Aspergillus endocarditis in lung transplant recipients: case report and literature review

Abstract

We present a case of endocarditis caused by Aspergillus in a lung transplant (LT) patient and review 6 previously reported cases. All cases were caused by Aspergillus fumigatus. Five patients (71%) were transplanted due to cystic fibrosis. None of the patients had any previously known valvular heart disease. The time that elapsed between LT surgery and the diagnosis of Aspergillus endocarditis was 8±6 months. Large peripheral emboli were observed in 6 patients (85%); blood cultures were negative in all. Transthoracic echocardiography did not detect the presence of vegetations in 3 patients (43%); the vegetations measured >1.5 cm in all cases. Five patients (71%) died from disseminated disease. Both survivors underwent combined therapy with antifungal drugs and surgical treatment.

Exophiala dermatitidis endocarditis on native aortic valve in a postrenal transplant patient and review of literature on E. dermatitidis infections

“…Aspergillus and Candida species are the predominant fungi implicated in FE 1–4 . The present case is a rare episode, as it represents the second case of endocarditis due to E. dermatitidis .…”

“…Fungal endocarditis is responsible for <10% of the infective endocarditis cases 1–4 . It is being increasingly reported over the past two decades as a consequence of advancement in medical and surgical therapies 1–4 . FE has been observed in all age groups with male predominance 1–4 .…”

“…It is being increasingly reported over the past two decades as a consequence of advancement in medical and surgical therapies 1–4 . FE has been observed in all age groups with male predominance 1–4 . It is claimed to exhibit a bimodal distribution, with a higher frequency in neonates under the intensive care and in adults during their second half of life 1–4 .…”

“…Fungal endocarditis (FE) is a growing challenge for the last two decades 1–4 . Aspergillus and Candida species are the major fungi implicated in this disease 1–4 .…”

The Neurology of Solid Organ Transplantation

“…If negative, brain MRI and the usual workup to determine the mechanism of stroke should follow. It is important to keep in mind that in transplant recipients, certain infections can be associated with strokes, including hemorrhagic strokes with Aspergillus and cardioembolic strokes with endocarditis [81]. In the early posttransplant period, thrombolytic treatment with intravenous tissue plasminogen activator (tPA) is contraindicated because of the recent major surgery.…”