First Reported Case of <i>Candida dubliniensis</i> Endocarditis Related to Implantable Cardioverter-Defibrillator

Merza, Nooraldin; Lung, John; Bainum, Taryn B.; Mohammedzein, Assad; James, Shanna; Saadaldin, Mazin; Naguib, Tarek

doi:10.1155/2020/6032873

Cited by 4 publications

(7 citation statements)

References 34 publications

(26 reference statements)

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“…Nearly all articles included small numbers of patients that satisfied the inclusion criteria, ranging from one to eight patients. We identified 48 cases from 41 individual studies that satisfied the prespecified inclusion criteria 9–49 . Among these patients, the mean age was 58 years, and 31% were female.…”

Section: Resultsmentioning

confidence: 99%

Management of systemic fungal infections in the presence of a cardiac implantable electronic device: A systematic review

Baman

Medhekar

Jain

et al. 2020

Pacing Clinical Electrophis

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Evidence to inform the management of systemic fungal infections in the setting of a cardiac implantable electronic devices (CIED), such as a permanent pacemaker or implantable cardioverter‐defibrillator, is scant and limited to case reports and series. The available literature suggests high morbidity and mortality. To better characterize the shared experience of these cases and their outcomes, we performed a systematic review. We investigated all published reports of systemic fungal infections—fungemia and fungal vegetative disease—in the context of CIED, drawing from PubMed, EMBASE, and the Cochrane database of systematic reviews, inclusive of patients who received treatment between January 2000 and May 2020. Exclusion criteria included presence of ventricular assist device and concurrent bacteremia, bacterial endocarditis, bacterial vegetative infection, or viremia. Among 6261 screened articles, 48 cases from 41 individual studies were identified. Candida and Aspergillus species were the most commonly isolated fungi. There was significant heterogeneity in antifungal medication selection and duration. CIED extraction—either transvenous or surgical—was associated with increased survival to hospital discharge (92%) and clinical recovery at latest follow‐up (81%), compared to cases where CIED extraction was deferred (56% and 40%, respectively). Importantly, there were no prospective data, and the data were limited to individual case reports and one small case series. In summary, CIED extraction is associated with improved fungal clearance and patient survival. Reported antifungal regimens are heterogeneous and nonuniform. Prospective studies are needed to verify these results and define optimal antifungal regimens.

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Section: Resultsmentioning

confidence: 99%

Management of systemic fungal infections in the presence of a cardiac implantable electronic device: A systematic review

Baman

Medhekar

Jain

et al. 2020

Pacing Clinical Electrophis

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“…Among all cases of IE, fungal IE comprises anywhere from 1% to 10% of etiologies in which approximately 10% of agents originated from a bloodstream infection, with Candida albicans (46%) found most frequently [ 16 ]. Candida dubliniensis is far less common but has been linked to infected intracardiac devices [ 17 ]. Candida dubliniensis was first identified in 1995 as a phenotypically and genetically different species than Candida albicans though it is frequently mistakenly identified as Candida albicans [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Candida dubliniensis Fungemia Leading to Infective Endocarditis and Septic Pulmonary Emboli

Jafroodifar¹,

Thibodeau²,

Scalzetti³

2023

Cureus

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Illicit drugs, especially those injected intravenously, are becoming increasingly more common worldwide. Individuals who use intravenous drugs often reuse or share needles which predisposes them to life-threatening infections. We present the case of a patient who was injecting intravenous drugs into her internal jugular vein, which eventually led to acutely worsening sepsis secondary to fungal infective endocarditis and bilateral septic pulmonary emboli. Transthoracic echocardiogram demonstrated multilobulated and spherical vegetations on the tricuspid and mitral valves, respectively. On computed tomography of the thorax, numerous cavitary lesions and ground-glass opacities were present in both lungs. Multiple hyperdense, linear structures consistent with broken needles were seen on chest radiography. It is important for radiologists to recognize the possibility of broken needles in patients with a history of intravenous drug use as astute recognition of broken needles may lead to better source control and improved outcomes.

