Infective Endocarditis of Native Valves due to Aspergillus in an Immunocompetent Host: A Rare Presentation

Abstract

Aspergillus endocarditis is a rare entity in an immunocompetent host with native valves. Late or misdiagnosis leads to increased morbidity and mortality. In this report authors present a case of native valve Aspergillus endocarditis, in 30-year-old male immunocompetent patient with no co-morbidities. The patient also had a parietal glioma. He underwent four surgeries including valve replacement during the course of illness. Patient improved with appropriate antifungal therapy and surgeries. He was on suppressive antifungals and continued to do well. Aspergillus endocarditis is to be considered in culture negative endocarditis. The optimal management includes adequate surgical debridement in conjunction with prolonged antifungal therapy.

“Not much room for mushrooms” in the heart: knowns and unknowns of fungal infective endocarditis

“…This could be the reason for the surprisingly low mortality rate of the current case series, particularly those with prosthetic valve endocarditis (PVE) [1,53,58,80,89,103,107] . However, in line with prior observations, Candida species, with a reported 40%-60% rate [44,52,57,60,69,62,94,96,123,126] , is the most frequently reported infectious agent in the current case series.…”

“…In many cases with negative cultures or difficulties in identifying the infecting fungal microorganism, beta-D-glucan testing was performed. This was needed in a minority of Candida infections [51,54,55] but more often in Aspergillus [81,84,87,90,92,96] and certain other fungal species [101,106,107,118,[120][121][122][123][124] . Detection for the presence of galactomannan was also performed in IE by Aspergillus [85,89,92,93] and other uncommon species [112][113][114]120,121,125] .…”

“…Most of the cases underwent computer tomographic (CT) imaging and MRI of the brain, thorax, abdomen, and pelvis, as well as CT-angiography, encompassing almost all infective species involved. A positron emission tomography or PET/CT scan was performed in order to confirm or exclude other septic foci for various fungal species such as Candida [50,60,69,80] , Aspergillus [96,97] , and other infective agents [104,119] . and delay of diagnosis of > 30 days showed no significant effect.…”

“…Second, prior valve implantation and electronic cardiac implants or indwelling central catheters should also raise suspicion. An infection of ascending aortic graft is also a cause for concern [96,121,123] . Prior valve replacement might lead to sooner detection of fungal IE [106] .…”

“…After discussion with clinical laboratory experts, serial blood testing or incubation for several weeks can be considered necessary since these organisms are fastidious [41,55,64,90,102,107,118] . So-called negative results should not be discarded [86,96,102,104] . Candida is likely to be recovered as a causative agent in blood cultures, but a timely diagnosis of Aspergillus endocarditis remains elusive.…”