Polymicrobial Pseudomonas Plus Candida Parapsilosis Endocarditis in an Injection Drug User: Considerations for Diagnosis and Management

Maninder Kaur,Parminder Virdi,Diane L Levine,Ramanjit Kaur,Aiden Abidov

doi:10.7759/cureus.13507

Abstract

Fungal endocarditis (FE) is a potentially lethal condition and its diagnosis can be challenging due to the low yield from blood cultures. FE should be suspected in patients with associated risk factors despite the identification of positive bacterial blood cultures. The common risk factors for FE discussed in the literature are total parenteral nutrition, immune suppression, prior antimicrobial therapy, intravenous drug addiction, and cardiac surgery. In this report, we discuss a patient who had positive blood cultures for Pseudomonas but was found to have Candida parapsilosis on valve culture. Physicians need to maintain a high index of suspicion for co-infective endocarditis in this patient population.

Highlights

Fungal endocarditis (FE) is a rare entity, which accounts for only 2-4% of all cases of infective endocarditis (IE) [1]
In the setting of multiple risk factors, we suggest that identification of a bacterium should not decrease suspicion of FE
FE is a serious disease associated with high mortality rates

Summary

Introduction

Fungal endocarditis (FE) is a rare entity, which accounts for only 2-4% of all cases of infective endocarditis (IE) [1]. The patient had idiopathic CD4 lymphocytopenia and had repeatedly tested negative for HIV and other causes of CD4 cell depletion He was an active injection drug user with his latest injection of heroin occurring on the day of admission. On day three of admission, a transthoracic echocardiogram (TTE) was performed and showed possible vegetation on the aortic valve. This was confirmed by a transesophageal echocardiogram (TEE), which demonstrated large mobile vegetation on the non-coronary cusp protruding into the left ventricle outflow tract with each systole suggestive of an aortic root abscess (Figure 1, Figure 2). The patient completed six weeks of therapy and was found to be doing well three months after presentation

Discussion

Conclusions

Findings

Disclosures