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“…In 86 reports, 91 cases of definitive fungal IE were described. These reports involved fifteen cases with Candida parapsilosis [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] , seven cases with C. albicans [55][56][57][58][59][60][61] , three cases with C. tropicalis [62][63][64] , eight other species with Candida [65][66][67][68][69][70][71][72] , eight cases with Candida with a bacterium [73][74][75][76][77][78][79][80] , ten cases with Aspergillus fumigatus [81][82][83][84][85][86][87][88][89]…”

Section: Case Reportsmentioning

confidence: 99%

“…It was used in five patients with Candida infection [52,63,66,68,72] , and in 5 patients with other species [109,111,[113][114][115][116] , but not with Aspergillus. Quantitative polymerase chain reaction (qPCR) with genetic sequencing was performed in only one patient with Candida infection [71] , three with Aspergillus infection [81,92,95] , and for several other microorganisms [112,117,122,124,125] . To document and, if necessary, treat ocular involvement, an ophthalmic examination was performed in ten patients with Candida infection [45,49,52,56,57,59,62,63,76,78] , five patients with Aspergillus [81,87,88,93,97] , and three patients with other species [113,114,124] .…”

Section: Case Reportsmentioning

confidence: 99%

“…Stroke was documented in 29 of the included cases, while splenic, renal, pulmonary, or peripheral embolism were documented in 20 cases. Endophthalmitis and ophthalmic emboli should be reasons for an ophthalmologic examination [49,50,57,71,78,87,88,97,114] . Second, prior valve implantation and electronic cardiac implants or indwelling central catheters should also raise suspicion.…”

Section: Signs and Symptoms Of Fungal Iementioning

confidence: 99%

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“Not much room for mushrooms” in the heart: knowns and unknowns of fungal infective endocarditis

Mistiaen

2024

Vessel Plus

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Fungal infective endocarditis is a rare but highly lethal condition. Its diagnosis is often delayed due to nonspecific symptoms, inconclusive medical imaging, and negative blood cultures. Recent reviews of cases and series over the last 5 years indicate that the condition remains rare and lethal. If fungi are identified as the causative agents in more than 5% of patient cases with infective endocarditis, it is likely that risk factors such as immune suppression or cardiac implants are probably involved. A series derived from recent case reports indicates that Candida and Aspergillus are still the main causative infectious agents, with. C parapsilosis on the rise. From these cases, diagnostic clues (frequent embolisms, ophthalmic involvement, large, mobile and friable vegetation, non-valvular cardiac manifestations) are pointing towards fungal IE. These reports, however, are not standardized and a publication bias towards rare microorganisms or towards a favorable outcome might exist. Complications might be underreported, and important data such as diagnostic delay are absent or difficult to retrieve. Pharmacologic treatment is not fully standardized. Knowledge of resistant strains in this respect is important. Statistical analysis for the effect of complications and treatment modalities on outcome shows that any result should be treated cautiously. The current series is by no means a valid substitute for a well-designed series of fungal endocarditis. However, the better outcome with Candida and patients treated with surgery confirm earlier results. An international multicentric standardized registry of cases with fungal endocarditis in order to improve the outcome of this disease is highly needed. The effect of diagnostic delay on outcome remains elusive and should be resolved.

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First Reported Case of Candida dubliniensis Endocarditis Related to Implantable Cardioverter-Defibrillator

Cited by 4 publications

References 34 publications

Management of systemic fungal infections in the presence of a cardiac implantable electronic device: A systematic review

Management of systemic fungal infections in the presence of a cardiac implantable electronic device: A systematic review

Candida dubliniensis Fungemia Leading to Infective Endocarditis and Septic Pulmonary Emboli

“Not much room for mushrooms” in the heart: knowns and unknowns of fungal infective endocarditis

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