Fungal endocarditis: what do we know in 2019?

Ammannaya, Ganesh Kumar K.; Sripad, Ninada

doi:10.33963/kp.14869

Cited by 28 publications

(41 citation statements)

References 27 publications

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“…Similarly, because fungemia was limited to candida blood stream infections on review of ICD-9 codes, other common fungal organisms in IE, such as aspergillus [22] could not be used in the model. However, because candida is the leading cause of fungemia in IE [23], we suspected that it was an appropriate variable to include. Additionally, it is possible that there may be unmeasured confounders, which can occur with observational studies.…”

Section: Discussionmentioning

confidence: 99%

The influence of race in older adults with infective endocarditis

et al. 2020

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Background: Age is a risk factor for infective endocarditis, and almost half of diagnosed patients are age ≥ 60 years. Large national studies have not evaluated inpatient mortality and surgical valvular interventions between older White and Black patients hospitalized with infective endocarditis. Methods: We used the Nationwide Inpatient Sample database to identify older adults ≥60 years in North America with a principle diagnosis of infective endocarditis. Multivariate logistic regression was used to compare in-hospital mortality and valvular repairs/replacement between older Black and White patients. Results: Of 10,390 adults, age ≥ 60 years hospitalized for infective endocarditis during 2013 and 2014, 7356 were White and 1089 Black. Blacks were younger (mean age: 70.5 ± 0.5 vs. 73.5 ± 0.2 years, p < 0.01), lived in more zip codes with a median annual income <$39,000/yr. (40.4% vs 18.8%, p < 0.01), and had higher co-morbidity burden (Charlson comorbidity score ≥ 3: 54.6% vs 40.7%, p < 0.01). After multivariate adjustment, Blacks had higher odds for in-hospital mortality (Odds Ratio (OR) = 2.0, [Confidence Interval (CI) 1.1-3.8]; p = 0.020), and lower odds for mitral valve repairs/replacements (OR = 0.53, CI: 0.29-0.99, p = 0.049). Conclusions: Blacks age ≥ 60 years hospitalized in North America with infective endocarditis are less likely to undergo mitral valvular repairs/replacement and had higher in-hospital mortality compared to White patients.

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Section: Discussionmentioning

confidence: 99%

The influence of race in older adults with infective endocarditis

et al. 2020

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“…FE presents with subacute, systemic signs of infection with higher involvement of the aortic valve, and a 34% to 46% incidence of peripheral embolization [ 2 , 4 , 5 ]. Positive fungal blood cultures are the criterion standard method for definitive diagnosis of fungemia, but they can be challenging because fungal blood cultures are negative in over 50% of cases or slow to show growth as in our case [ 5 – 7 ]. Newer and quicker nonculture tests such as the BG quantitative assay can aid clinicians in early diagnosis and intervention [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Use of the 1,3-b-D-Glucan Assay for the Early Detection of Fungal Endocarditis in a 45-Year-Old Man

2020

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Patient: Male, 45-year-old Final Diagnosis: Fungal endocarditis Symptoms: Cough • fever • hemiplegia • malaise • shortness of breath Medication: — Clinical Procedure: Endarterectomy • valve replacement surgery Specialty: Cardiology Objective: Challenging differential diagnosis Background: The management of fungal endocarditis is difficult due to high mortality and incidence of embolization. Fungal blood cultures are the criterion standard for diagnosis but show slow growth or remain negative in more than 50% of cases. We present a case in which the 1,3-β-D-glucan (BG) assay was used to initiate antifungal treatment prior to growth in blood culture. Case Report: A 45-year-old man with known intravenous drug use presented to the Emergency Department in acute hypoxemic respiratory failure with a prominent aortic regurgitation murmur. Imaging findings were suggestive of endocarditis. In the Intensive Care Unit, investigations confirmed aortic valve infective endocarditis with abscess. Evidence of widespread embolization, including a shin abscess positive for Candida albicans combined with a positive BG assay prompted treatment with antifungal medication prior to positive fungal cultures. The patient underwent valve replacement and during recovery was incidentally found to have subclinical cerebral infarctions caused by a septic thrombus positive for C. albicans in the right carotid artery despite weeks of antifungal treatment. Carotid endarterectomy successfully removed the thrombus, but the patient developed a right-sided stroke. Four months later, the patient has no evidence of aortic insufficiency on echocardiogram and has made a nearly full recovery from the stroke. Conclusions: We report a case of left-sided fungal endocarditis in which the BG assay was used for timely medical and surgical management leading to a successful cardiac outcome. Stroke from septic emboli is a potential complication even after weeks of antifungal therapy and valvular replacement.

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“…FE can mimic many diseases and often presents as a fever of unknown origin with nonspecific B-symptoms, making diagnosis even more challenging in patients with lymphoma. FE can also mimic heart failure or even primary cardiac malignancies as illustrated in this case [4].…”

Section: Introductionmentioning

confidence: 87%

Fungal endocarditis resembling primary cardiac malignancy in a patient with B-cell ALL with culture confirmation

Girod

Guja

Davidzon

et al. 2020

Radiology Case Reports

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Fungal endocarditis is a rare subtype of infective endocarditis that often presents with nonspecific symptoms in patients with complex medical histories, making diagnosis challenging. Patients with a history of ALL may present with congestive heart failure, chemo-induced cardiomyopathy, acute coronary syndrome, cardiac lymphomatous metastasis, or infections. We present the case of a patient with a history of ALL who presented with acute coronary syndrome and imaging concerning for primary cardiac lymphoma, when in fact the patient ended up suffering from culture proven fungal endocarditis.

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Fungal endocarditis: what do we know in 2019?

Cited by 28 publications

References 27 publications

The influence of race in older adults with infective endocarditis

The influence of race in older adults with infective endocarditis

Use of the 1,3-b-D-Glucan Assay for the Early Detection of Fungal Endocarditis in a 45-Year-Old Man

Fungal endocarditis resembling primary cardiac malignancy in a patient with B-cell ALL with culture confirmation

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