Exophiala (Wangiella) dermatitidis Prosthetic Aortic Valve Endocarditis and Prosthetic Graft Infection in an Immune Competent Patient

Berger, Jay; Cusumano, Lucas R.; DeRose, Joseph J.; Sarwar, Uzma

doi:10.1155/2017/4839314

Cited by 5 publications

(5 citation statements)

References 16 publications

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“… 8) To our knowledge, only one report has described PVE caused by E. dermatitidis infection in an immunocompetent patient. 9) We believe that our patient represents the first reported case of PVE due to E. dermatitidis infection with a large cerebral vessel occlusion treated successfully with MT. AIS secondary to IE is a common neurological complication, but in the case of fungal IE, the diagnosis is usually difficult, and previous cardiac surgery alone is usually not considered a risk factor for fungal infection.…”

Section: Discussionmentioning

confidence: 62%

Mechanical Thrombectomy for Acute Ischemic Stroke Caused by Prosthetic Aortic Valve Endocarditis Due to Exophiala dermatitidis Infection: A Case Report

Hiruta

Sato

Ishikawa

et al. 2021

NMC Case Report Journal

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Prosthetic valve endocarditis (PVE) can cause large cerebral vessel occlusion. Many reports suggested that mechanical thrombectomy (MT) is effective and useful for early diagnosis from the histopathological findings of thrombus. We present the case of a 62-year-old man, with a history of prosthetic aortic valve replacement and pulmonary vein isolation for his atrial fibrillation, who developed a high fever and an acute neurological deficit, with left hemiplegia and speech disorder. He was diagnosed as having an acute right middle cerebral artery embolism and underwent an MT. The embolic source was found to be a PVE vegetation. However, histopathological analysis of the thrombus could not detect the actual diagnosis. Although he was treated for bacterial endocarditis, his blood culture revealed a rare fungal infection with Exophiala dermatitidis not until >3 weeks after admission. Subsequently, a ß-D-glucan assay also indicated elevated levels. Although he underwent an aortic valve replacement on day 36, MRI showed multiple minor embolic strokes till that day. Early diagnosis of fungal endocarditis and detection of the causative pathogen are still challenging, and the disease has a high risk of occurrence of early and repeated embolic stroke. In addition to clinical findings and pathological studies, ß-D-glucan assay might be a good tool for the diagnosis and evaluation of fungal endocarditis.

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Section: Discussionmentioning

confidence: 62%

Mechanical Thrombectomy for Acute Ischemic Stroke Caused by Prosthetic Aortic Valve Endocarditis Due to Exophiala dermatitidis Infection: A Case Report

Hiruta

Sato

Ishikawa

et al. 2021

NMC Case Report Journal

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“…The sensitivity of the modified Duke’s criteria for diagnosing fungal endocarditis is lower than for bacterial endocarditis, with only half of the fungal cases testing positive within 3 weeks of admission 2 4. Therefore, in patients with risk factors like prolonged catheter use, intravenous drug use, steroid therapy, organ transplants, cancer, cystic fibrosis, prosthetic valves and cardiac surgery, and fungal infection should be included in the initial diagnostic evaluation 2–6. Given the long incubation period for fungal cultures, non-culture-based tests like the 1–3-B-D-Glucan test, can be instrumental in early diagnosis, with high sensitivity and specificity of 77% and 85%, respectively 10…”

Section: Discussionmentioning

confidence: 99%

“…Current evidence is derived from case reports, without conclusive guidelines on optimal antifungal therapy and treatment duration. The systemic disease usually warrants a combination of prolonged antifungal therapy with novel compounds and azoles, along with surgical intervention 1–6. Optimal treatment strategies warrant further investigations.…”

Section: Discussionmentioning

confidence: 99%

“…Candida and Aspergillus species are the most common fungi, while Exophiala dermatitidis , as in our case, has been rarely reported. With just four cases reported involving the aortic valve in immunocompetent2 5, immunocompromised post-transplant,3 or patients using intravenous drugs6 ( Supplemental Table 1 ), our case represents the first report of a prosthetic mitral valve infection in an immunocompetent individual.…”

