Successful treatment of liposomal amphotericin B refractory Candida glabrata fungaemia in a patient undergoing a stem cell transplantation

Blood stream infections caused by Candida glabrata are difficult to manage. We describe a patient who underwent an allogeneic peripheral stem cell transplantation for acute myeloid leukaemia. The patient developed C. glabrata fungaemia that was refractory to liposomal amphotericin B therapy. After changing the therapy to caspofungin, blood cultures became sterile within two days and the patient recovered clinically. The patient died shortly after due to graft-versus-host disease and at autopsy there was no evidence of residual or persistent Candida infection. Caspofungin was effective in liposomal amphotericin-B refractory C. glabrata fungaemia and proved to rapidly clear the infection. Treatment options for candidaemia are discussed.     

Primary angioplasty with DES-supported culottes stenting to revascularizing a dual left anterior descending coronary artery

We report a case of aortic valve endocarditis with aortic root abscess from Candida parapsilosis occurring 8 months after transient candidemia. Despite the fact that the patient was treated appropriately, candidemia persisted and later on presented with an embolic stroke as a complication of fungal endocarditis.     

New antifungal agents

Two new antifungal agents, voriconazole and caspofungin, are now available for treatment of systemic fungal infections. Voriconazole is an extended-spectrum triazole that is fungicidal for filamentous fungi, including Aspergillus, Scedosporium, Fusarium, Paecilomyces, and is active against all species of Candida. It has become first-line therapy for invasive aspergillosis. Voriconazole is given either by the oral or the intravenous route. Clinicians must be aware of drug-drug interactions and side effects, including visual disturbances and photosensitivity rash that can occur when voriconazole is used. Caspofungin is the first drug available from a new class of antifungal agents, echinocandins, that act to inhibit fungal cell wall synthesis. Caspofungin is fungicidal for all species of Candida and more slowly kills Aspergillus species. Caspofungin, available only for intravenous administration, has minimal side effects and very few drug interactions. The echinocandins will find most use for Candida infections and as second-line therapy for Aspergillus infections.     

卡泊芬净治疗高龄患者侵袭性真菌病29例临床分析

目的 观察卡泊芬净治疗高龄患者侵袭性真菌病(IFD)的疗效和安全性. 方法 回顾分析我院老年病房接受过卡泊芬净治疗的IFD患者的临床资料. 结果 2007年1月至2009年8月共有29例患者接受卡泊芬净治疗,且均为80岁以上高龄患者.除1例于用药当天死亡外,28例可评价疗效的患者中,痊愈13例(46.4%),显效6例(21.4%),进步3例(10.8%),无效6例(21.4%),总有效率为67.8%.13例痊愈者中,12例为念珠菌菌血症患者,1例为拟诊肺白念珠菌病患者.无效6例患者中,2例为念珠菌菌血症患者,1例为拟诊肺念珠菌病患者,3例为疑诊肺IFD患者.治疗过程中1例患者出现谷丙转氨酶升高,考虑为与用药有关的肝功能受损. 结论 卡泊芬净是治疗高龄患者侵袭性真菌病的安全有效药物.     

Fighting fungus with a laser and a hose: Management of a giant Candida albicans implantable cardioverter‐defibrillator lead vegetation with simultaneous AngioVac aspiration and laser sheath lead extraction

Infections involving internal cardiac devices can be very challenging to treat, and almost universally require complete device extraction for successful management. Of the pathogens that cause device‐related endocarditis, fungi such as Candida albicans are notoriously difficult to manage because of their propensity to produce large vegetations and the need for long‐term treatment with potentially toxic medications. Furthermore, individuals who develop fungal, device‐associated endocarditis are typically among the most complex patients, with significant comorbidities that place them at high risk for open heart procedures such as surgical device extraction. We present a case of one such patient in whom treatment of Candida albicans device‐related endocarditis was managed using AngioVac^® aspiration of a large right atrial vegetation with simultaneous laser sheath extraction of the implantable cardioverter‐defibrillator lead.     

