Candida endocarditis: role of new antifungal agents

Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report seven cases, which occurred during a period of 1 year in western France. Six cases were because of Candida albicans , and one pacemaker endocarditis was because of Candida parapsilosis . All patients were men and presented risk factors for candidaemia. Of the six patients with valvular involvement, five received caspofungin and two had surgical valve replacement. Three patients treated with caspofungin antifungal therapy without valve replacement were cured from endocarditis. Antifungal and surgical strategies are discussed, in particular, the possible role of new antifungal therapies and long-term suppression therapy without surgery. One patient died in the acute phase of endocarditis, three patients died of causes unrelated to infective endocarditis and three patients had a favourable outcome.     

Candida endocarditis associated with cardiac rhythm management devices: review with current treatment guidelines

Coincident with an increased use of cardiac rhythm management devices (CRMD) has been an increase in the number of pacemaker and cardioverter-defibrillator infections. CRMD endocarditis accounts for about 10% of all device-related infections, and cardiac infection caused by Candida sp. is a rare event. To date, only sporadic reports of this unusual and life-threatening event have been reported. By describing a case of CRMD-related Candida endocarditis and conducting a literature review, we provide a detailed characterisation of this unusual clinical entity with an emphasis on diagnosis, management and treatment. A case of CRMD-related Candida endocarditis is presented and a computer search for confirmed cases of CRMD-Candida endocarditis was conducted. Current recommendations for management and treatment were documented. From 1969 to 2009, 15 patients with CRMD-Candida endocarditis (12 pacemaker and three implanted cardioverter-defibrillator) were documented. All were males, non-albicans Candida sp. were frequently recovered, a major fungal embolus occurred in 27% of patients and two of 10 patients who received defined antifungal therapy and device explantation expired. CRMD Candida endocarditis is a rare and serious clinical event; isolates can include Candida albicans and other Candida sp., and treatment involves both targeted antifungal therapy and device removal.     

A case of Candida parapsilosis endocarditis

The authors report a case of Candida parapsilosis endocarditis in a non-drug-addicted young patient who, 6 months before the manifestation of endocarditis, was submitted to cardiac surgery. This is the first report from Greece and the second found in the accessible literature.     

Treatment of neonatal fungal infective endocarditis with recombinant tissue plasminogen: activator in a low birth weight infant case report and review of the literature

With advances in medical sciences, an increase in survival rates of low birth weight; increased incidence in use of catheter and antibiotics, and total parenteral nutrition are reported, therefore, the rate of fungal infections in late and very late onset neonatal sepsis have increased. Although fungal endocarditis rarely occur in newborns, it has a high morbidity and mortality. Antifungal therapy is often insufficient in cases who develop fungal endocarditis and surgical treatment is not preferred due to its difficulty and high mortality. Herein, fungal endocarditis in a preterm newborn treated with single‐dose recombinant tissue plasminogen activator in addition to antifungal therapy is presented and relevant literature has been reviewed. The vegetation completely disappeared following treatment and no complication was observed.     

Otomastoiditis caused by Candida auris: Case report and literature review

Fungal otomastoiditis is a rare disease, but can be fatal for immunocompromised patients. Recently, there have been increasing cases of otologic infection caused by Candida auris. Candida auris can be easily misdiagnosed for other species and treatment is difficult due to multidrug resistance. Clinician should be aware of this rare pathogen, and it should be treated with appropriate antifungal agent with surgical debridement.     

Castleman病五例并文献复习

目的 探讨Castleman病(CD)的流行病学、临床特征、诊治现状及预后,提高其诊治水平.方法 回顾性分析山西大医院2012年12月至2015年12月收治的5例CD患者临床资料并复习国内外相关文献.结果 5例患者中男性1例,女性4例,年龄15～47岁;按美国国立综合癌症网络(NCCN)指南诊断分类标准:多中心型CD(MCD)1例,单中心型CD(UCD)4例;MCD组织学分型未明,UCD包括透明血管型(HVV)2例及浆细胞型(PCV)、混合型(Mix型)各1例;经手术及综合治疗,1例达部分缓解,4例疾病稳定,随访时间5～ 23个月.结论 CD流行病学复杂,诊断依靠组织病理学;UCD首选手术治疗,而MCD多需全身治疗;预后因分型、病毒感染、种族等差异不尽相同.     

