amphotericin-b and Endocarditis

Candidemia is the fourth most common nosocomial bloodstream infection. Endocarditis from candidemia is a rare but possibly fatal complication. The efficacy of amphotericin and echinocandins for induction and azoles for suppression has been well studied. Source control of infection, including removal of foreign bodies, remains the cornerstone for the success of any antifungal therapy.. We are describing a case of a 63-years old patient with multiple comorbidities who developed candidemia secondary to Candida albicans. The prospect of curing the fungemia was made difficult by prosthetic devices, including prosthetic heart valves, intracardiac defibrillator, and inferior vena filter, which could not be extracted due to poor cardiovascular status and higher postoperative mortality risk. Combination therapy with amphotericin and 5-Flucytosine (5FC) was used with the first recurrence. Suppression with fluconazole was contraindicated due to prolonged corrected QT (QTc) interval. Isavuconazole was employed for chronic lifelong suppression.. Retaining prosthetics in higher surgical risk patients presents us with unique clinical and pharmacological challenges regarding breakthrough infections, drug interaction, and side effects from prolonged suppressive therapies.

Topics: Amphotericin B; Candida albicans; Candidemia; Drug-Related Side Effects and Adverse Reactions; Endocarditis; Humans; Middle Aged

Aspergillus endocarditis is a rare infection that may affect immunocompetent patients following heart valve replacement or heart surgery. We report the case of a 39 year old woman with a history of intravenous drug use who developed endocarditis with direct examination of the resected valve and vegetation showing the presence of mycelia. Cultures were positive for an Aspergillus of section Nigri, which was subsequently identified as Aspergillus tubingensis by sequencing. The clinical course was favorable following surgery and prolonged antifungal therapy (8 months in total). Antifungal susceptibility testing showed good in vitro activity of amphotericin B, voriconazole and echinocandins against planktonic cells of this A. tubingensis isolate. However, only amphotericin B displayed significant activity against biofilms. In vitro combinations of voriconazole or amphotericin B with echinocandins did not meet the criteria of synergism. Our review of the literature identified 17 other cases of endocarditis attributed to Aspergillus of section Nigri with an overall mortality rate of 57% (100% in the absence of surgery). Endocarditis caused by Aspergillus niger and related cryptic species are rare events, for which surgical management appears to be crucial for outcome. While amphotericin B was the only antifungal drug displaying significant anti-biofilm activity, the type and duration of antifungal therapy remain to be determined.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Echinocandins; Endocarditis; Female; Humans; Microbial Sensitivity Tests; Voriconazole

Although it is the most common agent among the fungal causes of endocarditis, Candida albicans endocarditis is rare.. To evaluate the efficacy of amphotericin B in the treatment of C. albicans endocarditis beyond a systematic review.. Articles in English, Spanish and Portuguese, conducted in the following databases: MEDLINE, LILACS, IBECS and SciELO, in humans and published in the last 25 years.. Observational studies, clinical trials, and case series providing data on the amphotericin B use in patients with a C. albicans endocarditis diagnosis without age limitations.. From the initial search (n=79), 25 articles were fully evaluated, of which 19 were excluded for meeting one or more exclusion criteria, remaining five articles (two observational studies and three case series). Patients using amphotericin B demonstrated improvement in survival rates, and its main use was in association with the surgical method as well as with caspofungin association.. Literature lacks evidence to conclude about efficacy and safety of amphotericin B in the treatment of fungal endocarditis. Randomized clinical trials are necessary to provide better evidence on the subject.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Child; Cross-Sectional Studies; Endocarditis; Humans; Infant, Newborn

