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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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Lennard K, Bannan A, Grant P, Post J. Potential benefit of combination antifungal therapy in Aspergillus endocarditis. BMJ Case Rep 2020; 13:13/6/e234008. [PMID: 32532907 DOI: 10.1136/bcr-2019-234008] [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] [Indexed: 11/03/2022] Open
Abstract
Aspergillus endocarditis (AE) is a rare condition with a mortality rate greater than 60%. While it is generally accepted that both antifungal therapy and surgery are necessary for survival, the optimal antifungal regimen is unclear. A 62-year-old man was diagnosed with AE of a prosthetic aortic valve, complicated by cerebral emboli. He underwent debridement of the aortic valve abscess and valve replacement, and was managed with a combination of liposomal amphotericin B and voriconazole for 7 weeks followed by long-term suppressive azole therapy. He remained well at follow-up 18 months later. Data from a review of case reports published between 1950 and 2010 revealed greater survival rates in patients managed with two or more antifungals as opposed to single agent therapy. We provide an updated literature review with similar findings, suggesting that dual agent antifungal therapy should be considered in patients with AE.
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Affiliation(s)
- Kate Lennard
- Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Aiveen Bannan
- Infectious Diseases, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Peter Grant
- Cardiothoracic Surgery, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Jeffrey Post
- Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia .,Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
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Vaideeswar P, Chaudhari J, Goel N. Fungal fibrosing mediastinitis in pregnancy - Case report with review of literature. J Postgrad Med 2020; 65:52-55. [PMID: 30693874 PMCID: PMC6380127 DOI: 10.4103/jpgm.jpgm_358_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fibrosing mediastinitis (FM) is characterized by extensive and invasive fibro-inflammatory proliferation, triggered by a delayed hypersensitivity reaction to variety of infective or noninfective stimuli. The infective agents often have a geographic distribution such as Histoplasma capsulatum in North America and Mycobacterium tuberculosis in Asian regions. In few reports, the mediastinitis is caused by fungi, particularly Aspergillus species. We report the first case of possible aspergillous FM in a young pregnant woman.
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Affiliation(s)
- P Vaideeswar
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - J Chaudhari
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Goel
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Stern JB, Wyplosz B, Validire P, Angoulvant A, Fregeville A, Caliandro R, Gossot D. Bulky mediastinal aspergillosis mimicking cancer in an immunocompetent patient. Ann Thorac Surg 2014; 98:1472-5. [PMID: 25282220 DOI: 10.1016/j.athoracsur.2013.11.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 10/09/2013] [Accepted: 11/11/2013] [Indexed: 01/30/2023]
Abstract
We describe the case of a previously healthy 42-year-old woman who presented with a chronic cough and occasional night sweats. Radiologic exploration showed a bulky mediastinal mass surrounding the aortic arch, associated with a left subclavicular lymph node and a cerebral round lesion, mimicking a disseminated lung cancer. Surgical left subclavicular and computed tomography-guided mediastinal biopsy specimens showed granulomatous patterns. Mycologic culture of both samples grew Aspergillus flavus. Resolution was obtained after 9 months of oral voriconazole therapy.
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Affiliation(s)
- Jean-Baptiste Stern
- Département Thoracique, Institut Mutualiste Montsouris, Paris, France; Assistance Publique-hôpitaux de Paris, CHU Bicêtre, Service des maladies infectieuses et tropicales, Le Kremlin-Bicêtre, France.
| | - Benjamin Wyplosz
- Assistance Publique-hôpitaux de Paris, CHU Bicêtre, Service des maladies infectieuses et tropicales, Le Kremlin-Bicêtre, France
| | - Pierre Validire
- Département d'anatomopathologie, Institut Mutualiste Montsouris, Paris, France
| | - Adela Angoulvant
- Assistance Publique-hôpitaux de Paris, CHU Bicêtre, Service de Mycologie et Parasitologie, Le Kremlin-Bicêtre, France
| | - Aude Fregeville
- Département d'imagerie médicale, Institut Mutualiste Montsouris, Paris, France
| | | | - Dominique Gossot
- Département Thoracique, Institut Mutualiste Montsouris, Paris, France
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