Aspergillus Endocarditis Research Articles

Recurrent Aspergillus endocarditis in an immunocompetent patient: challenges in diagnosis and management

We describe an unusual case of recurrent Aspergillus endocarditis in an immunocompetent 64-year-old lady. Four weeks after aortic valve replacement surgery, she presented with an inferior ST elevation myocardial infarction. Coronary angiography demonstrated compromise of the ostium of the right coronary artery, which was successfully treated by primary angioplasty and stenting. Six weeks later, she suffered from a subarachnoid haemorrhage secondary to a mycotic aneurysm. A transoesphageal echocardiogram suggested a large aortic root vegetation. She underwent urgent aortic root replacement with removal of the vegetation, which was subsequently confirmed to be caused by Aspergillus. She was discharged on long term anti-fungal medication (Voriconazole), which she discontinued after seventeen weeks. Several years later, she presented with non-specific symptoms and was ultimately diagnosed with a recurrence of Aspergillus endocarditis. This case illustrates one of the many non-specific ways Aspergillus endocarditis can present. A high index of suspicion can prevent significant life-threatening complications.

Right atrial aspergilloma mimicking atrial mixomax

Infective endocarditis is a serious but relatively rare infection that is associated with high morbidity and mortality rates. Aspergillus endocarditis is an uncommon entity and invasive cardiac aspergillosis is a severe and extremely life threatening disease. Prolonged use of intravascular catheters, anatomical cardiac conditions, exposure to multiple broad-spectrum antibiotics, intravenous drug abuse, and previous history of surgery are the most common risk factors of fungemia and fungal endocarditis. Diagnosis is based on the isolation of etiologic agents from cardiac and blood samples or specimens from other sterile sites or positive histopathological findings of pathologic specimens. Echocardiographic findings of endocardial involvement can lead to diagnosis. Echocardiographically, differencial diagnosis of tumor extensions, especially myxoma, atipically located bacterial vegetations, thrombus or fungal masses is very difficult as thrombi and infective verrus can mimic myxomas. Treatment of fungal endocarditis only with antifungal agents is generally unsuccessful and additional surgical intervention is usually required. In this case report we present an fungal endocarditis caused by Aspergillus species that mimicked an atrial myxoma echocardiographically in a patient who had a history of treatment with wide spectrum antibiotics for a long time. We suggest that patients who had broad spectrum antibiotic treatment for a long time should be scanned for fungal infections and if intracardiac mass is determined, fungal endocarditis should be considered in differential diagnosis.

Aspergillus endocarditis in a 33‑year‑old patient with bone marrow aplasia

Aspergillus endocarditis in a 33‑year‑old patient with bone marrow aplasia

Pulmonary endarterectomy for saddling pulmonary embolism by Aspergillus fungus in an immunocompetent patient

We present a case of Tricuspid valve Aspergillus endocarditis with saddle shaped massive pulmonary embolism occurring in an immunocompetent host. The patient was managed uniquely by pulmonary endarterectomy (PEA) and combination antifungal chemotherapy with Liposomal amphotericin-B + caspofungin.

Fungal endocarditis observed over an 8-year period and a review of the literature.

Fungal endocarditis (FE) is a "modern" disease that is considered an emerging cause of infective endocarditis (IE). The most frequently identified fungal pathogens are Candida spp., which are responsible for up to two-thirds of all cases; the remaining cases are due to Aspergillus spp., Histoplasma capsulatum or, more rarely, other yeasts and moulds. To describe the prevalence, clinical characteristics and outcome of FE diagnosed in a single tertiary centre and review the literature concerning FE. An 8-year retrospective review of the case records of patients attending a single Italian University Centre and diagnosed as having definite or probable IE as defined by the modified Duke criteria. Six patients were identified from 229 episodes of IE: five cases involved a prosthetic valve, and one a native valve of an intravenous drug user. Five cases were caused by Candida spp. (two by C. albicans, one each by C. lusitaniae, C. dubliniensis and C. glabrata) and one by Aspergillus flavus. Three patients were treated by means of surgery plus antifungal therapy; two received antifungal therapy alone. Three patients survived, but only the patient with Aspergillus endocarditis was followed up for a long time. FE is difficult to diagnose but generally associated with healthcare infections. The optimal treatment is poorly characterised, and international collaborative studies are urgently needed to evaluate newer antifungal agents.

Aspergillus endocarditis in a paediatric patient after a cardiac surgery, associated with septic pulmonary embolism and pulmonary hypertension

We report a rare case of pulmonary prosthetic valve endocarditis due to Aspergillus fumigatus, associated with septic pulmonary embolism and secondary pulmonary hypertension, in a 4-year-old boy with surgically corrected tetralogy of Fallot. The diagnosis and treatment of Aspergillus endocarditis remains highly challenging. The best therapeutic option for chronic thromboembolic pulmonary hypertension due to an infectious thromboembolic event is highly debatable and the results are poor.