Trichoderma species are saprophytic filamentous fungi producing localized and invasive infections that are cause of morbidity and mortality, especially in immunocompromised patients, causing up to 53% mortality. Non-immunocompromised patients, undergoing continuous ambulatory peritoneal dialysis, are other targets of this fungus. Current molecular diagnostic tools, based on the barcode marker ITS, fail to discriminate these fungi at the species level, further increasing the difficulty associated with these infections and their generally poor prognosis.. We report on the first case of endocarditis infection caused by Trichoderma longibrachiatum in a 30-year-old man. This patient underwent the implantation of an implantable cardioverter defibrillator in 2006, replaced in 2012. Two years later, the patient developed fever, treated successfully with amoxicillin followed by ciprofloxacin, but an echocardiogram showed large vegetation onto the ventricular lead. After CIED extraction, the patient had high-grade fever. The culturing of the catheter tip was positive only in samples deriving from sonication according to the 2014 ESCMID guidelines, whereas the simple washing failed to remove the biofilm cells from the plastic surface. Subsequent molecular (ITS sequencing) and microbiological (macromorphology) analyses showed that the vegetation was due to T. longibrachiatum.. This report showed that T. longibrachiatum is an effective threat and that sonication is necessary for the culturing of vegetations from plastic surfaces. Limitations of the current barcode marker ITS, and the long procedures required by a multistep approach, call for the development of rapid monophasic tests.

Topics: Adult; Amphotericin B; Antifungal Agents; Base Sequence; Biofilms; Defibrillators, Implantable; DNA, Intergenic; Endocarditis; Heart; Humans; Male; Mycoses; Sequence Analysis, DNA; Trichoderma; Voriconazole

Bloodstream infection with Candida species is not uncommon in the intensive care unit setting and has the potential to distribute organisms to many different organ systems causing secondary infections, such as endophthalmitis, osteomyelitis, and endocarditis. In some patients, these types of infections become manifested shortly after the episode of candidemia. In others, especially vertebral osteomyelitis, weeks pass before the diagnosis is entertained. Endophthalmitis should be sought by a retinal examination in all patients early after an episode of candidemia. Both osteomyelitis and endocarditis are less common complications of candidemia than endophthalmitis. In patients who manifest symptoms or signs suggesting these infections, magnetic resonance imaging and transesophageal echocardiography, respectively, are extremely helpful diagnostic tests. Newer approaches to the treatment of these infections allow the use of better tolerated, safer antifungal agents. Endophthalmitis is often treated with fluconazole or voriconazole, and the echinocandins are increasingly used, instead of amphotericin B, as initial therapy for osteomyelitis and endocarditis before step-down therapy to oral azole agents.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidemia; Echinocandins; Echocardiography; Endocarditis; Endophthalmitis; Fluconazole; Humans; Intensive Care Units; Magnetic Resonance Imaging; Osteomyelitis; Voriconazole

Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report five cases of Candida endocarditis admitted to our hospital in the period between 2005 and 2011. Two cases were caused by C. albicans, two cases were caused by C. parapsilosis and in the last one, we didn't identify the species of Candida. All but one had clear risk factors for candidemia. Treatment consisted of amphotericin B with / without flucytosine in four patients, and they all underwent surgery for valve replacement and / or removal of intravascular devices. Overall mortality was 60% (40% of mortality was directly related to endocarditis). All patients who survived were given suppressive therapy with fluconazole for a minimum of two years.After stopping fluconazole there was a case of recurrence.

Topics: Acute Kidney Injury; Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Candida; Candidiasis; Carcinoma, Transitional Cell; Combined Modality Therapy; Disease Susceptibility; Drug Therapy, Combination; Endocarditis; Fatal Outcome; Female; Fluconazole; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Immunosuppressive Agents; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Pacemaker, Artificial; Postoperative Complications; Pregnancy; Pregnancy Complications, Infectious; Rheumatic Heart Disease; Sjogren's Syndrome; Spain; Tertiary Care Centers; Urinary Bladder Neoplasms

