- Department of Infectious Diseases, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | | | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000 Aalborg, Denmark
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17
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Kornberger A, Walter V, Jaeger F, Lehnert T, Soriano M, Moritz A, Stock UA, Beiras-Fernandez A. Necrotizing pulmonary aspergillosis and ventricular assist device infection: case report and review of literature. Transpl Infect Dis 2015. [PMID: 26224318 DOI: 10.1111/tid.12427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Necrotizing pulmonary aspergillosis and Aspergillus device infection are rare and have potentially fatal complications after left ventricular assist device (LVAD) implantation. To date, few cases of patients surviving Aspergillus device infection have been published, with survival reported only after device removal. We present a patient implanted with an LVAD in whom necrotizing pulmonary aspergillosis with device involvement was successfully treated by segmentectomy and prolonged antifungal treatment without device exchange or removal. Similar cases in the literature were searched for and are discussed in view of the severity of this complication.
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Affiliation(s)
- A Kornberger
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - V Walter
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - F Jaeger
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - T Lehnert
- Department of Radiology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - M Soriano
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - A Moritz
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - U A Stock
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - A Beiras-Fernandez
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
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18
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Hussein N, Qamar S, Abid Q. Systemic aspergilloma post aortic root surgery following coronary artery stenting: diagnostic and management dilemma. BMJ Case Rep 2015; 2015:bcr-2014-207702. [PMID: 26025972 DOI: 10.1136/bcr-2014-207702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Aspergillus infections such as Aspergillus endocarditis were once relatively rare occurrences, however, due to the increased use of intracardiac devices, the incidence has grown. With mortality rates close to 100%, in medically treated cases, it is paramount that early diagnosis and treatment are performed. An immunocompetent aviculturist presented 8 months post aortic root replacement for severe aortic regurgitation with a composite graft, with central crushing chest pain. Investigations confirmed ST elevation inferior myocardial infarction due to stenosis of the origin of the right coronary artery, which was stented. Echocardiogram demonstrated a mobile mass posterior to the left ventricular outflow tract. Following referral to our cardiothoracic surgeons, a polypoidal mass covering the right ostial button was noted along with systemic complications of the disease. Emergency redo aortic valve replacement with a homograft and coronary artery bypass was performed. Histological analysis confirmed A. fumigatus and the patient was started on intravenous voriconazole.
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Affiliation(s)
| | - Sombul Qamar
- Medical School, Keele University, Stoke on Trent, UK
| | - Qamar Abid
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
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19
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Abuzaid AA, Zaki M, Tarif H. Atypical early Aspergillus endocarditis post prosthetic mitral valve repair: a case report. Heart Views 2015; 16:30-3. [PMID: 25838877 PMCID: PMC4379640 DOI: 10.4103/1995-705x.152999] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 64-year-old female operated 1 month previous for mitral valve repair presented with acute respiratory distress and dyspnea. Echocardiography showed large echogenic valvular mass measuring 2.3 × 1.3 cm with severe mitral regurgitation and dehiscence of the mitral ring posteriorly. The mass was attached subvalvularly to the ventricular septal-free wall and eroding through it, which required complete aggressive dissection of the infected tissues. Diagnosis was confirmed after resection of the valve by multiple negative blood cultures and positive valvular tissue for Aspergillus fumigatus endocarditis. She was treated with high dose of voriconazole for 3 months. Her postoperative period was complicated by acute-on-chronic renal failure. She responded very well to the management.
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Affiliation(s)
- Ahmed AbdulAziz Abuzaid
- Department of Cardiovascular Surgery, Mohammed bin Khalifa Cardiac Centre, Bahrain Defence Force Hospital, Al-Riffa, Bahrain
| | - Mahmood Zaki
- Department of Intensivest of cardiac anesthesia, Mohammed bin Khalifa Cardiac Centre, Bahrain Defence Force Hospital, Al-Riffa, Bahrain
| | - Habib Tarif
- Department of Cardiovascular Surgery, Mohammed bin Khalifa Cardiac Centre, Bahrain Defence Force Hospital, Al-Riffa, Bahrain
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20
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Aspergillus endocarditis in a paediatric patient after a cardiac surgery, associated with septic pulmonary embolism and pulmonary hypertension. Cardiol Young 2015; 25:563-5. [PMID: 24702799 DOI: 10.1017/s1047951114000432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a rare case of pulmonary prosthetic valve endocarditis due to Aspergillus fumigatus, associated with septic pulmonary embolism and secondary pulmonary hypertension, in a 4-year-old boy with surgically corrected tetralogy of Fallot. The diagnosis and treatment of Aspergillus endocarditis remains highly challenging. The best therapeutic option for chronic thromboembolic pulmonary hypertension due to an infectious thromboembolic event is highly debatable and the results are poor.
