Native valve endocarditis due to Pichia ohmeri

Abstract

Candida species can cause clinical manifestations in various organs of the cardiovascular system, i.e., the pericardium, myocardium, and endocardium, with endocarditis being the best-known clinical entity. Endocarditis is seen primarily in intravenous drug users and in individuals with damaged native valves, especially in congenital heart disease or rheumatic valvular diseases, and in prosthetic heart valves. The authors present a case of Pichia ohmeri endocarditis in an intravenous drug user, with an unusual presentation form. This is a case of a 42-year-old man, an intravenous heroin user, who was admitted to our Vascular Surgery Department because of fever and acute serious ischemia of the left inferior limb. He presented with fever (39 degrees C), a pale and cold left limb, absence of the left popliteal pulse, and a pansystolic murmur at the cardiac apex. The transthoracic echocardiogram showed a large vegetation on the anterior leaflet of the mitral valve and severe mitral regurgitation with good left ventricular systolic function. Empirical antibiotic therapy was started. Six days after admission, embolectomy was performed with partial clinical recovery. Three blood cultures and the embolus showed a teleomorphic form of Candida guilliermondii - Pichia ohmeri. Therapy with intravenous liposomal amphotericin B, fluocitosin, imipenem, and aztreonam was started. Two weeks later, his clinical condition deteriorated with acute heart failure refractory to medical therapy, mandating mechanical ventilation and high-dose vasopressor and inotropic amine support. He underwent urgent mitral valve replacement with a biologic prosthetic valve. Rapid stabilization of the cardiac status occurred, but ischemic limb lesions required further vascular interventions.

Kodamaea ohmeri infections in humans: A systematic review

“…No additional studies were found during the hand‐screening of the included articles' references. Finally, 35 met the present study's inclusion criteria 3,4,7–39 . The review process is graphically presented in Figure 1.…”

Kodamaea ohmeri fungemia in severe burn: Case study and literature review

“…Recently, K. ohmeri was established as one of the important fungi causing invasive infections in humans [8] . Sepsis or fungemia [4] , [5] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , catheter-related blood stream infection [10] , [17] , phlebitis [9] , peritonitis [19] , and endocarditis [14] , [16] have been reported. Diabetes mellitus, malignant tumor, prosthetic heart valves, and chronic kidney diseases are considered to be risk factors for invasive infections due to K. ohmeri .…”

An outbreak of Pichia ohmeri infection in the paediatric intensive care unit: case reports and review of the literature

“…Pichia ohmeri , a teleomorphic form of Candida guilliermondii , is an environmental strain 9 used commonly in the food industry for fermentation of pickles, rinds, and fruit. Its first clinical isolation was made in the pleural fluid of a patient in whom the fungus was considered a contaminant 10 or a harmless coloniser.…”

“…Pichia ohmeri fungaemia of an intravenous drug user, the first case of P. ohmeri prosthetic valve endocarditis in an immunocompetent man, and the first case of urinary tract infection due to this fungus, and P. ohmeri fungaemia related to central venous catheter were reported. All these cases were successfully treated with amphotericin B and fluconazole 9,14–16 . In 2003, Shin et al.…”