Endovascular infection is an uncommon but devastating manifestation of histoplasmosis, which is often diagnosed late in disease.. To evaluate the clinical and pathologic characteristics of patients with endovascular infections caused by Histoplasma capsulatum.. All cases of patients with documented endovascular histoplasmosis at a single tertiary care center in an endemic region during the period 1993-2010 were reviewed.. Patients presented with a subacute febrile illness and a history of endovascular devices. All patients had positive Histoplasma serology. Routine bacterial culture results were negative for all patients. In addition to yeast forms typical of histoplasmosis, pathologic findings also revealed mycelial forms in 4 of 5 patients. Inflammation was scant. Urinary antigen detection was positive in 4 of 5 patients and Histoplasma blood culture results were positive for 3 of 5 patients. Four patients were treated with a combination of surgical and medical therapy, which consisted of amphotericin B followed by itraconazole; these 4 patients had complete resolution of symptoms and no documented relapse. One patient died before planned surgery.. Histoplasma capsulatum endovascular infections are clinically characterized by a subacute febrile illness with negative bacterial cultures in patients with prosthetic endografts or valves. Noninvasive diagnostics are often the initial clue to the diagnosis. Combined medical and surgical treatment is associated with survival. On histopathologic examination both mycelial and yeast forms are often observed, with absent to minimal tissue inflammatory reaction.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Endocarditis; Endovascular Procedures; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Middle Aged

Scedosporium prolificans is an emerging agent for severe infections. Although among the dematiaceous fungi Scedosporium is the most frequently isolated in blood cultures, Scedosporium endocarditis is rarely reported. We show herein a patient with acute leukaemia who developed S. prolificans endocarditis. Twelve cases were found in an extensive review of the English literature. In six cases (46%), there was predisposing heart conditions such as a prosthetic valve or an intracavitary device. Only 4 patients (31%) were immunocompromised hosts with haematologic neoplasia, solid-organ transplantation or acquired immunodeficiency syndrome (AIDS). Exposure to Scedosporium was observed in immunocompetent patients who developed infection while in the community. Scedosporium endocarditis occurred on both sides of the heart. Systemic and pulmonary emboli and other metastatic complications were seen in all of these patients. The overall mortality was 77% and, specifically, all of the immunocompromised hosts and 6 out of 7 patients with mitral or aortic valve endocarditis died. Patients with right-sided endocarditis associated with a removable intracardiac device exhibited a better prognosis. Scedosporium endocarditis, although still rare, is an emerging infection with an ominous prognosis. At the present time, valve replacement or the removal of cardiac devices plus combined antifungal treatment may offer the best possibility of cure.

Topics: Adult; Amphotericin B; Antifungal Agents; Communicable Diseases, Emerging; Embolectomy; Endocarditis; Fatal Outcome; Female; Femoral Artery; Humans; Immunocompromised Host; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prognosis; Pyrimidines; Scedosporium; Thrombosis; Tomography, X-Ray Computed; Triazoles; Voriconazole

Fungal endocarditis is a cardiac complication that has been increasing throughout the world. We present a case of infective endocarditis by Paecilomyces variotii in a male patient with a prosthetic mitral valve. Successful treatment consisted of administration of amphotericin B (total dose 3670 mg) and mitral valve replacement. Only six cases have been reported previously, with a 100% mortality rate.

Topics: Adult; Amphotericin B; Antifungal Agents; Bioprosthesis; Combined Modality Therapy; Device Removal; Endocarditis; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Mycoses; Paecilomyces; Postoperative Complications; Prosthesis-Related Infections; Pulmonary Edema; Reoperation; Rheumatic Heart Disease

Infection with Histoplasma capsulatum occurs commonly in areas in the Midwestern United States and Central America, but symptomatic disease requiring medical care is manifest in very few patients. The extent of disease depends on the number of conidia inhaled and the function of the host's cellular immune system. Pulmonary infection is the primary manifestation of histoplasmosis, varying from mild pneumonitis to severe acute respiratory distress syndrome. In those with emphysema, a chronic progressive form of histoplasmosis can ensue. Dissemination of H. capsulatum within macrophages is common and becomes symptomatic primarily in patients with defects in cellular immunity. The spectrum of disseminated infection includes acute, severe, life-threatening sepsis and chronic, slowly progressive infection. Diagnostic accuracy has improved greatly with the use of an assay for Histoplasma antigen in the urine; serology remains useful for certain forms of histoplasmosis, and culture is the ultimate confirming diagnostic test. Classically, histoplasmosis has been treated with long courses of amphotericin B. Today, amphotericin B is rarely used except for severe infection and then only for a few weeks, followed by azole therapy. Itraconazole is the azole of choice following initial amphotericin B treatment and for primary treatment of mild to moderate histoplasmosis.