成人型肺母细胞瘤五例报告及文献复习

背景与目的　肺母细胞瘤是一种少见的肺部原发恶性肿瘤,分为成人型肺母细胞瘤和儿童胸膜肺母细胞瘤。本文主要讨论成人型肺母细胞瘤的临床特点、诊断和治疗。方法　回顾我院从1964 年4 月至2004年3月收治的5例成人型肺母细胞瘤的临床资料,并复习有关国内外文献。结果　5 例中男3 例,女2例;发病年龄22~70岁;以咳嗽、咳血丝痰为主要症状,次为胸闷、胸痛;影像学主要表现为肺部单发实性肿块,纤维支气管镜检查及痰细胞学检查均没有发现肿瘤细胞。3 例行肺叶切除加肺门纵隔淋巴结清扫术,1例行左全肺切除加肺门纵隔淋巴结清扫术,1例行肺楔形切除术并行术后化疗。到随访结束,3 例死亡,2 例生存,生存期最短6个月,最长11年。结论　肺母细胞瘤术前难明确诊断。治疗以肺叶切除加纵隔淋巴结清扫术为主,对放疗及化疗不敏感,预后差别较大。     

Aggressive Natural Killer-Cell Leukemia: report of five cases and review of the literature

We report 5 cases of Aggressive Natural Killer-Cell Leukemia (ANKL) diagnosed and treated in our institution within a period of 5 years. Presented are the clinical, hematological, immunophenotypic, immunogenotypic and cytogenetic data. ANKL is a very rare disorder. On review of the English-language literature only 68 published cases were identified. Analysis was performed on a total number of 73 cases (68 from the literature and the series of 5 presented hereby). Presented and discussed are the epidemiology, clinical picture, morphology, cell marker, immunogenotype, cytogenetics, and survival data of the analysis, as well as the associations with the Epstein-Barr virus (EBV). To our knowledge this is the largest series of cases of ANKL analyzed and therefore it is hoped to contribute towards a better characterization of the disorder.     

皮肤转移癌5例报告并文献复习

目的:了解皮肤转移癌的特点,提高皮肤转移癌的诊治水平.方法:报道5例来源于不同恶性肿瘤的皮肤转移癌病例,并复习相关文献.结果:5例肿瘤的恶性程度较高,皮肤转移发生在术后6月到18月,其中4例合并重要脏器转移,临床症状与皮肤病症状类似,通过以化疗为主的综合治疗获得较好疗效.结论:皮肤转移癌的临床发生率较低,常合并其他重要脏器转移,预示肿瘤已进入晚期,其诊断依靠病史和结节活检.及时诊断、积极治疗对于减轻患者痛苦,延长生存期有重要意义.     

皮下脂膜炎样T细胞淋巴瘤五例并文献复习

目的 探讨皮下脂膜炎样T细胞淋巴瘤(SPTCL)的临床特点及预后.方法 回顾性分析南京医科大学第一附属医院5例SPTCL患者的临床资料,并复习相关文献.结果5例SPTCL患者中,4例患者首发症状为皮疹,3例患者有肝脏和(或)脾脏大,1例伴有噬血细胞性淋巴组织细胞增生症(HLH).病理形态学可见肿瘤细胞在皮下组织弥漫浸润,并在单个脂肪细胞周边围绕.免疫组织化学可见肿瘤细胞表达T细胞特征性CD3、CD43、CD45RO,并有典型的CD4- CD8+CD56-及细胞毒性颗粒相关蛋白表达.2例患者一线采用DHAP方案治疗,3例患者一线采用DA-EPOCH方案治疗;2例患者二线采用自体造血干细胞移植治疗.中位总生存(OS)时间未达到(4~107个月),5年OS率为75 %,伴有HLH的患者OS时间仅10个月.结论 SPTCL患者总体预后较好,伴有HLH者预后较差.     