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21
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Successful surgical treatment of rare Aspergillus terreus prosthetic valve endocarditis complicated by intracranial and mesenteric artery mycotic aneurysms. J Thorac Cardiovasc Surg 2014; 148:e221-3. [PMID: 25156465 DOI: 10.1016/j.jtcvs.2014.06.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 11/23/2022]
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22
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Vohra S, Taylor R, Aronowitz P. The tell-tale heart: Aspergillus fumigatus endocarditis in an immunocompetent patient. Hosp Pract (1995) 2013; 41:117-121. [PMID: 23466974 DOI: 10.3810/hp.2013.02.1017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aspergillus is a saprophytic, spore-forming fungus that is ubiquitous in our daily environment. Inhalation of the airborne conidia leads to a variety of diseases, from asymptomatic colonization to disseminated disease. Immunocompromised patients are usually viewed as the population most susceptible to aspergillosis because of their lack of host immune defenses. However, a healthy immune system does not preclude an individual from susceptibility to aspergillosis. Our case illustrates an immunocompetent patient with disseminated aspergillosis involving the tricuspid valve. A high degree of suspicion is imperative in patients who present without the classic risk factors. Recognition of disseminated aspergillosis in such patients is necessary to promote early diagnosis, treatment, and improved outcomes in an otherwise fulminant, life-threatening infection.
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Affiliation(s)
- Sheba Vohra
- Department of Hospital-Based Specialists, Kaiser Permanente, Santa Rosa, CA, USA.
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23
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Dupouey J, Faucher B, Normand AC, Hadrich I, Ranque S, Dumon H, Casalta JP, Collart F, Piarroux R. Late post-operative Aspergillus flavus endocarditis: Demonstration of a six years incubation period using microsatellite typing. Med Mycol Case Rep 2012; 1:29-31. [PMID: 24371731 DOI: 10.1016/j.mmcr.2012.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 04/25/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022] Open
Abstract
Late post-operative Aspergillus endocarditis is an under recognized life-threatening complication of heart valvular surgery. Optimal prevention and treatment need enhanced awareness. We report three cases of post-operative Aspergillus flavus endocarditis, including one with a 6-year long incubation period. Microsatellite typing incriminated a recurrent contamination of hospital environment.
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Affiliation(s)
- Julien Dupouey
- Laboratoire de Parasitologie et mycologie, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre 13385, Marseille Cedex 05, France
| | - Benoit Faucher
- Laboratoire de Parasitologie et mycologie, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre 13385, Marseille Cedex 05, France ; Université de la Méditerranée, UMR MD3, Marseille, France
| | - Anne-Cécile Normand
- Laboratoire de Parasitologie et mycologie, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre 13385, Marseille Cedex 05, France
| | - Inès Hadrich
- Laboratoire de Parasitologie et mycologie, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre 13385, Marseille Cedex 05, France
| | - Stéphane Ranque
- Laboratoire de Parasitologie et mycologie, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre 13385, Marseille Cedex 05, France ; Université de la Méditerranée, UMR MD3, Marseille, France
| | - Henri Dumon
- Laboratoire de Parasitologie et mycologie, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre 13385, Marseille Cedex 05, France
| | - Jean-Paul Casalta
- Fédération de microbiologie, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre 13385, Marseille Cedex 05, France
| | - Frédéric Collart
- Service de Chirurgie cardio-thoracique, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre 13385, Marseille Cedex 05, France
| | - Renaud Piarroux
- Laboratoire de Parasitologie et mycologie, Centre Hospitalo-Universitaire Timone, 264 rue Saint-Pierre 13385, Marseille Cedex 05, France ; Université de la Méditerranée, UMR MD3, Marseille, France
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24
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Aspergilosis. Formas clínicas y tratamiento. Enferm Infecc Microbiol Clin 2012; 30:201-8. [DOI: 10.1016/j.eimc.2011.12.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 12/13/2011] [Indexed: 11/24/2022]
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Pelaez T, Munoz P, Guinea J, Valerio M, Giannella M, Klaassen CHW, Bouza E. Outbreak of Invasive Aspergillosis After Major Heart Surgery Caused by Spores in the Air of the Intensive Care Unit. Clin Infect Dis 2012; 54:e24-31. [DOI: 10.1093/cid/cir771] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Abstract
This lesson reports the case of endophthalmitis, a rare presentation of infective endocarditis (IE), two months following cardiac surgery. Although inflammatory markers were increased, blood cultures were negative. Transoesophageal echocardiography demonstrated an aortic root abscess. Culture of tissue obtained at surgery revealed the infective organism to be Aspergillus fumigatus, a rare cause of IE in the immunocompetent patient.