Topics: Amphotericin B; Antifungal Agents; Central Nervous System Diseases; Endocarditis; Histoplasmosis; Humans; Lung Diseases, Fungal; Mediastinitis

Topics: Aged; Amphotericin B; Antifungal Agents; Arterial Occlusive Diseases; Cardiac Surgical Procedures; Device Removal; Endarterectomy; Endocarditis; Fatal Outcome; Female; Femoral Artery; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Leg; Mitosporic Fungi; Mitral Valve; Mycoses; Prosthesis-Related Infections; Pyrimidines; Reoperation; Triazoles; Voriconazole

Reported here is the case of a 72-year-old man who was diagnosed with Candida glabrata prosthetic mitral valve endocarditis and treated successfully with fluconazole plus caspofungin after he refused and was determined unfit for surgery. Initial treatment with intravenous amphotericin B resulted in acute renal impairment. Despite 8 days of intravenous fluconazole therapy, he remained fungemic. Caspofungin was added to the treatment regimen with subsequent sterilisation of blood culture. The patient was treated for 34 days with caspofungin and 41 days with fluconazole. He continued oral fluconazole after hospital discharge and remained well at follow-up 11 months later. The role of fluconazole and caspofungin in the treatment of Candida endocarditis is discussed.

Topics: Acute Kidney Injury; Aged; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Caspofungin; Drug Therapy, Combination; Echinocandins; Endocarditis; Fluconazole; Heart Valve Prosthesis; Humans; Lipopeptides; Male; Mitral Valve; Peptides, Cyclic; Prosthesis-Related Infections

The use of pacemakers and implantable cardioverter-defibrillators continues to increase for the management of cardiac dysrhythmias and, more recently, heart failure. Long-term complications associated with their use include infection, lead failure, and spurious shocks. Although the risk of infection with intracardiac devices is well known, the clinical presentation of this complication can be insidious, delayed in onset, and difficult to diagnose. We report a case of Aspergillus fumigatus infection of an implantable cardioverter-defibrillator with right-sided endocarditis in a 55-year-old man. The infection presented as persistent pulmonary infiltrates (due to recurrent septic pulmonary embolism) and anemia more than 2 years after implantation of the device. Clinicians should be aware of the variable manifestations resulting from infection of intracardiac devices.

Topics: Amphotericin B; Anemia; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Biopsy; Blood Sedimentation; Chronic Disease; Coronary Artery Bypass; Defibrillators, Implantable; Echocardiography, Transesophageal; Endocarditis; Humans; Male; Middle Aged; Prosthesis Failure; Prosthesis-Related Infections; Pulmonary Embolism; Recurrence; Tomography, X-Ray Computed

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

Fungal infections caused by Fusarium in the immunocompromised host are highly resistant to all antifungal agents. Fusarium endocarditis is a rare and usually fatal disease. We report an immunocompromised child who survived Fusarium solani endocarditis despite the in vitro resistance of the organism to all available antifungal agents.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Drug Therapy, Combination; Endocarditis; Female; Follow-Up Studies; Fungemia; Fusarium; Humans; Immunocompromised Host; Infant; Leukemia, Myeloid, Acute; Liposomes; Opportunistic Infections; Pyrimidines; Risk Assessment; Treatment Outcome; Triazoles; Voriconazole

Candida albicans endocarditis occurs mostly in patients with congenital heart disease; open heart surgery is the greatest predisposing factor. We report on a child with truncus arteriosus communis and a large Candida vegetation within the prosthetic pulmonary valve, causing severe right ventricular outflow tract obstruction. Treatment was performed successfully by surgery and administration of liposomal amphotericin B (AmBisome) and 5-flucytosine.