近平滑念珠菌性心内膜炎致多发动脉栓塞1例并文献复习

<正>对临床上反复发热伴严重栓塞并发症的患者,需警惕真菌性心内膜炎(fungal endocarditis,FE)可能。由于其临床表现的多样性和高死亡率,因此需早期诊断及早期手术治疗以改善预后。在FE致病菌中,近平滑念珠菌仅次于白色念珠菌成为第二大致病菌。现报道1例由近平滑念珠菌感染的FE致多发动脉栓塞的病例,并复习相关文献。病例资料患者男,53岁,因"间断发热3个月,加重伴上腹痛3 d"于2015年10月20日收住院,患者诉3个     

Successful medical treatment of Candida albicans in mechanical prosthetic valve endocarditis

Fungal prosthetic valve endocarditis is particularly serious, and is usually a result of nosocomial candidaemia. This report describes a patient with Candida albicans prosthetic valve endocarditis in whom surgery was believed to be contraindicated. After 45 d of amphotericin B, treatment was continued with fluconazole daily with a follow-up of 16 months, with no recurrent or adverse effects.     

Late recurrent Candida endocarditis

Late recurrent Candida endocarditis (LRCE) developed on a prosthetic mitral valve 22 months after treatment for primary native mitral valve endocarditis. The LRCE was difficult to diagnose; results of two dimensional echocardiography and repeated blood cultures were negative. Only transesophageal echocardiography revealed a vegetation and only lysis centrifugation blood cultures demonstrated candidemia. Postmortem examination revealed a large Candida vegetation on the prosthetic valve and Candida in the mitral valve ring. This case and a review of the literature indicate that Candida endocarditis treated with amphotericin B and prosthetic valve replacement may recur months after treatment, and that LRCE, which is difficult to diagnose and treat, may be best prevented by lifelong antifungal suppressive therapy.     

Development of Candidemia on Caspofungin Therapy: a Case Report

Abstract Caspofungin, an echinocandin, is approved for use in invasive candidiasis. Few cases of break-through candidal infections during caspofungin therapy have been reported and none have involved Candida parapsilosis. Here, we report a patient who developed multiple post-operative complications after pancreaticoduodenectomy for a pancreatic mass, including fungemia due to C. parapsilosis, while on caspofungin for treatment of Candida glabrata peritonitis. The fungemia resolved after a central venous catheter was removed and therapy was switched from caspofungin to amphotericin B lipid complex. Studies of C. parapsilosis susceptibility and the pharmacodynamics and drug interactions of caspofungin that may contribute to breakthrough fungemia are discussed.     

Infectious endocarditis caused by Candida. Presentation of 3 cases and review of the literature

We present 3 patients with infective endocarditis due to Candida sp. They were not immunodeficient subjects, but they had major surgery, longterm antimicrobial therapy and prosthetic implants. Candida endocarditis is a difficult diagnosis for biological and technical. There is also poor results with and therapeutic reasons. The combined treatment with amphotericin B and 5-fluorocytosine, plus surgical removal of the infected tissue is recommended widely in the literature.     

Candida endocarditis

A patient who developed Candida albicans endocarditis following therapy with intravenous penicillin for bacterial endocarditis is presented. She had received adrenal corticosteroids with the penicillin because of known sensitivity to this antibiotic. Yeast was cultured from indwelling venous catheters used to administer the penicillin.

The pathogenesis of Candida endocarditis is discussed and the importance of corticosteroids and previous antibiotics as predisposing factors in this and other cases is stressed.     

Candida tricuspid endocarditis in a non-addict

Isolated native non-rheumatic fungal tricuspid valve endocarditis is rarely described in the absence of intravenous drug addiction or use of intracardiac catheters or concomitant cardiac anomalies. Herein, we report a case of tricuspid valve endocarditis in a non-addict, which was successfully treated with valve replacement. The cultures of blood and vegetations revealed Candida Pichia Etschelsii. Candida tricuspid endocarditis must be considered in any patient with tricuspid vegetation, regardless of predisposing factors.     

Mitral valve endocarditis following balloon mitral valvotomy

The case of a patient who developed fungal valve endocarditis due to Candida albicans following balloon mitral valvotomy is presented. The patient did not have any obvious predisposing factors which led to the development of fungal endocarditis.     

Clinical and echocardiographic observations in pulmonary valve endocarditis

Clinical and echocardiographic data from 12 patients with pulmonary valve endocarditis are described. Seven patients had isolated pulmonary endocarditis and in 5 patients other valves were infected (aortic, tricuspid, mitral or all 3). Two patients were heroin addicts and 4 had underlying heart disease (congenital heart disease in 3 and aortic regurgitation in 1 patient). The organisms involved were alpha streptococci in 3 patients (all with underlying heart disease), Staphylococcus aureus in 4, Streptococcus D bovis in 1 patient and Candida guillermondii in 1. M-mode and 2-dimensional echocardiography was performed in 10 patients and revealed vegetations in 8. Pulsed Doppler echocardiography was performed in 6 patients and revealed pulmonary regurgitation in all 6. Seven patients had pulmonary emboli. Four patients underwent surgery. Four patients died, including 1 after cardiac surgery. Five patients, including the patient infected with Candida guillermondii, recovered with antibiotic treatment.     

