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Sahra S, Javed A, Jahangir A, Thind SK. Pharmacological options for Candida albicans Endocarditis at the roadblock with irrecoverable prosthetics and drug interactions: a case report and review of literature. BMC Infect Dis 2023; 23:304. [PMID: 37158828 PMCID: PMC10165830 DOI: 10.1186/s12879-023-08267-z] [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: 02/07/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Candidemia is the fourth most common nosocomial bloodstream infection. Endocarditis from candidemia is a rare but possibly fatal complication. The efficacy of amphotericin and echinocandins for induction and azoles for suppression has been well studied. Source control of infection, including removal of foreign bodies, remains the cornerstone for the success of any antifungal therapy. CASE PRESENTATION We are describing a case of a 63-years old patient with multiple comorbidities who developed candidemia secondary to Candida albicans. The prospect of curing the fungemia was made difficult by prosthetic devices, including prosthetic heart valves, intracardiac defibrillator, and inferior vena filter, which could not be extracted due to poor cardiovascular status and higher postoperative mortality risk. Combination therapy with amphotericin and 5-Flucytosine (5FC) was used with the first recurrence. Suppression with fluconazole was contraindicated due to prolonged corrected QT (QTc) interval. Isavuconazole was employed for chronic lifelong suppression. CONCLUSION Retaining prosthetics in higher surgical risk patients presents us with unique clinical and pharmacological challenges regarding breakthrough infections, drug interaction, and side effects from prolonged suppressive therapies.
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Affiliation(s)
- Syeda Sahra
- Department of Infectious Diseases, Veterans Affairs Medical Center, Oklahoma City, OK, 73104, USA.
- Department of Infectious Diseases, The University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, 73104, USA.
| | - Aneeqa Javed
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, 10305, USA
| | - Abdullah Jahangir
- Department of Critical Care, Veterans Affairs Medical Center, Oklahoma City, OK, 73104, USA
| | - Sharanjeet K Thind
- Department of Infectious Diseases, Veterans Affairs Medical Center, Oklahoma City, OK, 73104, USA
- Department of Infectious Diseases, The University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, 73104, USA
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Davoodi L, Faeli L, Mirzakhani R, Jalalian R, Shokohi T, Kermani F. Catastrophic Candida prosthetic valve endocarditis and COVID-19 comorbidity: A rare case. Curr Med Mycol 2021; 7:43-47. [PMID: 35028485 PMCID: PMC8740850 DOI: 10.18502/cmm.7.2.7157] [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: 07/30/2021] [Revised: 08/14/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Coronavirus disease 2019 (COVID-19) and Candida prostatic valve endocarditis present various clinical manifestations which may overlap; hence, discrimination between them is extremely difficult. CASE REPORT The case was a 66-year-old man with a past medical history of mitral and aortic valves replacement one year before COVID-19 co-infection. He was admitted with fever (for 7 days), shortness of breath, cough, seizure, lethargy, headache, and 85% oxygen saturation. Transesophageal echocardiography revealed multiple large-sized, highly mobile masses on both sides of the mechanical mitral valve highly suggestive of vegetation. Chest computed tomography scanning showed simulating scattered COVID-19 peripheral ground-glass opacities confirmed by reverse-transcription polymerase chain reaction. The set of blood cultures yielded yeast colonies that were identified as Candida tropicalis. The patient died of septic shock shortly after receiving antifungal therapy. CONCLUSION This case emphasized the importance of early diagnosis and implementation of antifungal treatment, particularly in patients with prosthetic cardiac valves, to reduce their unfavorable outcomes in COVID-19 patients.
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Affiliation(s)
- Lotfollah Davoodi
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, and Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Faeli
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rogheye Mirzakhani
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rozita Jalalian
- Department of Cardiology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Firoozeh Kermani
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Dai T, Hu Q, Xie Z, Li C. Case Report: Infective Endocarditis Caused by Aspergillus flavus in a Hemodialysis Patient. Front Med (Lausanne) 2021; 8:655640. [PMID: 34026787 PMCID: PMC8131528 DOI: 10.3389/fmed.2021.655640] [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: 01/19/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Abstract
Fungal endocarditis (FE) is a rare but fatal disease. The incidence of infective endocarditis (IE) in hemodialysis patients with catheters is thought to be obviously higher than that in the general population. We reported a case of IE caused by Aspergillus flavus (A. flavus) in a 36-year-old woman on hemodialysis. Because the blood cultures were persistently negative, so we used mNGS (Metagenomic next generation sequencing) for early clinical diagnosis. After treatment with voriconazole, the patient's condition improved rapidly. She continued oral voriconazole treatment 1 year after discharge and is in good condition. The diagnosis and treatment strategies of FE in hemodialysis patients were discussed.
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Affiliation(s)
- Tingting Dai
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Qinghua Hu
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongshang Xie
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Chunhui Li
- Hospital Infection Control Center, Xiangya Hospital, Central South University, Changsha, China
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Jalalian R, Shokohi T, Mirzakhani R, Ghasemian R, Hedayati MT, Ardalani S, Azizi S, Kalhori S, Kermani F, Mayahi S. Fatal Prosthetic Valve Endocarditis Due to Aspergillus flavus in a Diabetic Patient. Infect Drug Resist 2020; 13:2245-2250. [PMID: 32765000 PMCID: PMC7360421 DOI: 10.2147/idr.s258637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/26/2020] [Indexed: 12/25/2022] Open
Abstract
Aspergillus endocarditis (AE) accounts for a-quarter of all fungal endocarditis, mainly in immunocompromised hosts prior to heart-valve surgery with high mortality, even with treatment. Herein, we report a rare case of AE in a diabetic 60-year-old woman with a history of redo mitral valve prosthesis suspecious of acute endocarditis. She underwent second redo surgical mitral valve replacement in combination with mechanical aortic valve replacement. Blood cultures were negative. The explanted valve and vegetation were subjected to identification. Grown colonies were identified as Aspergillus flavus, based on conventional and molecular methods. Despite the administration of liposomal amphotericin B and improvement in her general condition shortly after initiation of therapy, the patient passed away. As AE is a late consequence of redo prosthetic valve replacement, extended follow-up, early diagnosis, repeating valve-replacement surgeries, and timely selective antifungal treatments are warranted.
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Affiliation(s)
- Rozita Jalalian
- Department of Cardiology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Centre (IFRC), Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roghayeh Mirzakhani
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Ghasemian
- Antimicrobial Resistance Research Center, and Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Centre (IFRC), Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sirus Ardalani
- Department of Cardiac Surgery, Cardiovascular Research Center of Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soheil Azizi
- Department of Pathology, Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shamsi Kalhori
- Department of Pathology, Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Firoozeh Kermani
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sabah Mayahi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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