Topics: Amphotericin B; Bacteria; Candida albicans; Candidiasis; Child; Endocarditis; Fungi; Humans; Male

A case is reported of isolated native tricuspid calve Candida parapsilosis endocarditis (INTVCE) in a male patient with no history of drug abuse or heart disease. The patient had received hyperalimentation and antibiotics for four months via a central venous catheter after abdominal surgery. He underwent successful treatment with tricuspid valve debridement, liposomal amphotericin (AmBisome) and fluconazole, and remained without relapse during an eight-year follow up. A literature review of 12 similar cases (including the present patient) without history of drug abuse or heart disease, dating from 1970, is included.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Debridement; Echocardiography; Endocarditis; Fluconazole; Humans; Male; Middle Aged; Parenteral Nutrition, Total; Substance-Related Disorders; Tomography, X-Ray Computed; Tricuspid Valve

Topics: Amphotericin B; Antifungal Agents; Arteries; Brain; Endocarditis; Hip Joint; Humans; Mycoses; Risk Factors

The implantable cardioverter-defibrillator (ICD) represents an important advance in the treatment of ventricular arrhythmias, but infection has remained a serious complication of device implantation. Fungal infections associated with these devices are uncommon, with only 4 cases previously reported. We describe a case of ICD-associated endocarditis caused by Candida albicans that was successfully treated with complete device explantation and prolonged antifungal therapy, and we review the features of ICD-related fungal infections.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Defibrillators, Implantable; Endocarditis; Humans; Male; Middle Aged; Prosthesis-Related Infections; Tachycardia, Ventricular

Candida species is now being increasingly recognised as an important cause of endocarditis especially in immunocompromised patients. A case of Candida albicans endocarditis in a child with acute lymphoblastic leukemia (ALL) is reported. The child did not have a central venous catheter at any time. Treatment consisted of intravenous amphotericin B and fluconazole for 3 weeks followed by oral fluconazole for 2 weeks. No surgical resection was necessary. We highlight here the importance of echocardiography in the management of prolonged febrile neutropenia and discuss the dilemma of continuing chemotherapy in such patients.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Child, Preschool; Drug Therapy, Combination; Endocarditis; Fluconazole; Humans; Injections, Intravenous; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Treatment Outcome

We report a case of fungal endocarditis due to Aspergillus terreus in a leukaemia patient who received a bone marrow allograft from a matched unrelated donor. He presented with persistent fever. microangiopathic haemolytic anaemia but there was no cardiac signs and symptoms. He died despite intravenous amphotericin B. Review of the English literature showed five other patients with fungal endocarditis in the setting of bone marrow transplantation and revealed the same features of difficult diagnosis and poor outcome.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Bone Marrow Transplantation; Endocarditis; Fatal Outcome; Humans; Male; Postoperative Complications

Fungal prosthetic valve endocarditis is an unusual cause of endocarditis, yet very important because of its historical poor prognosis. This article will review the incidence, presentation, diagnosis, and treatment results of fungal prosthetic valve endocarditis. In addition, 11 patients at The Cleveland Clinic over the last 16 years were treated with a strategy consisting of aggressive perioperative amphotericin B therapy, radical surgical debridement of all infected tissue and prosthetic valve replacement with biological tissue when possible, as well as the chronic use of oral azole antifungal agents for suppression. This combined approach has resulted in 82% of patients being discharged and a 55% 5-year survival rate. Unfortunately, 36% of patients developed recurrent fungal prosthetic valve endocarditis, at an average of 25.8 months after their first operation for fungal prosthetic valve endocarditis. The use of oral antiazole antifungal agents for suppression may prevent the high incidence of recurrent endocarditis in this patient population.

