Case Of Fungal Endocarditis Research Articles

Successful management of fungal pericarditis and endocarditis in a neonate: A case report

Neonatal fungal endocarditis is a rare but serious infection, which does not have a well-accepted management method. This is the second report of this condition in Saudi Arabia. A preterm, very low birth weight, female neonate presented with fever and shortness of breath. An echocardiogram showed moderate pericardial effusion and two masses in the heart, one in the right ventricle and the other in the inferior portion of the posterior mitral valve of the left ventricle. Blood and pericardial fluid cultures revealed an infection with Candida albicans. The patient received a 60days course of intravenous fluconazole and amphotericin B lipid complex. At the conclusion of treatment, she was discharged in good condition with no echocardiographic evidence of pericardial effusion or fungal vegetations. Thus, a successful outcome to a serious case of fungal endocarditis was achieved through aggressive antifungal therapy with intravenous fluconazole and amphotericin B lipid complex.

Endocarditis por hongos en pacientes no adictos a drogas por vía parenteral. Nuestra experiencia en 10 años

Fungal endocarditis is an uncommon but serious disease. Five cases of fungal endocarditis, involving non-addict patients, were diagnosed at our hospital in the last 10 years. Causal organisms included Candida albicans (3 patients), Saccharomyces (1 patient) and Torulopsis glabrata (1 patient). The predisposing condition to fungal infection was previous cardiac surgery in four cases (three of them with prosthetic heart valves, and the other patient underwent total surgical correction of Tetralogy of Fallot). No predisposing cause was found in one patient. All patients developed important complications. Three cases underwent cardiac surgery that evolved favorably, and two patients had contraindications for surgery and died from multiorgan septic involvement (overall survival was 60%). The incidence of fungal endocarditis involving non-addict patients has represented 3% of all cases of infective endocarditis. Even nowadays, fungal endocarditis is a disease with a high mortality and a precocious diagnosis is important to approach surgical treatment and to improve its prognosis.

Early fungal endocarditis in homograft recipients

Retrospective analysis of 200 homograft valve recipients at our institution revealed two cases of fungal endocarditis. Pathogenesis appears to be related to either recipient seeding in one elderly immunocompromised patient or a previously contaminated donor valve implanted in an otherwise healthy recipient. Therefore, our experience underscores the need for both meticulous prevention of fungal infection preoperatively in the recipient and elimination of previously contaminated homograft valves from the donor pool.

Postoperative infection in cardiac surgery: the influence of a change in prophylactic antibiotic regimen

A total of 448 patients undergoing cardiovascular surgery were followed for the development of postoperative infection. Non-extracorporeal procedures were assigned to group 1 and open-heart procedures to group 2. The incidence of infection was compared in two groups who received prophylactic antibiotics. Patients (n = 253) received ampicillin alone (group 1) or in combination with gentamicin (group 2) for 7 days starting 1 day before the operation (period A). One hundred and ninety-five patients (period B) received cefazolin starting preoperatively 30 min before induction, alone (group 1) or in combination with gentamicin (Group 2) for 3 days. The percentage of patients developing infection in periods A and B for group 1 patients was 4·2% and 3·5% and for group 2 it was 25·8% and 18·7% respectively. The overall infection rate was 13%. The number of infection sites involved were 1·5 per infected patient. Urinary tract infections were the most frequent followed by endocarditis and other deep infections, wound infections and respiratory infection. Gram-negative rods were the predominant pathogens ( Klebsiella spp. and Pseudomonas aeruginosa) during both periods (47 out of 70 isolates). Wound infections due to Gram-positive cocci were higher in period A ( 4 8 ) as compared to period B ( 1 5 ). During period B there were three cases of fungal endocarditis whereas no case occurred during period A. Although the incidence of infection was reduced during the period of cefazolin prophylaxis, the difference was not statistically significant.

Aspergillus endocarditis after open heart surgery: an epidemiological investigation

The occurrence of aspergillus endocarditis in four patients after open heart surgery, within a period of 10 months, in a centre where no case had been encountered in the previous 7 years, led us to investigate the possible source and factors contributing to this ‘outbreak’. The ventilation system, air conditioning plant, air and inanimate sources in the operating theatre were investigated. With the exception of the operating room which was fitted with laminar air flow, it was possible to isolate Aspergillus spp. from all rooms in the operating suite. Air conditioner cooling coils and pigeon droppings on the ledges outside the suite were found to harbour aspergillus spores in large amounts. The ubiquitous presence of Aspergillus spp. in the operating suite indicated that the existing ventilation system was ineffective in eliminating aspergillus spores from the operating environment. The use of a newly introduced broad spectrum antibiotic protocol seemed to be a major contributory factor according to incidental evidence (although no case control studies were done). Improvements in the ventilation system and the restriction of newly introduced antibiotics was recommended. No further case of fungal endocarditis was observed up to the time of reporting (6 months after the last case).

Fungal endocarditis caused byArnium leporinumfollowing cardiac surgery

A case of fungal endocarditis caused by the coprophilous ascomycete Arnium leporinum is reported in a 19-year-old male living in Colombia. The fungus was seen in tissue and recovered in pure culture from peripheral emboli, a mitral valve, pus from an osteolytic lesion, and kidney. The patient died 21 months after cardiac surgery. The range of A. leporinum in the Americas is expanded to include Colombia.

Results of Replacement of Cardiac Valves by Homologous Dura Mater Valves

Homologous dura mater valve was employed in a series of 533 patients in the period between January 1971 and May 1974. The dura mater was sterilized and preserved in 98 percent glycerol solution at room temperature. Important data were the following (1) no significant pressure gradient through the vale at rest; (2) no bacterial endocarditis; (3) two cases of fungal endocarditis; (4) no degeneration or retraction of the leaflets; (5) no thrombus formation in the valve; and (6) no anticoagulants were used in this series.