Catheter-Related Candida Endocarditis on the Right Atrial Septum – A Case Report

Abstract

The use of subcutaneous catheter devices has increased over the past two decades along with its associated infections. One of the complications is infective endocarditis (IE), which usually occurs on the valves of the heart. However, IE can rarely occur on the atrial septal wall. The most common pathogens associated with catheter-related IE are staphylococcus bacteria, and it is rarely caused by fungi. We present a case of a 75-year-old Caucasian female with infective endocarditis located on the right side of the atrial septum, caused by Candida albicans due to the use of a subcutaneous catheter port. We will discuss the diagnostic criteria and treatment plan for this patient and other treatment options available for these cases. To our knowledge, a similar case was reported in Brazil, but this is the first reported case in the United States of catheter-related infective endocarditis of the right atrial septal wall due to Candida albicans.

Surgical Management of Right Atrial Mass Associated with a Vascular Access Catheter

“…Secondary cardiac metastases occur 20 times more often, the most common primaries being mesothelioma, lung cancer, and melanoma [4]. Primary atrial mural endocarditis is rare with reported organisms including staphylococcus species, streptococci species, aspergillus, and candida [2,[5][6][7]. Secondary infection complicating myxoma has also been reported with similar bacterial pathogens [8].…”

Candida Endocarditis: A Review of the Pathogenesis, Morphology, Risk Factors, and Management of an Emerging and Serious Condition

“…However, the location and association to a particular valve are dependent on a wide array of risk factors. For instance, a case report about C. albicans in a 75-years-old female using subcutaneous catheter devices found that there was no valve involvement; it seemed that the right atrial septum was involved [15]. This rare case depicted the propensity of C. albicans to implant itself on any location of the endothelium [15].…”

“…For instance, a case report about C. albicans in a 75-years-old female using subcutaneous catheter devices found that there was no valve involvement; it seemed that the right atrial septum was involved [15]. This rare case depicted the propensity of C. albicans to implant itself on any location of the endothelium [15]. Another case report supports this theory; this report depicted a foreign body, a fishbone, leading to left atrial C. albicans infective endocarditis as a result of its penetration through the esophagus [28].…”

“…Patients with neutropenia should also consider echinocandins, such as caspofungin and anidulafungin, as the initial therapy [40]. However, case reports from different institutions suggest management on a case-by-case basis, keeping in mind the severity, prognosis, and autonomy of the patient [2,8,[14][15][16]. For example, according to an Italian study, prolonged antibiotic exposure and abdominal surgery more likely predisposed the patient to develop native valve endocarditis than prosthetic valve endocarditis [46].…”

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

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Other, less common, sites of infection have also been described, such as the right atrial septum, right ventricular cavity, and left atrial cavity. [22][23][24][25][26] Exogenous material in the body, such as CEID, are particularly susceptible to infection with C albicans as the microorganism produces a highly organized biofilm covered in an extracellular matrix that facilitates binding. [27][28][29] Multiple cases of CEID lead infections have been reported in the literature.…”