Fungal Endocarditis: Update on Diagnosis and Management

Pasha, Ahmed K.; Lee, Justin Z.; Low, See Wei; Desai, Hem; Lee, Kwan S.; Mohajer, Mayar Al

doi:10.1016/j.amjmed.2016.05.012

Cited by 67 publications

(70 citation statements)

References 40 publications

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“…Fungal endocarditis is an uncommon cause of infective endocarditis and massive pulmonary embolism of a mycetoma is exceptionally rare 4. The positive blood cultures to Candida albicans prior to death, have led to two possibilities.…”

Section: Discussionmentioning

confidence: 99%

Fatal fungal endocarditis in a patient with primary antibody deficiency

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Fatal fungal endocarditis in a patient with primary antibody deficiency

et al. 2017

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“…The diagnosis of fungal endocarditis is often challenging to make clinically due in part to inconsistent and nonspecific clinical presentations. While blood cultures remain the most important indication of the much more common entity of bacterial endocarditis, they have a limited role in the diagnosis of fungal endocarditis since less than 50% of reported cases demonstrated positive blood culture results (6,7). Of these positive cultures, yeast were much more likely to be isolated than molds.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the incidence of fungal endocarditis has increased in the recent past, likely due to more-frequent use of cardiovascular prosthetic devices (5). Fungal endocarditis is most prevalent in patients who are immunocompromised, intravenous drug abusers, recipients of prolonged antibiotic therapy, recipients of parenteral nutrition, and recipients of prosthetic heart valves and in those who have undergone reconstructive cardiac surgery (6). The diagnosis of fungal endocarditis is often challenging to make clinically due in part to inconsistent and nonspecific clinical presentations.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is especially important that prompt antifungal susceptibility testing is performed for the selection of the optimal antifungal regimen in cases of invasive infections. It is also recommended to use long-term suppressive therapy with antifungals after medical and surgical treatment of fungal endocarditis in general due to a high relapse rate, as well as a protracted delay in treatment response (4,6).…”

Section: Discussionmentioning

confidence: 99%

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The Brief Case: Scopulariopsis Endocarditis—a Case of Mistaken Takayasu's Arteritis

et al. 2017

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A 37-year-old Japanese woman with a past medical history of aortic valve replacement secondary to a congenital aortic aneurysm and presumed Takayasu's arteritis treated with prednisone (60 mg daily) presented to the inpatient service with shortness of breath, abdominal pain, and leg and foot pain. The patient had a 9-month history of repeated emboli and fevers. Due to the concern for an unidentified source of the emboli, a computed tomography angiography (CTA) of the chest was conducted, revealing a moderately sized pseudoaneurysm arising from the posterior margin of a previously performed ascending aortic graft and filling defects concerning for thrombi in the distal ascending aorta/proximal aortic arch near the graft anastomosis. The patient was started empirically on broad-spectrum antimicrobials consisting of intravenous vancomycin (750 mg every 12 h [q12h]), piperacillin-tazobactam (3.37 g q8h), and voriconazole (200 mg q12h).The patient underwent thrombectomy and resection of ascending aortic graft tissues, portions of which were submitted for histopathological and microbiological analysis. Histopathologic examination of the ascending aortic tissue and left iliac artery embolus and thrombus utilizing hematoxylin and eosin (H&E) stain, Gomori methenamine silver (GMS) stain, and periodic acid-Schiff stain (PAS) revealed numerous septate hyphae with dichotomous branching (Fig. 1). Based on this finding, voriconazole therapy was continued and converted to oral voriconazole (360 mg q12h) postextubation to cover suspected aspergillosis. The diagnosis of Takayasu's arteritis was dismissed as the etiology of the patient's aneurysm, and the patient's regimen of prednisone was discontinued. Blood cultures were negative throughout her hospitalization.After 3 days of incubation at 30°C, mold growth was observed on brain heart infusion agar and Sabouraud dextrose agar with chloramphenicol. The colony surface was at first white and glabrous and then became powdery and light brown with a light tan periphery (Fig. 2). The reverse was tan with a brownish center. Microscopic examination of tape preparations from the mold colony revealed septate hyphae giving rise to short conidiophores which bore annellides mostly arranged in brushlike groups. Conidia were 5 to 8 m in size, round, light brown in color, and with truncated bases (Fig. 2). Based on the colony and microscopic morphologies, the identification was most consistent with Scopulariopsis brevicaulis. Definitive species-level identification based on molecular testing was beyond the scope of this study; accordingly, the final identification was made at the genus level.Following reporting of these findings, the antibacterial therapy was discontinued after a total of 4 days and intravenous amphotericin B (65 mg q24h) was added to the Citation Arroyo MA, Walls TB, Relich RF, Davis TE, Schmitt BH. 2017. The Brief Case: Scopulariopsis endocarditis-a case of mistaken Takayasu's arteritis. J Clin Microbiol

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“…1 La citología fúngica representa entre 1 y 10% del total de las endocarditis infecciosas reportadas en los Estados Unidos, tasa que va en aumento con una mortalidad cercana a 50%. 2 La cándida albicans es la especie aislada con mayor frecuencia con 40-50% de los casos de endocarditis, seguida de cándida parapsilosis 33%, Cándida glabrata y Cándida tropicalis (4.5%). El Aspergillus spp, es responsable de 20 a 25% de las endocarditis fúngicas que se producen en especial en las válvulas cardiacas protésicas, siendo menos frecuentes El caso clínico corresponde a un paciente masculino de 77 años de edad con antecedente de cardiopatía isquémica e hipertensiva, hipertensión arterial crónica, enfermedad pulmonar obstructiva crónica (EPOC) y secuelas de evento cerebrovascular, que ingresa al servicio de urgencias por cuadro clínico de 2 días de evolución con episodios eméticos múltiples de contenido alimentario, asociados con hematemesis.…”

Section: Abstract D I S C U S I ó Nunclassified

Heterogeneidad del tratamiento para cándida parapsilosis en endocarditis micótica de válvula nativa

Baquero¹,

Cuervo²,

Moscoso³

et al. 2021

Repert. Med. Cir.

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Las infecciones por cándida en el ámbito intrahospitalario han ido en ascenso en las últimas décadas en especial en las unidades de cuidado intensivo (UCI), dado el uso cada vez más frecuente de antibióticos de amplio espectro y de procedimientos invasivos tanto diagnósticos como terapéuticos. Hoy se consideran las especies de cándida como la cuarta causa de infección del torrente sanguíneo en los Estados Unidos de Norteamérica, con alto riesgo de complicaciones que incluyen endocarditis, trombosis y embolismo séptico al sistema nervioso central (SNC) entre otros. En relación con la endocarditis por especies de cándida, se han considerado de mal pronóstico por el alto riesgo de afectación al SNC, por lo que se ha recomendado el manejo quirúrgico como piedra angular de su tratamiento. A continuación, se describe el caso clínico de un paciente con endocarditis y con candidemia por cándida parapsilosis a quien se le realizó manejo médico.

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Fungal Endocarditis: Update on Diagnosis and Management

Cited by 67 publications

References 40 publications

Fatal fungal endocarditis in a patient with primary antibody deficiency

Fatal fungal endocarditis in a patient with primary antibody deficiency

The Brief Case: Scopulariopsis Endocarditis—a Case of Mistaken Takayasu's Arteritis

Heterogeneidad del tratamiento para cándida parapsilosis en endocarditis micótica de válvula nativa

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