Combination antifungal therapy for treatment of Candida parapsilosis prosthetic valve endocarditis and utility of T2Candida Panel®: A case series

Abstract

Although Candida species are common pathogens for nosocomial infections, Candida endocarditis is still considered a rare entity. Here, we report two cases of Candida parapsilosis endovascular infections in patients with prosthetic valves, both of which responded to combination antifungal therapy without surgical intervention. Additionally, T2 magnetic resonance (T2MR) was used to assess for resolution of invasive candidiasis. The first case is of an elderly man with Candida parapsilosis endovascular infection who responded to combination antifungal therapy with micafungin and fluconazole followed by suppressive therapy, without surgical intervention. The second case is of a middle-aged man with Candida parapsilosis prosthetic valve endocarditis who also responded to combination antifungal therapy with micafungin, flucytosine and fluconazole, without surgical intervention.

Endocarditis Caused by Candida parapsilosis Presenting With Severe Thrombocytopenia in a Patient With Tetralogy of Fallot

“…In line with these studies, however, our patient did have success with amphotericin induction treatment and combination echinocandin–amphotericin therapy while hospitalized. 7,8…”

“…In line with these studies, however, our patient did have success with amphotericin induction treatment and combination echinocandin-amphotericin therapy while hospitalized. 7,8 Although patients with CHD have increased survival into adulthood due to significant advances in surgical corrections and palliations, it is important to consider uncommon diagnoses, such as fungal IE, even in the absence of classical signs or symptoms. A good outcome in this case was possible only through early identification of the vegetation, early initiation of appropriate antimicrobial agents, and surgical repair.…”

“…The decision for early surgery is in line with current guidelines for fungal IE. 5 Although recent case reports suggest success with antifungal therapy alone 7 or no difference between surgical and medical management, 8 these reports do not distinguish the CHD population from the general IE population and the majority of these patients had IE of the aortic valve, not the pulmonary valve. In line with these studies, however, our patient did have success with amphotericin induction treatment and combination echinocandin–amphotericin therapy while hospitalized.…”

A case series of medically managed Candida Parapsilosis complex prosthetic valve endocarditis and literature review

“…Through up-to-date review of all previous cases, 12 cases of Candida Parapsilosis complex prosthetic valve endocarditis had been reported (Table 2) [13][14][15][16][17][18][19][20][21][22][23] . Besides, two articles described outbreaks of Candida parapsilosis prosthetic valve endocarditis following cardiac surgery, including 8 dead cases and one alive case without detailed information 24,25 .…”

Infectious endocarditis and infection of intracardiac devices in adults. Clinical guidelines 2021

“…• Пациентам с кандидозным ИЭ рекомендовано назначать #микафунгин** 200 мг/сут. в/в капельно [122], #каспофунгин** 70 мг в первый день, далее 50-100 мг в сутки в/в капельно [160,161], #анидулафунгин 200 мг в первый день, далее 100-200 мг в сутки в/в капельно [162][163][164], а также #амфотерицин В** в дозе 1 мг/кг/сут. [112] или #амфотерицин В [холестерилсульфатный комплекс] в дозе 4 мг/кг/сут.…”