Candida parapsilosis endocarditis. Report of cases and review of the literature

Abstract

Introduction Infective endocarditis (IE) due to Candida species is a rare disease representing about 1-2% of all IE cases and carries a high mortality rate. Given the rarity of the disease, there are no clear guidelines on the type and duration of antifungal therapy. Thus, long-term or even life-long antifungal treatment is commonly used.Case report We report two patients with prosthetic valve C. parapsilosis IE and persistent candidemia that failed conservative treatment and ultimately developed heart failure. They underwent prosthetic valve replacement and prolonged antifungal treatment with favorable outcome. Discussion Candida IE commonly occurs in the setting of underlying malignancy, chronic liver disease, previous endocarditis, previous antimicrobial exposure, previous abdominal surgery, intravenous drug use, presence of a central venous catheter, and previous cardiac surgery. Both present patients had undergone a cardiac surgery and had a prosthetic heart valve, while one patient had an underlying autoimmune disease that could be associated with higher risk of IE. In both patients transthoracic ultrasound failed to diagnose IE. In our patients, conservative treatment alone was not enough to control the infection, thus, both patients underwent valve replacement and were subsequently treated with antifungals for 6 weeks. Furthermore, both patients were put on long-term antifungal suppression treatment.Conclusions Given the absence of controlled randomized trials, the treatment of Candida endocarditis mostly relies on experts' opinion, and, thus, future studies focusing on the type and duration of antifungal treatment are required.

Native Valve Candida metapsilosis Endocarditis Following a Ruptured Appendix: A Case Report

“…Invasive Candida infections are often caused by C. albicans followed by C. parapsilosis complex, C. gabrata , and C. tropicalis [ 1 ]. C. parapsilosis complex is further subdivided by molecular studies into C. parapsilosis , C. orthopsilosis , and C. metapsilosis [ 3 , 5 ].…”

“…C. parapsilosis complex is further subdivided by molecular studies into C. parapsilosis , C. orthopsilosis , and C. metapsilosis [ 3 , 5 ]. Although Candida parapsilosis complex is less virulent than C. albicans , C. parapsilosis complex has high rates of resistance to echinocandins and some azoles, making this infection difficult to treat [ 1 , 3 ].…”

“…However, invasive disease caused by C. parapsilosis can occur without prior colonization and is often transmitted in a healthcare setting via sources such as medical devices or fluids, the hands of health care workers, prosthetic devices, and catheters [ 3 ]. Most important predisposing factors for C. parapsilosis endocarditis include the presence of pre-existing valvular disease, implanted prosthetic valves or devices, immunosuppression, IV drug use, neutropenia, chronic indwelling central venous catheters, parenteral nutrition, diabetes mellitus, and previous abdominal surgery [ 1 - 3 ]. Although we have no clear way of proving the source of infection, our patient’s recent history of appendiceal rupture makes the GI tract a likely source.…”

“…Candida is an uncommon cause of infective endocarditis (IE) accounting for about 1-2% of all cases of IE but can be associated with a remarkably high mortality rate [ 1 ]. Candida species are normal flora on human skin, the gastrointestinal tract, and the lower genitourinary tract [ 2 , 3 ].…”

“…Candida usually affects damaged heart valves or hardware, like prosthetic heart valves (2%-10%), pacemakers (4.5%), implantable cardioverter defibrillators, and ventricular assist devices (35%-39%) by forming biofilms [ 2 ]. However native valve endocarditis is seldom reported but may be seen in presence of other concurrent risk factors like immunosuppression, intravenous drug use, neutropenia, diabetes mellitus, chronic indwelling central venous catheters, parenteral nutrition, previous abdominal or cardiac surgery [ 1 , 2 ].…”