amphotericin-b and Embolism

Systemic infection with Aspergillus fumigatus is an opportunistic disease that affects mainly immunocompromised hosts and is associated with a high mortality rate. We report a case of A. fumigatus endocarditis after an episode of thrombotic thrombocytopenic purpura. Diagnosis was established after sudden rupture of posterior papillary muscle of the normal native mitral valve. Soon after mitral valve replacement, Aspergillus endocarditis recurred, associated with multiple peripheral emboli, which necessitated a second operation.

Topics: Amphotericin B; Anti-Infective Agents; Aspergillosis; Aspergillus fumigatus; Candidiasis; Drug Resistance, Fungal; Embolism; Endocarditis; Fatal Outcome; Female; Heart Valve Prosthesis Implantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Lung Diseases, Fungal; Middle Aged; Mitral Valve Insufficiency; Opportunistic Infections; Papillary Muscles; Postoperative Complications; Prednisolone; Pseudomonas Infections; Purpura, Thrombotic Thrombocytopenic; Recurrence; Rupture, Spontaneous; Shock, Septic; Sputum; Ultrasonography; Urinary Tract Infections

A 38-year-old Japanese man with severe aplastic anemia had invasive pulmonary aspergillosis as a complication. He was treated with amphotericin B for six weeks, but the aspergillosis did not improve. Then he experienced a fatal myocardial infarction. An autopsy revealed disseminated aspergillosis involving pericarditis and Aspergillus embolization to the coronary arteries. This led to the acute myocardial infarction. Cardiac aspergillosis is rare, but should be included within the differential diagnosis when chest pain of unknown origin occurs in an immunosuppressed patient.

Topics: Adult; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Coronary Disease; Embolism; Humans; Immunocompromised Host; Lung Diseases, Fungal; Male; Myocardial Infarction; Pericarditis

A 54-year-old farmer with moderate mitral valve regurgitation was admitted to hospital because of suspected infective endocarditis.. Echocardiography revealed a large mitral valve vegetation as the source of multifocal septic emboli to the central nervous system, spleen, mesenteric and femoro-popliteal arteries, eyes, and kidneys. Eventually an embolus removed from the femoro-popliteal artery and vegetations on the replaced mitral valve grew C. albicans.. Despite treatment with amphotericin B and valve replacement the patient died of septicemia due to E. coli.. Endocarditis due to C. albicans is commonly associated with severe complications. Diagnosis of this rare disease is often delayed because of negative blood cultures. Large cardiac vegetations and embolization of major arterial vessels should raise the suspicion of fungal endocarditis.

Topics: Amphotericin B; Candida albicans; Candidiasis; Echocardiography; Embolism; Endocarditis; Escherichia coli Infections; Fatal Outcome; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Sepsis

The use of indwelling central catheters for long-term administration of hyperalimentation, chemotherapy or other intravenous therapies is increasing. This unusual presentation of a catheter-induced right atrial thrombus was complicated by fungal infection. We present a case of a paediatric sickle-cell patient who underwent surgical removal of a right atrial thrombus secondary to fungal (Candida tropicalis) endocarditis from an indwelling catheter. Successful thrombus removal utilizing cardiopulmonary bypass and subsequent discharge underscores the importance of surgical therapy in treating this important complication.

Topics: Amphotericin B; Anemia, Sickle Cell; Antifungal Agents; Blood Transfusion; Candidiasis; Cardiopulmonary Bypass; Catheterization, Central Venous; Child, Preschool; Combined Modality Therapy; Embolism; Endocarditis; Heart Atria; Heart Diseases; Humans; Intraoperative Complications; Male; Postoperative Complications; Respiratory Tract Infections; Thrombosis

Valvular endocarditis caused by Aspergillus is a lethal disease. Only two survivors, both with infections of prosthetic valves, have been reported in the world literature. This report describes a patient with an Aspergillus valvular endocarditis on a native valve with embolization to the right axillary, left iliac, and left popliteal arteries and the distal aorta. Diagnosis was made from a thromboembolectomy specimen. Treatment consisted of removal of the peripheral arterial emboli, mitral valve replacement, and prolonged intravenous infusion of high-dose amphotericin B. The patient presently has the longest survival period of any patient with an Aspergillus infection on a native heart valve. The importance of early diagnosis and aggressive operative management by the vascular surgeon needed to properly treat these patients is emphasized.

Topics: Adult; Amphotericin B; Aortic Diseases; Aspergillosis; Axillary Artery; Embolism; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Iliac Artery; Mitral Valve; Popliteal Artery

The fungicidal effect of amphotericin B and 5-fluorocytosine (5-FC) on fungi incorporated into blood and fibrin clots was investigated. Amphotericin B was ineffective against fungi incorporated into blood clots, but effective in the eradication of fungi in fibrin clots. 5-FC was ineffective both against fungi incorporated in blood clots as well as in fibrin clots. The combination of 5-FC and amphotericin B was likewise ineffective against fungi incorporated into blood clots. The failure of these drugs to penetrate blood clots may explain the treatment failure in fungal endocarditis.

Topics: Amphotericin B; Blood; Blood Platelets; Candida; Cytosine; Embolism; Endocarditis, Bacterial; Fibrin; Flucytosine; Humans; Models, Biological

Topics: Amphotericin B; Atrial Fibrillation; Candidiasis; Digoxin; Embolism; Endocarditis; Female; Flucytosine; Heart Valve Prosthesis; Humans; Middle Aged; Mitral Valve; Warfarin

Topics: Aged; Amphotericin B; Aortic Valve; Aspergillus; Blood; Candida; Candida albicans; Cryptococcus; Embolism; Endocarditis; Flucytosine; Fungi; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Mycoses; Postoperative Complications

Topics: Amphotericin B; Arterial Occlusive Diseases; Aspergillosis; Aspergillus fumigatus; Embolism; Endocarditis; Femoral Artery; Humans; Male; Middle Aged; Mitral Valve; Myocardium

Topics: Amphotericin B; Aortic Valve; Catheterization; Chromoblastomycosis; Embolism; Endocarditis; Female; Heart Valve Prosthesis; Humans; Middle Aged; Mitosporic Fungi; Mitral Valve; Prognosis

Topics: Adult; Amphotericin B; Angiography; Aortic Diseases; Aortic Valve; Aspergillosis; Embolism; Humans; Male; Popliteal Artery; Postoperative Complications

Topics: Amphotericin B; Complement Fixation Tests; Embolism; Endocarditis; Fluorescent Antibody Technique; Histoplasmosis; Humans; Male; Middle Aged

Topics: Adult; Amphotericin B; Aneurysm, Infected; Aorta; Aortic Diseases; Aortic Valve; Aspergillosis; Embolism; Endocarditis; Endocardium; Heart Aneurysm; Humans; Liver; Liver Cirrhosis; Male; Tricuspid Valve