An unusual case of fungal endocarditis.

A case of fungal endocarditis in an unusual location is presented, in a patient with prolonged hospitalization due to extensive burns. The vegetations were located in the superior vena cava (probably adhering to a thrombus) at the site of a previous central venous catheter. The patient was treated with medical therapy only (voriconazole); after 5 months of therapy, she is without fever and transesophageal echocardiography shows that the thrombus and vegetations have disappeared.     

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 60 days 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.     

真菌性心内膜炎的诊治

真菌性心内膜炎是一种发病率低但病死率很高的疾病.随着医疗水平的快速发展,心脏手术的开展、深静脉置管的应用以及广谱抗生素的使用越来越广泛,该病的发病率有上升趋势,其危险因素及病原学也发生相应变化.与细菌性心内膜炎相比,除了赘生物大、动脉栓塞发病率高外,该病临床表现并无特殊,其早期诊断相对困难.目前诊断仍主要依靠超声心动图...     

Reliability of two-dimensional echocardiography in diagnosing fungal endocarditis

Although the techniques of M-mode and two-dimensional (2D) echocardiography (echo) have been found to be useful in patients with bacterial endocarditis, the 2D findings of fungal endocarditis are not known. In this report, we present the case of a young female narcotic addict with Candida albicans endocarditis in whom we diagnosed a large vegetation by 2D echo. Decision for surgery was made solely on the basis of the 2D-echo findings. We feel that 2D-echo findings are reliable in diagnosing fungal endocarditis because, with this technique, the size, shape, mobility, and exact location of the vegetation can be better identified than by the M-mode echo. In addition, early diagnosis of fungal endocarditis helps in treating the patients with medical and surgical therapy which may result in lower mortality.     

Clinical and echocardiographic correlations in right heart endocarditis

The echocardiographic findings were correlated with the clinical findings and outcome in 23 patients with tricuspid valve or pulmonary valve endocarditis. There were 15 males and 8 females with a mean age of 33.1 ± 8.4 years. Eighteen patients had tricuspid valve endocarditis, 1 patient had pulmonary valve endocarditis, 3 patients had concomitant mitral valve and tricuspid valve endocarditis, and 1 patient had tricuspid valve and pulmonary valve endocarditis. Twenty of the 23 (87%) patients had a history of intravenous drug abuse. The most common organisms were Staphylococcus aureus (10 of 23 patients or 43%), Streptococcus viridans (5 patients) and Pseudomonas aeruginosa (4 patients). Pulmonary manifestations with septic pulmonary emboli were present in $\text{18}\text{23}$ (80%) patients, and a regurgitant murmur in $\text{16}\text{23}$ (73%) patients. Vegetations on the tricuspid valve or pulmonary valve were detected in all patients who had 2D echo, but they were missed by M-mode echo in 2 patients. Nine of the 23 patients (40%) improved on medical therapy, 5 (21%) expired, and 7 (30%) required surgery (tricuspid valve or pulmonary valve replacement in 3, and tricuspid valve excision without replacement in 4). Conclusions: (1) 11 of 13 patients with persistent infection, multivalvular involvement, fungal or Pseudomonas infection and increasing size of vegetations by echo died or underwent surgery compared to only 1 of 8 patients without these features (P < 0.01). (2) Staphylococcus aureus infection (10 patients) and flail tricuspid valve or pulmonary valve by echo (6 patients) were not predictive of outcome.     

Broad-range fungal PCR in diagnosis of complicated infective endocarditis

Infective endocarditis (IE) frequently causes problems in diagnosis, especially where blood cultures are negative and when IE has fungal etiology. The aim of this study was to evaluate the usefulness of broad-range fungal PCR in diagnosis of fungal super-infection of bacterial IE. Twenty five blood samples were taken for analysis from patients with infective endocarditis. IE was diagnosed according to Duke criteria including positive blood cultures. Suspicion of fungal superinfection was established in 5 patients on serological investigation and confirmed by blood culture in 2 patients. Control group consisted of 15 patients without infection. DNA was isolated using the commercially available S.N.A.P. kit. Amplification products were analyzed by gel electrophoresis. Fungal DNA was found in 2 patients with fungal super-infection of bacterial IE confirmed by culture. In the remaining patients with IE and controls no fungal DNA was found. CONCLUSION: Broad-range fungal PCR is a fast and inexpensive tool for the detection of fungal DNA. The method may be valuable in the diagnosis of fungal super-infection of bacterial IE.     

