Histoplasma capsulatum endocarditis

Blair, Timothy P.; Waugh, Robert; Pollack, Matthew; Ashworth, Halbert E.; Young, Nathaniel A.; Anderson, Seth E.; Thomas, Preenumol

doi:10.1016/0002-8703(80)90630-4

Cited by 16 publications

(6 citation statements)

References 31 publications

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“…The diagnosis of H. capsulatum infective endocarditis is challenging, as health care providers may not ask pertinent questions regarding acquisition risk factors (occupation, travel, and exposure sources). In this review, infected adults were predominantly male for both native (83%) and prosthetic (79%) valve infection, consistent with previous case series [ 26 , 29 , 32 , 38 , 41 , 44 , 48 ]. This is not surprising, as male-predominant occupations and activities (construction, farming, home repair, tree trimming, etc.)…”

Section: Discussionsupporting

confidence: 89%

“…Prosthetic tricuspid or prosthetic pulmonic valve endocarditis was not observed. This novel finding was likely obscured in previous case series as native and prosthetic valve involvement were presented in aggregate [ 26 , 29 , 32 , 38 , 41 , 44 , 48 ]. To our knowledge, individuals in this review did not have prosthetic tricuspid or pulmonic valves or risk factors (ie, intravenous drug use) predisposing them to have undergone native tricuspid or pulmonic valve replacement.…”

Section: Discussionmentioning

confidence: 89%

“…H. capsulatum infective endocarditis is invariably fatal without combined surgical intervention and antifungal treatment [ 26 , 29 , 32 , 38 , 41 , 44 , 48 ]. As observed in this review, individuals failing to receive both antifungal therapy and surgical intervention for native or prosthetic valve endocarditis had a mortality rate of 100%.…”

Section: Discussionmentioning

confidence: 99%

“…For those with disseminated infection, H. capsulatum endocarditis is a rare complication, with ~80 cases reported in the medical literature from 1940 to 2020 [ 2–53 ]. Over this 80-year period, published case series have summarized characteristics such as patient clinical features, patient treatment modalities and outcomes, and the utility of diagnostic laboratory tests [ 7 , 12 , 19 , 26 , 29 , 30 , 32 , 38 , 41 , 44 , 48 ]. However, these case series did not consider stratifying these characteristics by native vs prosthetic valve infection.…”

mentioning

confidence: 99%

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Native vs Prosthetic Valve Histoplasma capsulatum Infective Endocarditis: A Case Report and Systemic Literature Review Comparing Patient Presentation, Treatment Modalities, Clinical Outcomes, and Diagnostic Laboratory Testing

Boyanton

Boamah

Lauter

2021

Open Forum Infectious Diseases

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Histoplasma capsulatum is a rare cause of fungal endocarditis that affects both native and prosthetic valves. It is associated with a high mortality rate if not diagnosed early and treated with a combination of antifungal therapy and surgical intervention. We present a case of a 47-year-old man with histoplasmosis infective endocarditis. He was successfully treated with antifungal therapy and surgical replacement of the infected bioprosthetic aortic valve. Our systemic literature review includes fifty-two articles encompassing sixty individual cases of H. capsulatum infective endocarditis from 1940 to 2020. Patient presentations, diagnostic laboratory testing accuracy, treatment modalities and patient outcomes, comparing and contrasting native and prosthetic valve infection, are described.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Native vs Prosthetic Valve Histoplasma capsulatum Infective Endocarditis: A Case Report and Systemic Literature Review Comparing Patient Presentation, Treatment Modalities, Clinical Outcomes, and Diagnostic Laboratory Testing

Boyanton

Boamah

Lauter

2021

Open Forum Infectious Diseases

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“…In several valve specimens, there were large, thick-walled structures that could be derived from yeasts or perhaps represent abortive sporulation; they also could be large irregular hyphae cut in cross section. The ability of H. capsulatum to produce hyphae when causing an intravascular infection has been commented upon before 6 , 15 , 16 , 28 ; Hutton et al 16 noted that 9 of 27 cases of Histoplasma endocarditis described prior to 1986 showed hyphae in valvular tissue or arterial emboli. Recent cases of Histoplasma endocarditis, in addition to those in this report, also describe hyphae in valve tissue and emboli.…”

Section: Discussionmentioning

confidence: 99%

Histoplasma capsulatum Endocarditis

et al. 2014

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Infective endocarditis is an uncommon manifestation of infection with Histoplasma capsulatum. The diagnosis is frequently missed, and outcomes historically have been poor. We present 14 cases of Histoplasma endocarditis seen in the last decade at medical centers throughout the United States. All patients were men, and 10 of the 14 had an infected prosthetic aortic valve. One patient had an infected left atrial myxoma. Symptoms were present a median of 7 weeks before the diagnosis was established. Blood cultures yielded H. capsulatum in only 6 (43%) patients. Histoplasma antigen was present in urine and/or serum in all but 3 of the patients and provided the first clue to the diagnosis of histoplasmosis for several patients. Antibody testing was positive for H. capsulatum in 6 of 8 patients in whom the test was performed.Eleven patients underwent surgery for valve replacement or myxoma removal. Large, friable vegetations were noted at surgery in most patients, confirming the preoperative transesophageal echocardiography findings. Histopathologic examination of valve tissue and the myxoma revealed granulomatous inflammation and large numbers of organisms in most specimens. Four of the excised valves and the atrial myxoma showed a mixture of both yeast and hyphal forms on histopathology.A lipid formulation of amphotericin B, administered for a median of 29 days, was the initial therapy in 11 of the 14 patients. This was followed by oral itraconazole therapy, in all but 2 patients. The length of itraconazole suppressive therapy ranged from 11 months to lifelong administration. Three patients (21%) died within 3 months of the date of diagnosis. All 3 deaths were in patients who had received either no or minimal (1 day and 1 week) amphotericin B.

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