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27
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Affiliation(s)
- Matthew Brooks
- Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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28
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Singla MK, Shrivastava A, Mukherjee KC, Sodhi K. Potentially fatal tricuspid valve aspergilloma detected after laparoscopic abdominal surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2011. [DOI: 10.1080/22201173.2011.10872789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- MK Singla
- Department of Cardiac Anaesthesia, SPS Apollo Hospitals, Ludhiana
| | - A Shrivastava
- Department of Cardiac Anaesthesia, SPS Apollo Hospitals, Ludhiana
| | - KC Mukherjee
- Department of Cardiac Surgery, SPS Apollo Hospitals, Ludhiana
| | - K Sodhi
- Department of Critical Care, SPS Apollo Hospitals, Ludhiana
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29
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Ruiz-Camps I, Aguado J, Almirante B, Bouza E, Ferrer-Barbera C, Len O, Lopez-Cerero L, Rodríguez-Tudela J, Ruiz M, Solé A, Vallejo C, Vazquez L, Zaragoza R, Cuenca-Estrella M. Guidelines for the prevention of invasive mould diseases caused by filamentous fungi by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Clin Microbiol Infect 2011; 17 Suppl 2:1-24. [DOI: 10.1111/j.1469-0691.2011.03477.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hansen TN, Plambeck CJ, Barron MJ, Pagel PS, DeAnda A, Neustein S. CASE 3-2010 Dynamic partial obstruction of the tricuspid valve inlet produced by anterior mediastinal aspergillosis invading the right atrium. J Cardiothorac Vasc Anesth 2010; 24:506-12. [PMID: 20510248 DOI: 10.1053/j.jvca.2010.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas N Hansen
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
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32
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Ruiz-Camps I, Aguado JM, Almirante B, Bouza E, Ferrer Barbera C, Len O, López-Cerero L, Rodríguez-Tudela JL, Ruiz M, Solé A, Vallejo C, Vázquez L, Zaragoza R, Cuenca-Estrella M. Recomendaciones sobre la prevención de la infección fúngica invasora por hongos filamentosos de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC). Enferm Infecc Microbiol Clin 2010; 28:172.e1-172.e21. [DOI: 10.1016/j.eimc.2009.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 11/24/2009] [Indexed: 11/30/2022]
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Salavert-Lletí M, Zaragoza-Crespo R. [Future role of micafungin in the treatment of invasive mycoses caused by filamentous fungi]. Rev Iberoam Micol 2009; 26:81-9. [PMID: 19463284 DOI: 10.1016/s1130-1406(09)70015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 02/17/2009] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Micafungin is a echinocandin. It inhibits beta-1,3-D-glucan synthesis, thus achieving fungicidal activity against virtually all Candida spp., including those resistant to fluconazole, and fungistatic activity against Aspergillus spp., as well as several but not all pathogenic molds. Results from in vitro studies, animal models, small clinical trials, hint at possible future indications such as invasive aspergillosis and empirical viantifungal therapy, although currently there is little information published. AIMS To describe published data of micafungin as treatment against invasive mold infections, specially analysing its role in the inmunodepressed host and critical care setting. METHODS A systematic review of literature using the principal medical search engines was performed. Terms such as micafungin, aspergillosis, zygomycosis, invasive fungal infections, emerging fungal infections, antifungal treatment or therapy, antifungal prophylaxis, empiric or pre-emptive therapy were crossed. Febrile neutropenia patients were excluded. RESULTS Several studies in these setting were identified and were described in this review. Although there were no blinded randomized clinical trials published, treatment or prophylaxis of invasive aspergillosis and other invasive mould infections with micafungin described in open clinical studies were analyzed. CONCLUSIONS Micafungin could play a future important role as a primary or rescue therapy, alone or in combination, in the treatment or prophylaxis of invasive fungal infections caused by moulds. New randomized clinical trials are needed to confirm their efficacy.