Gonococcus endocarditis: Report of a case

A fatal case of gonococcus endocarditis with detailed autopsy findings is reported. Acute endocarditis followed a urethritis and affected an aortic valve which was already damaged by rheumatism.In addition to acute vegetative endocarditis of the aortic valve, autopsy revealed chronic productive changes in both mitral and aortic valves, subendocardial abscess with extension to the pericardium, diffuse suppurative and hemorrhagic pericarditis, acute intracapillary glomerular nephritis, acute focal interstitial nephritis, parenchymatous degeneration of the kidneys, infarction and suppuration of the spleen, degeneration and congestion of the liver, suppurative gastritis, pulmonary congestion, bilateral hydrothorax, ascites, conjunctival petechiae, suppurative leptomeningitis, gangrene of the legs, and a decubitus ulcer.     

Prosthetic valve fungal endocarditis due to histoplasmosis

Fungal endocarditis is associated with severe patient morbidity and mortality. Unfortunately, fungal endocarditis is difficult to diagnose because fungal pathogens are uncommonly isolated from routine blood cultures. Histopathological examination of surgically excised cardiac valves, peripheral emboli and systemic ulcers may be useful in identifying pathogens as etiological agents of culture-negative endocarditis. The authors describe a 63-year-old man who had culture-negative endocarditis. Multiple echocardiograms showed progression of the vegetations with valve stenosis despite treatment with multiple antimicrobials. He had multiple peripheral emboli before surgery. Disseminated histoplasmosis was diagnosed by bone marrow culture. Yeast organisms consistent with histoplasma were shown in the vegetations of his excised mitral valve prosthesis. The patient was treated with amphotericin and has been doing well in the two years since his surgery. The diagnosis and management of fungal endocarditis are emphasized.     

An unusual right-sided endocarditis: a case report of eustachian valve endocarditis

Thienopyridines and aspirin are beneficial in patients undergoing bare-metal stent implantation, and aspirin and clopidogrel treatment have also been proved effective after drug-eluting stent (DES) implantation. However, despite the common substitution of clopidogrel with ticlopidine because of cost or patient intolerance, there are no data on the comparison of ticlopidine vs. clopidogrel after DES implantation. We hereby compare ticlopidine vs. clopidogrel after paclitaxel-eluting stent implantation in subjects enrolled in the prospective multicenter Taxus in Real-life Usage Evaluation (TRUE) Study. Across the 505 analyzed patients (112 treated with ticlopidine and 393 with clopidogrel), similar rates of early and mid-term (7 months) adverse thrombotic events were found with either antiplatelet regimen, with the notable exception of 2 cases of late stent thrombosis in patients who had prematurely withdrawn ticlopidine treatment just 3 months after the procedure. These findings thus support the overall safety and effectiveness of ticlopidine after DES implantation, and also confirm the increased risk of late thrombosis when premature withdrawal of thienopyridines occurs.     

Balloon valvuloplasty for fungal endocarditis induced stenosis of a bioprosthetic tricuspid valve

Palliative treatment was provided without complications by double balloon valvuloplasty of a stenotic porcine tricuspid valve in a patient with fungal endocarditis. With two 15 mm diameter valvulotomy balloons the peak tricuspid gradient decreased from 21 to 7 mm Hg and valve area increased from 0.3 to 1.2 cm². After the procedure the patient clinically improved; however, valve replacement was not performed as planned because the patient developed an intracranial hemorrhage. She subsequently died of complications of fungemia. The present report demonstrates the possible use of valvuloplasty as a palliative procedure in selected patients with valvular stenosis involved with endocarditis.