Section: Introductionmentioning

confidence: 91%

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Exophiala dermatitidisfungal infective endocarditis on prosthetic mitral valve

Seo,

Mangeshkar,

Farooq

et al. 2023

BMJ Case Rep

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Fungal infective endocarditis, although rare, carries a high mortality risk. We present a case of successful multidisciplinary management ofExophiala dermatitidisinfective endocarditis in an immunocompetent male with a bio-prosthetic mitral valve. This case highlights the clinical presentation and provides valuable treatment insights into this rare fungal entity. Prompt consideration of fungal pathogens in predisposed patients, expedited detection through non-culture-based tests, and a combined surgical and prolonged antifungal approach are pivotal.

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“…Invasive E. dermatitidis disease involves the lungs, peritoneum, blood, liver, lymph nodes, and brain [4]. It is a rare and fatal infection that has predominantly been reported in patients with predisposing factors such as contaminated steroid use, continuous ambulatory peritoneal dialysis, acute lymphoblastic leukemia, and acquired immune deficiency syndrome [5][6][7]. In contrast, CNS infection caused by E. dermatitidis is extremely rare and primarily affects otherwise healthy people without known risk factors.…”

Section: Discussionmentioning

confidence: 99%

A fatal case of Exophiala dermatitidis meningoencephalitis in an immunocompetent host: A case report and literature review

Yang

et al. 2021

Journal of Infection and Chemotherapy

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Background: Central nervous system (CNS) infection due to Exophiala dermatitidis is rare and fatal, and primarily reported in immunocompromised patients or those with caspase recruitment domain-containing protein 9 deficiency. Herein, we describe a case of an otherwise healthy person (without underlying disease or gene deficiency) diagnosed with Exophiala dermatitidis meningoencephalitis. The patient achieved clinical remission under high-dose antifungal therapy in the first 14 months but died after 2 years of the therapy. Case presentation: A 15-year-old student with headache and fever was admitted to our department. Lumbar puncture showed increased cerebrospinal fluid (CSF) pressure, moderately high CSF protein levels and cell counts, and a remarkable decrease in CSF glucose and chloride. Magnetic resonance imaging of the brain revealed multiple lesions and cerebral pia mater enhancement. CSF culture confirmed E. dermatitidis infection. We administered 4-week antifungal therapy of amphotericin B, but his CSF culture remained positive. After receiving the 12-week standard dose of voriconazole (200 mg q12h), the patient's CSF culture became negative, but his condition deteriorated with intracranial lesion enlargement. We administered a high-dose voriconazole therapy (600-800 mg per day) for 12 months, which led to clinical remission. The voriconazole dose was reduced due to adverse effects including hepatic dysfunction and hypokalemia, and the disease progressed with high intracranial pressure and epileptic seizures. Conclusions: CNS infection caused by E. dermatitidis is fatal and the most serious form of fungal infection. Initially, high-dose and long-term antifungal therapy could be effective. Gene defect and related antifungal immunodeficiency may be the most important pathogenic and lethal factor.

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Exophiala (Wangiella) dermatitidis Prosthetic Aortic Valve Endocarditis and Prosthetic Graft Infection in an Immune Competent Patient

Cited by 5 publications

References 16 publications

Mechanical Thrombectomy for Acute Ischemic Stroke Caused by Prosthetic Aortic Valve Endocarditis Due to <i>Exophiala dermatitidis</i> Infection: A Case Report

Mechanical Thrombectomy for Acute Ischemic Stroke Caused by Prosthetic Aortic Valve Endocarditis Due to <i>Exophiala dermatitidis</i> Infection: A Case Report

Exophiala dermatitidisfungal infective endocarditis on prosthetic mitral valve

A fatal case of Exophiala dermatitidis meningoencephalitis in an immunocompetent host: A case report and literature review

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