Aspergillus tubingensis Endocarditis: A Case Report and Review of the Literature

Abstract

Aspergillus endocarditis is a rare infection that may affect immunocompetent patients following heart valve replacement or heart surgery. We report the case of a 39 year old woman with a history of intravenous drug use who developed endocarditis with direct examination of the resected valve and vegetation showing the presence of mycelia. Cultures were positive for an Aspergillus of section Nigri, which was subsequently identified as Aspergillus tubingensis by sequencing. The clinical course was favorable following surgery and prolonged antifungal therapy (8 months in total). Antifungal susceptibility testing showed good in vitro activity of amphotericin B, voriconazole and echinocandins against planktonic cells of this A. tubingensis isolate. However, only amphotericin B displayed significant activity against biofilms. In vitro combinations of voriconazole or amphotericin B with echinocandins did not meet the criteria of synergism. Our review of the literature identified 17 other cases of endocarditis attributed to Aspergillus of section Nigri with an overall mortality rate of 57% (100% in the absence of surgery). Endocarditis caused by Aspergillus niger and related cryptic species are rare events, for which surgical management appears to be crucial for outcome. While amphotericin B was the only antifungal drug displaying significant anti-biofilm activity, the type and duration of antifungal therapy remain to be determined.

Post‐COVID‐19 fatal Aspergillus endocarditis: A case report

“…The immunocompromising condition was steroid therapy, direct damage of respiratory virus to airway epithelium, and lymphopenia in the context of ARDS associated with COVID‐19. In general, Aspergillus fumigatus has been reported to be the most common cause of endocarditis and invasive infections, 1 which has also been the cause of infection in our case report.…”

“…Patients, who do not have surgery on an infected valve, pose a 100% risk of mortality while in patients who undergo cardiac valve replacement, 45% is reported. 1 Despite appropriate treatment measures, infective endocarditis has a high morbidity and mortality rate. Mortality rates can be approximately 25%.…”

“…The high mortality rate among survivors is very important due to the risk of relapsing infection. 1 A literature review from 2005 to 2016 showed that out of 374 cases of infective endocarditis, 43 (11.5%) had fungal infections, and the most common fungi (31/374 patients; 8.3%) were Aspergillus and Candida (9/374 patients; 2.4%). 2 Extracardiac manifestations, mistaken/delayed AE diagnosis, and long duration of symptoms before going to the hospital may contribute to wrong management in patients then causing a delay in the treatment and conclusive poor outcomes.…”

Pacemaker Associated Aspergillus fumigatus Endocarditis: A Case Report

“…In previous reports, all patients without recurrence received antifungal treatment with voriconazole or isavuconazole for more than 6 months, but there are no statistics on echinocandins due to a lack of data. 4 In this case, the classic first choice of antifungal drugs, voriconazole, was not used for antifungal treatment. This article provides a case of caspofungin antifungal treatment for patients who have a strong reaction to voriconazole.…”

“… 3 AE is an extremely rare and devastating disease associated with poor prognosis and mortality greater than 50%, and it is most prevalent in immunocompromised patients, intravenous drug abusers, patients with artificial heart valves or those undergoing cardiac reconstruction and recipients of prolonged antibiotics. 4–6 Aspergillus is the second most common factor causing fungal endocarditis (FE) after Candida , accounting for 20–25% of FE and 0.2–2.5% of all infective endocarditis (IE) and occurring mostly in prosthetic heart valves. 7 Most AE cases present with constitutional symptoms, including fever, hemoptysis, chest pain, dyspnea, murmur, emboli, sepsis and cardiac failure, which are indistinguishable from bacterial or viral endocarditis.…”