Pauci-immune proliferative glomerulonephritis and fungal endocarditis: More than a mere coincidence?

Aboud, Hussain; Bejjanki, Harini; Clapp, William L.; Koratala, Abhilash

doi:10.1136/bcr-2018-229059

Cited by 3 publications

(3 citation statements)

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“…There is a large variation in the rates of fungal IE, which ranges from less than 1% [10][11][12][13][14][15][16] , between 1% and 2% [17][18][19][20][21][22][23][24][25][26][27][28][29] , between 2% and 5% [30][31][32][33][34] , to over 5% [35][36][37][38][39] . The latter series included patients with an immune compromised state such as after transplantation [36] or with prosthetic valves [38,39] . Most authors group all fungal IE in one category [13,[15][16][17][18][19][20]29,30,32,[34][35][36] ; some only mention Candida ssp [10,15,[22]…”

Section: Rate Of Fungal Microorganisms In the Included Series Of Infe...mentioning

confidence: 99%

“…Most authors group all fungal IE in one category [13,[15][16][17][18][19][20]29,30,32,[34][35][36] ; some only mention Candida ssp [10,15,[22][23][24]28] . or specify the Candida subspecies [11,21,37,39] , or group Candida together with Aspergillus [25] or focus on one specific agent such as Malassezia [33] .…”

Section: Rate Of Fungal Microorganisms In the Included Series Of Infe...mentioning

confidence: 99%

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

Mistiaen

2024

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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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Section: Rate Of Fungal Microorganisms In the Included Series Of Infe...mentioning

confidence: 99%

Section: Rate Of Fungal Microorganisms In the Included Series Of Infe...mentioning

confidence: 99%

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

Mistiaen

2024

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“…a Six cases with chronic hepatitis infections: two cases with Staphylococcus aureus and chronic hepatitis C infections[23,77], two cases with Enterococcus faecalis and chronic hepatitis C infections[20,37], one with Abiotiophia defectiva and chronic untreated hepatitis B infections[9], and one with Candida parapsilosis and chronic hepatitis C infections[15] b Categorization according to Facklam[101] …”

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confidence: 99%

Antineutrophil cytoplasmic antibodies in infective endocarditis: a case report and systematic review of the literature

et al. 2022

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Infective endocarditis (IE) may be misdiagnosed as ANCA-associated vasculitis (AAV), especially when antineutrophil cytoplasmic antibodies (ANCA) are detected. Distinguishing IE from AAV is crucial to guide therapy. However, little is known about ANCA positivity in IE patients. We present a case report and systematic review of the literature on patients with ANCA-positive IE, aiming to provide a comprehensive overview of this entity and to aid clinicians in their decisions when encountering a similar case. A systematic review of papers on original cases of ANCA-positive IE without a previous diagnosis of AAV was conducted on PubMed in accordance with PRISMA-IPD guidelines. A predefined set of clinical, laboratory, and kidney biopsy findings was extracted for each patient and presented as a narrative and quantitative synthesis. A total of 74 reports describing 181 patients with ANCA-positive IE were included (a total of 182 cases including our own case). ANCA positivity was found in 18–43% of patients with IE. Patients usually presented with subacute IE (73%) and had positive cytoplasmic ANCA-staining or anti-proteinase-3 antibodies (79%). Kidney function was impaired in 72%; kidney biopsy findings were suggestive of immune complexes in 59%, while showing pauci-immune glomerulonephritis in 37%. All were treated with antibiotics; 39% of patients also received immunosuppressants. During follow-up, 69% of patients became ANCA-negative and no diagnosis of systemic vasculitis was reported. This study reviewed the largest series of patients with ANCA-positive IE thus far and shows the overlap in clinical manifestations between IE and AAV. We therefore emphasize that clinicians should be alert to the possibility of an underlying infection when treating a patient with suspected AAV, even when reassured by ANCA positivity. Key Points• This systematic review describes - to our knowledge - the largest series of patients with ANCA-positive infective endocarditis (IE) thus far (N=182), and shows a high degree of overlap in clinical manifestations between IE and ANCA-associated vasculitis (AAV).• ANCA positivity was found in 18-43% of patients with infective endocarditis. Of patients with ANCA-positive IE, the majority (79%) showed cytoplasmic ANCA-staining or anti-PR3-antibodies. We emphasize that clinicians should be alert to the possibility of an underlying infection when treating a patient with suspected AAV, even when reassured by ANCA positivity.• In patients with IE and ANCA-associated symptoms such as acute kidney injury, an important clinical challenge is the initiation of immunosuppressive therapy. All patients with data in this series received antibiotics; 39% also received immunosuppressive therapy. In many of these patients, ANCA-associated symptoms resolved or stabilized after infection was treated. ANCA titers became negative in 69% , and a diagnosis of AAV was made in none of the cases. We therefore recommend that (empiric) antibiotic treatment remains the therapeutic cornerstone for ANCA-positive IE patients, while a watchful wait-and-see approach with respect to immunosuppression is advised.

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Candida parapsilosis graft infection presenting as cutaneous leukocytoclastic vasculitis

Toyoshima

Unno

Mizuno

et al. 2021

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Pauci-immune proliferative glomerulonephritis and fungal endocarditis: More than a mere coincidence?

Cited by 3 publications

References 7 publications

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

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

Antineutrophil cytoplasmic antibodies in infective endocarditis: a case report and systematic review of the literature

Candida parapsilosis graft infection presenting as cutaneous leukocytoclastic vasculitis

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