Topics: Amphotericin B; Antifungal Agents; Azoles; Combined Modality Therapy; Endocarditis; Heart Valve Prosthesis; Humans; Mycoses; Prosthesis-Related Infections; Recurrence; Survival Rate

Fenestrated Fontan operation was performed in a 19-year-old male with a diagnosis of right isomerism syndrome. Postoperatively, fungal endocarditis due to Candida Albicans and mediastinitis by Methicilin resistant Staphylococcus Aureus (MRSA) occurred. For Candida endocarditis, combined surgery and medical treatment with amphotericin B was effective. MRSA mediastinitis was successfully treated by continuous closed irrigation with 0.5% povidone-iodine solution. This is the 17th reported case of fungal endocarditis after open heart surgery in Japanese literature.

Topics: Adult; Amphotericin B; Candidiasis; Cardiac Surgical Procedures; Endocarditis; Heart Atria; Humans; Male; Mediastinitis; Methicillin Resistance; Postoperative Complications; Pulmonary Artery; Staphylococcal Infections; Staphylococcus aureus

The authors report a case of primary aspergillus endocarditis with endophthalmitis and vertebral osteomyelitis. No underlying disease and no predisposing factors were found. Valve replacement plus combined antifungal chemotherapy proved to be effective as the patient is asymptomatic 18 months after the first symptoms. 48 cases of aspergillus endocarditis, without prior cardiac surgery have been reported in the literature. Aspergillus endocarditis was valvular or mural. Extracardiac dissemination was common but endophthalmitis and osteomyelitis were infrequent. In 11 cases, the diagnosis was made by histologic examination of embolectomy or ocular, skin biopsy tissue. All patients were febrile. Blood cultures showed no Aspergillus species. Clinical manifestations of endocarditis were described in less than fifty per cent of cases. Echocardiographic visualization of vegetations was obtained in 5 cases. Many patients experienced embolic phenomena. Mortality from Aspergillus endocarditis is extremely high (96%). Surgery is the main treatment, consisting of valve replacement. Antifungal chemotherapy should be combined. The proper duration and dosage and the combination of antifungal drugs have not been clearly defined.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Combined Modality Therapy; Drug Therapy, Combination; Endocarditis; Flucytosine; Humans; Itraconazole; Ketoconazole; Male; Middle Aged; Recurrence; Reoperation

Endocardial involvement associated with disseminated histoplasmosis has been infrequently documented, especially among patients with prosthetic valves. The therapeutic approach to these patients is also not yet clearly defined. A 54-year-old man with prosthetic valve endocarditis due to histoplasmosis was successfully treated with amphotericin B. A review of the literature suggests that the optimal form of therapy is likely a combination of surgical replacement of the involved valve and high dose amphotericin B. Successful therapy with amphotericin B alone may, however, be achieved if surgery is not a viable option.

Topics: Amphotericin B; Bioprosthesis; Endocarditis; Heart Valve Prosthesis; Histoplasmosis; Humans; Male; Middle Aged; Mitral Valve

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Endocarditis; Female; Flucytosine; Humans; Infant, Newborn; Infant, Premature, Diseases; Male

On the basis of the data currently available, no dogmatic statements can be made about optimal therapy for Candida endocarditis. In those with valve protheses, early surgery should be carefully assessed even though the differences in outcome (17% vs 53% survival) are not yet statistically significant.

