Abstract
Candida endocarditis is rare, but associated with a high mortality. The most common species implicated is Candida albicans . The epidemiology of invasive Candida infections is changing, with a predominance of non-albicans species causing invasive disease. We describe a case of Candida parapsilosis endocarditis in an HIV-positive patient with pre-existing mitral valve disease and renal failure on haemodialysis. The patient presented with fever and malaise. Clinical examination revealed pulmonary oedema and severe mitral regurgitation. Blood cultures were positive for C. parapsilosis . β-D-glucan assay levels were elevated. An echocardiogram showed large, friable vegetations on the mitral valve. C. parapsilosis was cultured from the haemodialysis tip and the vegetations. The patient responded well to mitral valve replacement and antifungal therapy. A high index of suspicion and aggressive diagnostic modalities and therapy are essential in patients with candidaemia, to decrease mortality due to this condition.
Highlights
Fungal endocarditis accounts for 2 - 4% of all endocarditis cases
25% are attributed to Candida albicans, other Candida species account for 25%, and Aspergillus species and other fungi account for the remainder.[1,2,3]
We present a case of native valve C. parapsilosis endocarditis, which to our knowledge, is the first reported case in South Africa
Summary
K Moodley, MB ChB, FCPath (Micro); C N Govind, MB ChB, FCPath (Micro); A K C Peer, MSc, MB ChB, MMed (Micro); S Dawood, MB ChB, FCP (SA); M H Hassim, MB ChB, FCP (SA); J Deonarain, MB ChB, FCPath (Anat). We describe a case of Candida parapsilosis endocarditis in an HIV-positive patient with pre-existing mitral valve disease and renal failure on haemodialysis. Fungal endocarditis accounts for 2 - 4% of all endocarditis cases Of these cases, 25% are attributed to Candida albicans, other Candida species account for 25%, and Aspergillus species and other fungi account for the remainder.[1,2,3] Predisposing factors for Candida parapsilosis endocarditis include prosthetic valves, intravenous (IV) drug use, parenteral nutrition, abdominal surgery, immunosuppression, treatment with broad-spectrum antibiotics and pre-existing valvular disease.[4] Mortality for Candida endocarditis is high (67%), with a lower mortality in younger patients with a history of IV drug use.[5] We present a case of native valve C. parapsilosis endocarditis, which to our knowledge, is the first reported case in South Africa
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