Co-infection with bacterial and fungal endocarditis at scar tissue in an immunocompromised patient

Hajsadeghi, Shokoufeh; Pakbaz, Marziyeh; Aziz-Ahari, Alireza; Kalantari, Saeed

doi:10.1016/j.jccase.2018.11.004

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…Eleven additional studies were found during the hand‐screening of the included articles’ references or the hand‐screening of the references of narrative reviews. Finally, 60 met the present study's inclusion criteria 5,6,11‐68 . The review process is graphically presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

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Fungal endocarditis in transplant recipients: A systematic review

Ιωάννου

Papakitsou

Kofteridis

2020

Mycoses

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Summary Background Invasive fungal infections remain a major cause of morbidity and mortality in transplant recipients. Moreover, Fungal Infective Endocarditis (FIE) is a rare infection that carries a higher mortality than bacterial IE in normal host, while in transplant recipients may be even higher. The purpose of this study was to systemically review all published cases of FIE in solid organ and allogeneic bone marrow transplant recipients, describe the epidemiology, microbiology, clinical characteristics, treatment and outcomes of these infections, and to identify risk factors for mortality by FIE. Methods A systematic review of PubMed, Scopus and Cochrane Library (through 20 May 2020) for studies providing epidemiological, clinical, microbiological and treatment data and outcomes of FIE in transplant recipients was performed. Results A total of 60 studies, containing data of 72 patients, were included. The most common transplants were those of the kidney and the liver, while the commonest causative pathogen was Aspergillus. Mitral valve was the commonest infected intracardiac site, followed by mural endocardium. Diagnosis was made with transthoracic echocardiography in 44.3%, while the diagnosis was made at autopsy in 37.3%. Embolic phenomena were the commonest clinical presentation, followed by fever, heart failure and endophthalmitis. Amphotericin B, voriconazole and caspofungin were the commonest antifungals used for treatment of FIE. Clinical cure was noted in 26.9%, while overall mortality was 78.6%. Amphotericin B or caspofungin use was negatively associated with overall mortality. Conclusions This systematic review thoroughly describes IE in transplant recipients and provides information on epidemiology, clinical presentation, treatment and outcomes.

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Section: Resultsmentioning

confidence: 99%

“…In particular, this patient population is susceptible to fungal disease 4 . FIE is a rarely described condition in transplant recipients, with a paucity of published data, currently limited to case reports and series 5,6 …”

Section: Introductionmentioning

confidence: 99%

Fungal endocarditis in transplant recipients: A systematic review

Ιωάννου

Papakitsou

Kofteridis

2020

Mycoses

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“…The battle between host immunity and pathogens dominates the course of the disease. Numerous studies have reported that refractory opportunistic infections were common in patients who died of sepsis because of immunosuppression [ 13–15 ]. Evidence indicates sepsis can affect the function of immune cells, including neutrophils, lymphocytes and monocytes [ 12 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Predictive value of immune cell counts and neutrophil-to-lymphocyte ratio for 28-day mortality in patients with sepsis caused by intra-abdominal infection

Liu

She

et al. 2021

Burns &Amp; Trauma

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Background The current study aimed to evaluate the value of immune cell counts and neutrophil-to-lymphocyte ratio (NLR) when attempting to predict 28-day mortality. Methods We conducted an observational retrospective study that included consecutive septic patients. Severity scores on the first day and peripheral circulating immune cell counts (at day 1, day 3, day 5 and day 7 of admission) were collected during each patient’s emergency intensive care unit stay. We assessed the associations of peripheral circulating immune cell counts and NLR with the severity of illness. The relationships between 28-day mortality and peripheral circulating immune cell counts and NLR with were evaluated using Cox proportional cause-specific hazards models. Results A total of 216 patients diagnosed with sepsis caused by IAI were enrolled. The lymphocyte counts (days 1, 3, 5 and 7) and monocyte counts (days 3, 5 and 7) were significantly lower in non-survivors (n = 72) than survivors (n = 144). The NLR values at each time point were significantly higher in non-survivors. The day 1 lymphocyte counts, as well as the monocyte counts, were significantly lower in the highest-scoring group, when stratified by the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, than in the other groups (p < 0.05). The day 1 NLR was significantly higher in the highest-scoring group than in the other groups (p < 0.05). The day 5 and day 7 lymphocyte counts, day 3 and day 7 monocyte counts and day 7 NLR were significant predictors of 28-day mortality in the Cox proportional hazards models (day 5 lymphocyte count: hazard ratio, 0.123 (95% CI, 0.055–0.279), p < 0.001; day 7 lymphocyte count: hazard ratio, 0.115 (95% CI, 0.052–0.254), p < 0.001; day 3 monocyte count: hazard ratio, 0.067 (95% CI, 0.005–0.861), p = 0.038; day 7 monocyte count: hazard ratio, 0.015 (95% CI, 0.001–0.158), p < 0.001; day 7 NLR: hazard ratio, 0.773 (95% CI, 0.659–0.905), p = 0.001). Conclusions The results showed that circulating lymphocytes and monocytes were dramatically decreased within 7 days in non-survivors following sepsis from an IAI. Lymphocyte counts, monocyte counts and NLR appeared to be associated with the severity of illness, and they may serve as independent predictors of 28-day mortality in septic patients with IAIs.

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“…Cases of co-infection have been described in blood culture-positive IE due to typical causative organisms ( staphylococcus , streptococcus , or enterococcus ) and other pathogens such as Coxiella , COVID-19, or fungi. 25 - 27 While a blood culture may be time-consuming and yield false-negative results, it remains the gold standard for diagnosis. Culture-negative endocarditis, which accounts for up to 20% of IE cases, poses a clinical challenge with increasing mortality.…”

Section: Discussionmentioning

confidence: 99%

Culture-Negative Endocarditis in an Immunocompromised Patient: A Case of Suspected Bartonella and Coxiella Co-Infection

Swarath¹,

Maharaj²,

Seecheran

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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We present the case of a 23-year-old man with a previous deceased-donor renal transplant maintained on tacrolimus and prednisone who developed culture-negative endocarditis (CNE) of the mitral and aortic valves. He was suspected of being co-infected with Bartonella henselae and Coxiella burnetii, confirmed with serology testing. He was successfully managed with appropriate antibiotics and dual valve replacement.

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Co-infection with bacterial and fungal endocarditis at scar tissue in an immunocompromised patient

Cited by 6 publications

References 11 publications

Fungal endocarditis in transplant recipients: A systematic review

Fungal endocarditis in transplant recipients: A systematic review

Predictive value of immune cell counts and neutrophil-to-lymphocyte ratio for 28-day mortality in patients with sepsis caused by intra-abdominal infection

Culture-Negative Endocarditis in an Immunocompromised Patient: A Case of Suspected Bartonella and Coxiella Co-Infection

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