Topics: Adolescent; Amphotericin B; Aortic Valve; Candidiasis; Drug Therapy, Combination; Endocarditis; Flucytosine; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Middle Aged; Nystatin; Tricuspid Valve

Topics: Amphotericin B; Aspergillosis; Candida; Candidiasis; Child; Child, Preschool; Coccidioidomycosis; Coccidiosis; Cryptococcosis; Endocarditis; Granuloma; Histoplasmosis; Humans; Infant; Kidney; Kidney Function Tests; Meningitis; Mycoses; Pneumonia

Topics: Amphotericin B; Cephalothin; Diagnosis, Differential; Endocarditis; Endocarditis, Bacterial; Humans; Infections; Mycoses; Penicillins; Streptomycin; Tetracycline; Vancomycin

Topics: Abscess; Amphotericin B; Antifungal Agents; Aortic Valve; Aortic Valve Stenosis; Aspergillosis; Aspergillus fumigatus; Azoles; Computed Tomography Angiography; Drug Therapy, Combination; Endocarditis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Intracranial Embolism; Male; Middle Aged; Postoperative Complications; Prosthesis-Related Infections; Treatment Outcome; Voriconazole

Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.. We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.. Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.. L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Disease Management; Endocarditis; Female; Fluconazole; France; Heart Valve Prosthesis; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Prosthesis-Related Infections; Registries; Retrospective Studies; Spain

We present a case of a rare association of infective endocarditis and a coin lesion in the lung caused by Candida albicans. The lesion disappeared after 6 weeks of treatment with 5 mg/kg/day amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Child; Echocardiography; Endocarditis; Humans; Male; Radiography, Thoracic; Rare Diseases; Solitary Pulmonary Nodule

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Diagnosis, Differential; Echocardiography; Endocarditis; Fatal Outcome; Female; Heart Atria; Humans; Micafungin; Middle Aged; Myxoma; Voriconazole

To compare the clinical and epidemiological features, treatments, and outcomes of patients with isolated right-sided and left-sided fungal endocarditis and to determine the risk factors for in-hospital mortality in patients with Candida sp endocarditis.. A retrospective review of all consecutive cases of fungal endocarditis from five hospitals was performed. Clinical features were compared between patients with isolated right-sided and left-sided endocarditis. In the subgroup of fungal endocarditis due to Candida species, binary logistic regression analysis was performed to determine variables related to in-hospital mortality.. Seventy-eight patients with fungal endocarditis were studied. Their median age was 50 years; 55% were male and 19 patients (24%) had isolated right-sided endocarditis. Overall, cardiac surgery was performed in 46 patients (59%), and in-hospital mortality was 54%. Compared to patients with left-side fungal endocarditis, patients with isolated right-sided endocarditis had lower mortality (32% vs. 61%; p=0.025) and were less often submitted to cardiac surgery (37% vs. 66%; p=0.024). The most frequent etiology was Candida spp (85%). In this subgroup, acute heart failure (odds ratio 5.0; p=0.027) and exclusive medical treatment (odds ratio 11.1; p=0.004) were independent predictors of in-hospital death, whereas isolated right-sided endocarditis was related to a lower risk of mortality (odds ratio 0.13; p=0.023).. Patients with isolated right-sided fungal endocarditis have particular clinical and epidemiological features. They were submitted to cardiac surgery less often and had better survival than patients with left-sided fungal endocarditis. Isolated right-sided endocarditis was also a marker of a less harmful illness in the subgroup of Candida sp endocarditis.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida; Echinocandins; Endocarditis; Female; Fluconazole; Follow-Up Studies; Heart Failure; Hospital Mortality; Humans; Male; Middle Aged; Mycoses; Retrospective Studies; Risk Factors; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Aortic Valve; Burns; Candida tropicalis; Candidemia; Echocardiography; Endocarditis; Heart Valve Prosthesis Implantation; Hospitalization; Humans; Invasive Fungal Infections; Male; Micafungin; Middle Aged; Mitral Valve