A Case of Infective Endocarditis with Cytomegalovirus Infection after Kidney Transplantation

Advances in immunosuppressive therapy have increased the survival of kidney transplant recipients, yet suppression of the immune system after transplantation can promote infectious complications. Cytomegalovirus (CMV) infection remains one of the most important complications following kidney transplantation and it is a risk factor for developing superinfections with other organisms. Aspergillus endocarditis is a rare life‐threatening complication in kidney transplantation. Coinfection of CMV and Aspergillus endocarditis is rare worldwide and has not been reported in Korea. We report a case of Aspergillus endocarditis that developed in a patient with CMV infection after kidney transplantation. His clinical condition did not improve despite mitral valve replacement and empirical antibiotic treatment, but he was eventually treated successfully with antifungal agents for 6 weeks. (Korean J Med 2014;86:627-631)

Fungal endocarditis

Fungal endocarditis remains a rare disease occurring mostly in patients with predisposing host conditions. Regarding its poor prognosis because of severe complications, there is an urgent need for properly established treatment guidelines and prophylaxis for patients at risk. In this review we provide up-to-date information on treatment recommendations, and discuss recent case reports on fungal endocarditis and challenges in prophylaxis and treatment. Over the last year, an increase in cases caused by non-albicans species of Candida and other fungi like Fusarium solani, Lodderomyces elongisporus and Exophiala dermatitidis was reported. They were treated individually in case-by-case approaches, lacking randomized controlled trials and, mostly, treatment recommendations. The scarcity of fungal endocarditis demands a high index of suspicion and knowledge of the group of at-risk patients. Diagnosis aggressively pursued by echocardiography and multiple blood cultures or surgical specimens has the potential to improve outcome. Candida endocarditis should be treated immediately, including surgical treatment in combination with liposomal amphotericin B or caspofungin with optional addition of flucytosine. Aspergillus endocarditis requires rapid surgery and voriconazole.

Aspergillus endocarditis presenting as acute right lower limb pain

Corrigendum: On 31/10/2013 the name of the author K. Shah was corrected to read K. Saha.Aspergillus endocarditis is an 2nd most common cause of endocarditis having poor prognosis. We report a rare case of fungal endocarditis following cardiac valve replacement presenting as acute pain in the right lower limb. Embolism and endocarditis were primarily detected by CT angiography and echocardiography respectively. Diagnosis was established by histopathology and culture of the emboli and was confirmed later by isolation of the Aspergillus species from the resected valve tissue. DOI: http://dx.doi.org/10.3126/jpn.v3i6.9002 Journal of Pathology of Nepal (2013) Vol. 3, 502-504

Aspergillus endocarditis in a patient with acute lymphoblastic leukemia

1Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey 2Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey 3Department of Infectious Diseases, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

Aspergillus Endocarditis in Lung Transplant Recipient: Successful Surgical Treatment

Solid organ transplantation can be followed by Aspergillus infection, implying high mortality rates. The highest infection rates are registered among lung transplant recipients. We present a recent case of an Aspergillus endocarditis in a young lung transplant recipient.

P47 FEATURES OF INFECTIVE ENDOCARDITIS CAUSED BY AEROCOCCI

P47 FEATURES OF INFECTIVE ENDOCARDITIS CAUSED BY AEROCOCCI

Fulminant invasive aspergillosis of the mediastinum in an immunocompetent host: a case report

IntroductionInvasive aspergillosis is a serious complication in immunocompromised patients. It is an opportunistic disease, which predominantly occurs in the lungs, although dissemination to virtually any organ is possible. Invasive aspergillosis in an immunocompetent patient with extension to the mediastinum has rarely been reported. Here, we present the case of a patient with no apparent immunodeficiency state, who presented with Aspergillus endocarditis and fulminant invasive aspergillosis with extensive involvement of the mediastinal structures, which ultimately was responsible for her death. To the best of our knowledge, this is the first reported case in the literature on fulminant invasive mediastinal aspergillosis with extension to the pulmonary vasculature and concomitant Aspergillus endocarditis in an apparently immunocompetent patient without pre-existing lung disease.Case presentationOur patient was a previously healthy 47-year-old Asian woman, who presented to our emergency room with severe progressive shortness of breath of one month’s duration, associated with orthopnea and unstable vital signs.ConclusionInvasive aspergillosis has been described in the presence of pulmonary disease, such as chronic obstructive pulmonary disorder, and one case has been reported in a patient without preexistent disease, but none of these have been fatal. Our case is therefore the first reported case of its kind. Our case shows that fulminant aspergillosis can occur in an immunocompetent host and can be fatal. We conclude that invasive aspergillosis should not be excluded from the differential diagnosis on the basis of immunocompetency.

Aspergillus endocarditis in a native valve without prior cardiac surgery

Aspergillus native valve endocarditis continues to be a lethal disease, even when maximal therapeutic options are taken. We describe herein a patient with mitral valve endocarditis due to Aspergillus fumigatus following colon cancer and invasive pulmonary aspergillosis. Voriconazole was effective in controlling pulmonary and cerebral aspergillosis, despite the relative ineffectiveness for the vegetation. With the combination of aggressive medical and surgical therapy, the patient survived and remains without any evidence of infection 2 years later.