Candida parapsilosis endocarditis without predisposing cause

Fungal endocarditis has become increasingly frequent in the past decade and invariably occurs in association with predisposing factors. We report a case of Candida parapsilosis in a patient with no predisposing cause.     

Candida albicans prosthetic valve endocarditis. Two cases

TWO CASES: Candida albicans prosthetic valve endocarditis (PVE) is a rare entity with serious complications. We report two cases of Candida albicans PVE, confirmed by culture of the prosthetic valve. The first patient died twenty days after surgery with cerebral bleeding secondary to multiple mycotic aneurysms, the second patient was still alive eight months following a Saint-Jude aortic valve replacement and prolonged antifungal therapy. The difficulty of diagnosis and management are discussed.     

Candida endocarditis: retrospective study in 12 patients

PURPOSE: Candida endocarditis are rare, with a poor prognosis. Actually, the principal problem concerns the growing incidence of nosocomial fungal infections. The objective of the present investigation is to assess a disease which risks becoming more pronounced in the future. METHODS: We have collected observations of Candida sp. endocarditis between 1985 to 1997 from three French university hospitals. RESULTS: Twelve of the observations fit the Duke criteria of acute endocarditis. Patients were eight men and four women, with a mean age of 46 years. An immunodepression was found in seven cases, and four patients were active drug addicts. Six had an underlying heart disease at risk to acute endocarditis. Candidemia risk factors were found in nine cases, with an average of 2.7 risk factors per patient. The fungal agents detected were Candida albicans (eight cases), C. tropicalis (one case), C. parapsilosis (two cases), and C. glabrata (one case). These vegetations were on aortic (seven cases), mitral (three cases), tricuspid valves (two cases) or in other areas (three cases), with multiple localizations (two cases). In three observations, vegetations were associated with myocardium abscesses. Eight patients had embolic complications, two had a cardiac insufficiency leading to death. The treatment was medical in all of the cases and combined with a surgical treatment in ten cases. The surgery was performed, on an average, 17 days after diagnosis, allowing seven surviving patients. Among them, five received a secondary prophylaxis and no recurrence was recorded. CONCLUSIONS: Prognosis remains severe because of the voluminous, friable and necrotic vegetations, which favor embolic migrations and which are not easily accessible to antifungals, which penetrate poorly into these vegetations. Therapy is based on a medical treatment combined with a valve replacement which needs to be done early on, and is followed by a relapse prevention which can occur several years after the initial episode.     

Fungal endocarditis in non drug-addict patients. 10-year experience

INTRODUCTION AND OBJECTIVES: 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. RESULTS: 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%). CONCLUSIONS: 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.     

Fungal prosthetic aortic valve endocarditis and endarteritis: An unusual cause of aortic root vegetations

Fungal endocarditis is a relatively rare occurrence with high morbidity and mortality. Patients may have an indolent and non‐specific course requiring a high index of suspicion to make a diagnosis. Here, we present the case of a 33‐year‐old patient who presented with fevers and acute lower limb ischemia requiring a 4‐compartment fasciotomy caused by septic emboli from Candida albicans endocarditis. The patient had a large vegetation in the ascending aorta associated with a mycotic aneurysm, which is an exceedingly rare location for a vegetation. We also review the literature and summarize the typical echocardiographic appearance and vegetation locations in fungal endocarditis.     

Candida endocarditis with mycotic pulmonary emboli following re-do Rastelli operation

A case of a 19 year old patient with Candida endocarditis complicated by pulmonary infarction and pulmonary mycotic abscesses following replacement of a right ventricle to pulmonary artery homograft conduit is presented. Despite preceding hospital admissions with probable septic pulmonary emboli, diagnosis was made only after massive pulmonary haemorrhage that ultimately proved fatal. This case highlights that Candida endocarditis should be considered in patients with symptoms and signs compatible with bacterial endocarditis when blood cultures are negative, especially in the setting of congenital cardiac malformations, and illustrates the high mortality associated with delayed diagnosis.