Primary adenocarcinoma of the appendix: report of five cases and review of the literature

Five patients with primary adenocarcinoma of the appendix are reported. All patients presented with symptoms resembling those of acute appendicitis or periappendicular abscess. In none of them was malignancy suspected prior to operation. It is advisable that every patient above 50 years of age presenting with symptoms of appendicitis undergo laparotomy, thus enabling a better exploration of the cecal region. If an appendiceal mass is present and frozen section shows malignancy, a right hemicolectomy should be performed. The prognosis of adenocarcinoma of the appendix is dismal as most patients present with an advanced stage of the disease.     

Malignant fibrous histiocytoma: report of five cases and a review of the literature.

Five cases of malignant fibrous histiocytoma are presented and the relevant literature is reviewed. All the patients had locally extensive tumor or eventual recurrent or metastatic disease. Determining malignancy by histologic criteria is difficult. Therefore, histologic, gross, and clinical behavior of the tumor is important. Though the role of radiation therapy and chemotherapy is not yet established, it appears that at least wide "cancer resection," if possible, is the treatment of choice. The unusually high incidence of nonresectable, recurrent, or metastatic disease in retroperitoneal histiocytomas raises the question as to whether all three modalities of therapy should be used in the treatment of tumors at this particular site.     

输卵管交界性肿瘤五例并文献复习

目的探讨输卵管交界性肿瘤的临床病理学特征及诊治要点。方法回顾性分析5例输卵管交界性肿瘤患者及文献报道的21例患者的临床及病理学资料。结果 26例患者年龄3～75岁,平均36.1岁,主要临床表现为下腹痛（30.8%）和盆腔包块（84%）,超声检查可于附件区探及囊性包块内有中强乳头状回声,血清CAl25水平多正常（〈35 U/ml）或仅轻度升高（平均89.9 U/ml）;肿瘤多局限于一侧输卵管或系膜内（96.2%,25/26）,直径1.7～13 cm,平均5.8 cm,22例为囊性,其中73%内壁有乳头突起,3例为实性,组织学类型以浆液性肿瘤（69.2%,18/26）居多;手术方式2例不详,16例行保留生育功能的手术,其中3例采取全面分期/再分期手术,13例未分期,仅行肿瘤剔除（4例）、输卵管部分或全部切除（6例）或患侧附件切除（3例）,其余8例接受子宫及双附件切除术,其中2例行全面分期/再分期手术;术后随访6～84个月,均无复发。结论输卵管交界性肿瘤好发于年轻女性,临床表现缺乏特异性,术前诊断困难,确诊依靠手术探查及病理检查,诊断时多为早期,预后好,保留生育功能的保守性手术是安全可行的,全面分期手术的治疗意义有待观察,进一步的结论需积累更多病例加以明确。     

Candida glabrata prosthetic joint infection,successfully treated with anidulafungin: A case report and review of the literature

Non‐albicans Candida prosthetic joint infection (PJI) is extremely rare. A case of a Candida glabrata knee PJI is a 68‐year‐old splenectomised female smoker, suffering from chronic obstructive pulmonary disease (COPD) and alcoholism is reported. The patient presented with a peri‐prosthetic fracture, 15 years after total knee replacement surgery. Cultures of the intraoperative peri‐prosthetic tissue and materials yielded C. glabrata, as well as a methicillin‐resistant S. epidermitis. The patient was treated with anidulafungin and vancomycin. The knee prosthetic joint was removed and cement‐spacer with vancomycin and gentamycin was placed. Additionally, an external fixation was performed. A second stage revision surgery was planned, after completion of the antimicrobial and antifungal treatment. The patient is followed up for 4 months without signs, symptoms or findings of infection. PJI Candida infections require a high clinical suspicion index. It is of utmost importance to report these cases, since there is no consensus yet of the proper antifungal treatment. Furthermore, a literature review regarding treatment of those cases is provided. First‐line treatment with an echinocandin seems most proper, due to their fungicidal properties, their effectiveness against biofilm, as well as their minimal toxicity, making them ideal for long‐term use. Further experience is needed, for better understanding the disease's pathogenesis and optimal treatment.     

Candida and cardiovascular implantable electronic devices: a case of lead and native aortic valve endocarditis and literature review

Use of cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left‐sided heart valve and a CIED lead. Here, we report the case of a 70‐year‐old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED‐associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED‐associated Candida endocarditis.     