Acute Myocardial Infarction Caused by Coronary Embolism from <i>Aspergillus</i> Endocarditis

Although the primary cause of acute coronary syndrome is atherosclerotic disease, it is important to include other causes of acute myocardial infarction. This report describes the case of a 53-year-old man with acute myeloid leukemia, who was referred to our cardiology department for treatment of acute myocardial infarction with ST segment elevation on an electrocardiogram. Portable echocardiography showed large areas of vegetation on the anterior mitral leaflet, while coronary angiography demonstrated the total occlusion of the left anterior descending artery. A histologic examination of the embolectomy specimen confirmed the presence of Aspergillus fungal thrombi. This report highlights a rare case of fatal Aspergillus endocarditis with myocardial infarction due to embolism in an immunosuppressed patient.

Aspergillus endocarditis: a case of near complete left ventricular outflow obstruction

A 60-year old woman presented with dyspnoea and fatigue. She was frail and cachectic (BMI 17.5) with a pancytopenia. Previously she had received chemotherapy for chronic lymphatic leukaemia. She relapsed one year ago necessitating a reduced intensity conditioning allogeneic haematopoietic cell transplantation. Subsequently, graft versus host disease required high-dose immunosuppressants. Computerized tomography on admission showed bilateral lung nodules and a suspicious cardiac mass. Bronchial biopsies demonstrated abundant hypae consistent with Aspergillus fumigatus infection. Echocardiography demonstrated a large fungus ball attached to the right coronary cusp of the aortic valve with near complete obliteration of the left ventricular outflow tract. Due to the high risk of embolization this was resected under cardiopulmonary bypass. The mass was attached subvalvularly to the ventricular septal free wall and eroding through it. It peeled off leaving intact aortic leaflets. Unresectable fungal deposits were discovered on the interventricular septum, the left ventricle free wall and posterior aortic wall. High-dose systemic antifungal therapy (Voriconazole and Amphoteracin B) was given for 4 months. After discharge she remained well till a 4-month follow-up, after which she eventually succumbed to her disease. We discuss the clinical difficulties in managing patients with fungal infective endocarditis and present a brief review of cardiac aspergillosis management.

Late post-operative Aspergillus flavus endocarditis: Demonstration of a six years incubation period using microsatellite typing

Late post-operative Aspergillus endocarditis is an under recognized life-threatening complication of heart valvular surgery. Optimal prevention and treatment need enhanced awareness. We report three cases of post-operative Aspergillus flavus endocarditis, including one with a 6-year long incubation period. Microsatellite typing incriminated a recurrent contamination of hospital environment.

Two Cases of Aspergillus Endocarditis in Non Neutropenic Children on Chemotherapy for Acute Lymphoblastic Leukaemia

Fungal endocarditis (FE) is a rare complication in immunocompromised patients which is difficult to diagnose and has been characterized by excessive mortality (> 50%) and morbidity, regardless of treatment. The lack of clinical trials due to the small number of cases contributes further to a poor outcome. In our two cases of aspergilllus endocarditis we reviewed the clinical features, echocardiographic findings, microbiologic data, treatment, and outcome of these 2 cases and provide a current characterization of the syndrome. In this paper we have demonstrated the diversity of presentation of a critical fungal infection in immunocompromised but non neutropenic paediatric patients. The prompt diagnosis and initiation of treatment is crucial for a favourable outcome along with the use of double antifungal treatment with liposomal amphotericin and voriconazole initially which could be later switched to oral voriconazole with a good tissue penetration. Histological samples as well as radiological evidence and echocardiograms should be reviewed by experienced clinicians in order to aid diagnosis and promptly initiate treatment for these patients in order to achieve a favourable outcome

Potentially fatal tricuspid valve aspergilloma detected after laparoscopic abdominal surgery

Fungal endocarditis accounts for 1.3-6% of all cases of infective endocarditis. The most common causative organism is Candida, followed by Aspergillus and other mould fungi. Aspergillus endocarditis is usually associated with high morbidity and mortality. Establishing a definitive and timely diagnosis remains difficult and there are many reports of undetected aspergillomas leading to fatalities in the perioperative period. We present a case report of preoperatively undiagnosed large mobile tricuspid valve aspergilloma obstructing the right ventricular inlet, diagnosed incidentally on the second postoperative day after laparoscopic pancreatic abscess drainage. The patient was successfully managed with emergency open-heart surgery and systemic antifungal agents in the postoperative period.

Aspergillus endocarditis in lung transplant recipients: case report and literature review

We present a case of endocarditis caused by Aspergillus in a lung transplant (LT) patient and review 6 previously reported cases. All cases were caused by Aspergillus fumigatus. Five patients (71%) were transplanted due to cystic fibrosis. None of the patients had any previously known valvular heart disease. The time that elapsed between LT surgery and the diagnosis of Aspergillus endocarditis was 8±6 months. Large peripheral emboli were observed in 6 patients (85%); blood cultures were negative in all. Transthoracic echocardiography did not detect the presence of vegetations in 3 patients (43%); the vegetations measured >1.5 cm in all cases. Five patients (71%) died from disseminated disease. Both survivors underwent combined therapy with antifungal drugs and surgical treatment.