Aspergillus Endocarditis After Cardiac Surgery

El-Hamamsy, Ismaı̈l; Dürrleman, Nicolas; Stevens, Louis–Mathieu; Perrault, Louis P.; Carrier, Michel

doi:10.1016/j.athoracsur.2004.08.070

Cited by 55 publications

(85 citation statements)

References 44 publications

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“…The additional magnitude of short and long term survival benefit from surgery has been long debated, and the timing of such a major operation is often precluded in these critically ill patients. The post-operative recurrence rate of Aspergillus endocarditis may approach 40% [19], and combination (medical and surgical) therapy may not necessarily improve prognosis with mortality rates exceeding 80% [1,2]. It is therefore critical to recognize the narrow window of opportunity for surgical intervention and to proceed promptly.…”

Section: Discussionmentioning

confidence: 99%

Fever and Peripheral Emboli in an Immunocompetent Host: A Case of Aspergillus Endocarditis

Yung

Kukaswadia

Ali

et al. 2008

Clinical medicine. Cardiology

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Despite diagnostic and therapeutic advances in medical, surgical, and critical care, the mortality rate for Aspergillus endocarditis remains dismal (approaching 100%). We report a case of a 49 year old immunocompetent woman with recent aortic valve prosthesis who presents with fever, chills, sweats, left facial droop, left arm weakness, petechial rash and cyanotic toes. Initial trans-esophageal echo was normal but a repeat study revealed a 9 × 5 mm vegetation abutting the aortic prosthesis. Microbiological correlation could not be documented despite the presence of persistent fever through serial blood cultures, and the diagnosis of Aspergillus fumigatus endocarditis was ultimately made on embolectomy specimen when she developed an ischemic right leg. Aggressive medical treatment was initiated with intravenous voraconazole, liposomal amphotericin-B and heparin. The timing of surgical intervention was contemplated, but was precluded by multiple comorbidities. She succumbed to her illness after developing cerebral herniation following intraparenchymal hemorrhage.The effectiveness of combined medical intervention and surgical valve replacement for Aspergillus endocarditis is therefore contingent on high diagnostic suspicion and early echocardiographic detection in a high risk individual with features of culture-negative endocarditis.

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Section: Discussionmentioning

confidence: 99%

Fever and Peripheral Emboli in an Immunocompetent Host: A Case of Aspergillus Endocarditis

Yung

Kukaswadia

Ali

et al. 2008

Clinical medicine. Cardiology

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“…The blood culture positivity rate is extremely low, at 6.4%-11%. 5) Aspergillus was not isolated from our patient's blood or pericardial fluid cultures but was histopathologically identified from myocardial tissue. The biopsy sample from the right atrium of hypertrophied atrial septum was essential for obtaining the definitive diagnosis in our patient.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Favorable Course of <i>Aspergillus</i> Endo-, Myo-, and Pericarditis

et al. 2017

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SummaryHere, we report on a healthy 30-year-old man with no significant medical history, who tested negative for human immunodeficiency virus antigenemia but developed Aspergillus pancarditis. A case of this kind is extremely rare, and to the best of our knowledge, this is the first report of a patient with Aspergillus pancarditis, which generally leads to a very poor outcome, who had a long-term favorable clinical course. A biopsy from the right atrium of hypertrophied atrial septum was essential for obtaining the definitive diagnosis. Long-term administration of an effective antifungal oral agent might account for the patient's favorable outcome.(Int Heart J 2017; 58: 1020-1023) Key words: Pancarditis, Biopsy A spergillus species infections can be severe and invasive, involving almost every major organ system. Aspergillus pancarditis is especially rare, with a very poor prognosis. Our patient with Aspergillus pancarditis had a long-term favorable course, which might be accounted for by the following important factors: a definitive diagnosis by a biopsy from the right atrium, early administration of an antifungal agent, timely changing to a more effective agent, and continuation of treatment based on serum β-d-glucan levels. This report should provide helpful information for the treatment of similar cases. Case ReportWe report a 30-year-old male patient with no significant medical, family, or occupational history, who had never used any intravenous drugs. The chief complaints of high fever and cough appeared in the latter third of March 2013; he was admitted to another hospital in April of the same year and received antibiotic therapy. However, his fever of 38°C and cough persisted, and he was admitted to our hospital for specialized workup and treatment.Malignant lymphoma or infective endocarditis was suspected at the time of his admission, based on test results indicating inflammation (C-reactive protein = 4.2 mg/mL, reference range < 0.3 mg/mL), chest computed tomography (CT) imaging showing pericardial effusion without findings suggestive of pulmonary aspergillosis, echocardiogram showing vegetations ( Figure 1A and B), and gallium scintigraphy scan showing abnormal accumulation of gallium within the pericardial space. However, because of an abnormally high serum β-d-glucan level (612 pg/mL, reference range < 20 pg/mL), which suggested fungal infection, we started an intravenous antifungal agent (voriconazole 400 mg/day). Transesophageal echocardiography showed extensive thickening of both atrial walls, focused around the mitral annular ring, and including the atrial septum (Figure 2). Moreover, malignant lymphoma was suspected because of the large pericardial effusion, and pericardiocentesis was performed. Approximately 800 mL of yellow to faintly bloody pericardial fluid was obtained. The cytological diagnosis was negative for malignancy; therefore, we performed a myocardial biopsy. Under intracardiac ultrasound guidance, we obtained a sample of the hypertrophied atrial septum from the right atrium, near ...

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“…4 The predisposition of patients to these infections has increased due to intravenous drug abuse, long-term antibiotic therapy, steroid administration, chemotherapy, immunosuppressive states and open-heart surgery. [5][6][7][8] Men are more frequently affected than women, with peak incidences occurring between the third and fourth decades of life. 8 Aspergillus endocarditis is usually associated with high morbidity and mortality, ranging from 80-96%, regardless of the treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8] Men are more frequently affected than women, with peak incidences occurring between the third and fourth decades of life. 8 Aspergillus endocarditis is usually associated with high morbidity and mortality, ranging from 80-96%, regardless of the treatment. In many of the case reports in the literature, large undetected aspergillomas have resulted in fatalities in the intraoperative and postoperative periods, with the diagnosis being completed at the autopsy.…”

Section: Discussionmentioning

confidence: 99%