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Ryu KM, Seo PW, Kim SH, Park S, Ryu JW. Surgical treatment of native valve Aspergillus endocarditis and fungemic vascular complications. J Korean Med Sci 2009; 24:170-2. [PMID: 19270834 PMCID: PMC2650974 DOI: 10.3346/jkms.2009.24.1.170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 01/23/2008] [Indexed: 11/20/2022] Open
Abstract
Systemic infection with Aspergillus is an opportunistic disease that affects mainly immunocompromised hosts, and is associated with a high mortality rate. It typically occurs in patients with several predisposing factors, but Aspergillus endocarditis of native valves is rare and experience in diagnosis and treatment is limited. We report a case of native valve endocarditis caused by Aspergillus. A 35-yr-old male patient who underwent pericardiocentesis four months previously for pericardial effusion of unknown etiology presented with right leg pain and absence of the right femoral artery pulse. Cardiac echocardiography revealed severe mitral insufficiency with large mobile vegetations, and computed tomographic angiography showed embolic occlusion of both common iliac arteries. We performed mitral valve replacement and thromboembolectomy, and Aspergillus was identified as the vegetation. We started intravenous amphotericin B and oral itraconazole, but systemic complications developed including superior mesenteric artery aneurysm and gastrointestinal bleeding. After aggressive management, the patient was discharged 78 days post surgery on oral itraconazole. He was well at 12 months post discharge but died in a traffic accident 13 months after discharge.
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Affiliation(s)
- Kyoung Min Ryu
- Department of Thoracic and Cardiovascular Surgery, Dankook University Hospital, Cheonan, Korea
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Brili S, Rokas C, Tzannos K, Barbetseas J, Pirounaki M, Stefanadis C. Fungal Ascending Aortic Aneurysm after Cardiac Surgery. Echocardiography 2009; 26:84-7. [DOI: 10.1111/j.1540-8175.2008.00776.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kim SY, Choi JY, Cho CH. A Case of Aspergillus Endocarditis Presenting as Endophthalmitis. Korean Circ J 2009. [DOI: 10.4070/kcj.2009.39.2.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- So Yeon Kim
- Department of Cardiology, Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Ji Yong Choi
- Department of Cardiology, Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Chang Ho Cho
- Department of Pathology, Catholic University of Daegu, School of Medicine, Daegu, Korea
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Esmaeilzadeh M, Parsaee M, Peighambari MM, Sadeghpour A, Khamooshi AJ, Hosseini SS, Mozaffari K. Late occurrence of fatal aortitis: a complication of Aspergillus endocarditis following coronary artery bypass graft surgery. ACTA ACUST UNITED AC 2008; 10:165-7. [DOI: 10.1093/ejechocard/jen204] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yung D, Kukaswadia S, Ali A, Haider S, Salehian O. Fever and Peripheral Emboli in an Immunocompetent Host: A Case of Aspergillus Endocarditis. Clin Med Cardiol 2008. [DOI: 10.4137/cmc.s874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Derek Yung
- Department of Medicine, Hamilton, Ontario, Canada
| | | | - Asma Ali
- Department of Medicine, Hamilton, Ontario, Canada
| | - Shariq Haider
- Division of Infectious Diseases, Hamilton, Ontario, Canada
| | - Omid Salehian
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
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Saitoh T, Matsushima T, Matsuo A, Yokohama A, Irisawa H, Handa H, Tsukamoto N, Karasawa M, Nojima Y, Murakami H. Small-bowel perforation accompanied by Aspergillus endocarditis in a patient with angioimmunoblastic T-cell lymphoma. Ann Hematol 2006; 86:71-3. [PMID: 17043778 DOI: 10.1007/s00277-006-0197-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2006] [Accepted: 09/04/2006] [Indexed: 11/27/2022]
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