Candida auris otomycosis in Iran and review of recent literature

Candida auris is a multidrug‐resistant yeast emerging in immunocompromised and in otherwise healthy individuals. Due to difficulties in microbiological identification of C. auris because of the lack of available laboratory technology in developing countries, the number of patients affected is most likely underestimated. We report the first case of C. auris otitis which now adds Iran as the fifth country around the Persian Gulf, in addition to Kuwait, Oman, United Arab Emirates and Saudi Arabia. Candida auris is an unknown pathogen in routine laboratories in Iran because most Candida isolates are probably misdiagnosed. Otomycosis seems to be a different clinical presentation of C. auris mainly involving isolates from the East‐Asian clade. We compared the mycological and clinical details of the Iranian patient with other cases of otitis reported since the last review of C. auris otomycosis in 2017.     

皮肤转移癌5例报告并文献复习

目的：了解皮肤转移癌的特点，提高皮肤转移癌的诊治水平。方法：报道5例来源于不同恶性肿瘤的皮肤转移癌病例，并复习相关文献。结果：5例肿瘤的恶性程度较高，皮肤转移发生在术后6月到18月，其中4例合并重要脏器转移，临床症状与皮肤病症状类似，通过以化疗为主的综合治疗获得较好疗效。结论：皮肤转移癌的临床发生率较低，常合并其他重要脏器转移，预示肿瘤已进入晚期，其诊断依靠病史和结节活检。及时诊断、积极治疗对于减轻患者痛苦，延长生存期有重要意义。     

原发性性腺外精原细胞瘤(附5例报告及文献复习)

目的：提高对原发性性腺外精原细胞瘤的认识，方法：5例原发性性腺外精原细胞瘤，均经手术切除及组织病理学证实，术后分别行化疗或放疗。结果：随访至今5例患者均健在，结合文献对原发性性腺外精原细胞瘤的组织发生，临床表现，治疗原则等进行讨论。结论：原发性性腺外精原细胞瘤少见，症状因部位而异，容易误诊，组织病理检查对该病诊断，治疗方案的选择有重要价值。治疗上尽量完整手术切除，但不必勉强，该肿瘤对放，化疗敏感。     

Portal vein thrombosis during antineoplastic chemotherapy in children: report of five cases and review of the literature

We report five paediatric cases of portal vein thrombosis (PVT) occurring during chemotherapy, observed in two institutions over an 8-year time period. These children aged 2.5–15 years were treated for Burkitt’s lymphoma, Ewing’s tumour, small cell bone tumour or medulloblastoma. PVT was diagnosed on colour Doppler ultrasonography (US). In four patients, thrombosis occurred 2–45 days after severe hepatic veno-occlusive disease (HVOD) secondary to intensive chemotherapy containing busulfan. In one case, PVT occurred in the absence of HVOD in a patient with pre-existing periportal lymphomatous infiltration. Four patients experienced persistent portal hypertension, which resulted in death in one. PVT during chemotherapy in children is a rare event and appears to be closely related to intensive chemotherapy containing busulfan and to be associated with HVOD.     

Primary deep cutaneous candidiasis caused by Candida duobushaemulonii in a 68‐year‐old man: the first case report and literature review

Superficial candida infections of the skin are common, but deep cutaneous candidiasis, including secondary dissemination to the skin from systemic candidiasis, candidaemia or primary invasion due to skin defects such as trauma, is rare. These patients are usually immunosuppressed, but immunocompetent hosts can be affected as well. Candida albicans is the most common pathogen. However, non‐albicans Candida species can cause deep skin invasion in rare circumstances. We report a case of deep cutaneous candidiasis caused by Candida duobushaemulonii in a 68‐year‐old man. Deep tissue invasion was confirmed by skin histopathology examination. The pathogen was initially identified as C. haemulonii using the VITEK^® 2 system for microbial identification, but was later determined to be C. duobushaemulonii based on sequencing of the internal transcribed spacer region of ribosomal DNA and D1/D2 region of 26S rDNA. The patient was successfully treated with amphotericin B, followed by fluconazole and surgical intervention. To the best of our knowledge, this is the first case of deep cutaneous infection by C. duobushaemulonii.