Infective endocarditis is a disease characterised by heart valve lesions, which exhibit extracellular matrix proteins that act as a physical barrier to prevent the passage of antimicrobial agents. The genus Candida has acquired clinical importance given that it is increasingly being isolated from cases of nosocomial infections.. To evaluate the activity of caspofungin compared to that of liposomal amphotericin B against Candida albicans in experimental infective endocarditis.. Wistar rats underwent surgical intervention and infection with strains of C. albicans to develop infective endocarditis. Three groups were formed: the first group was treated with caspofungin, the second with liposomal amphotericin B, and the third received a placebo. In vitro sensitivity was first determined to further evaluate the effect of these treatments on a rat experimental model of endocarditis by semiquantitative culture of fibrinous vegetations and histological analysis.. Our semiquantitative culture of growing vegetation showed massive C. albicans colonisation in rats without treatment, whereas rats treated with caspofungin showed significantly reduced colonisation, which was similar to the results obtained with liposomal amphotericin B.. The antifungal activity of caspofungin is similar to that of liposomal amphotericin B in an experimental model of infective endocarditis caused by C. albicans.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Caspofungin; Disease Models, Animal; Echinocandins; Endocarditis; Female; Lipopeptides; Rats; Rats, Wistar

Pulmonary valve infections without the involvement of other valves account for only 1.5- 2% of all infective endocarditis cases. Isolated pulmonary valve endocarditis due to fungus is extremely rare. The case is presented of a 36-year-old male who was found to have isolated pulmonary valve endocarditis caused by a very rare organism, Candida parapsilosis, and that was solely managed with medical therapy. The patient was evaluated for three weeks of lowgrade fever, generalized rash and fatigue, and found to have C. parapsilosis in the blood. Transesophageal echocardiography (TEE) demonstrated a 4.5 cm vegetation on the pulmonary valve, without involvement of other valves. The patient was deemed not to be a surgical candidate and was subsequently started on intravenous liposomal amphotericin B and 5-flucytosine, with excellent clinical outcome. Based on these case details, it must be emphasized that in selective cases and if there are no known complications, fungal endocarditis can be managed successfully using anti-fungal agents.

Topics: Administration, Intravenous; Adult; Amphotericin B; Antifungal Agents; Candida parapsilosis; Candidiasis, Invasive; Echocardiography, Transesophageal; Endocarditis; Flucytosine; Humans; Male; Pulmonary Valve; Treatment Outcome

Candida infective endocarditis is a rare disease with a high mortality rate. Our understanding of this infection is derived from case series, case reports, and small prospective cohorts. The purpose of this study was to evaluate the clinical features and use of different antifungal treatment regimens for Candida infective endocarditis. This prospective cohort study was based on 70 cases of Candida infective endocarditis from the International Collaboration on Endocarditis (ICE)-Prospective Cohort Study and ICE-Plus databases collected between 2000 and 2010. The majority of infections were acquired nosocomially (67%). Congestive heart failure (24%), prosthetic heart valve (46%), and previous infective endocarditis (26%) were common comorbidities. Overall mortality was high, with 36% mortality in the hospital and 59% at 1 year. On univariate analysis, older age, heart failure at baseline, persistent candidemia, nosocomial acquisition, heart failure as a complication, and intracardiac abscess were associated with higher mortality. Mortality was not affected by use of surgical therapy or choice of antifungal agent. A subgroup analysis was performed on 33 patients for whom specific antifungal therapy information was available. In this subgroup, 11 patients received amphotericin B-based therapy and 14 received echinocandin-based therapy. Despite a higher percentage of older patients and nosocomial infection in the echinocandin group, mortality rates were similar between the two groups. In conclusion, Candida infective endocarditis is associated with a high mortality rate that was not impacted by choice of antifungal therapy or by adjunctive surgical intervention. Additionally, echinocandin therapy was as effective as amphotericin B-based therapy in the small subgroup analysis.

Topics: Adult; Age Factors; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Cohort Studies; Cross Infection; Echinocandins; Endocarditis; Female; Hospital Mortality; Humans; Male; Middle Aged; Prospective Studies; Risk Factors

We herein report the case of a 72-year-old man with endocarditis of the aortic valve who underwent urgent aortic valve replacement 36 hours after admission due to an aggravation of aortic valve regurgitation. Postoperative cultures of the blood and site of valve vegetation identified Candida parapsilosis as a pathogen. Antifungal therapy with amphotericin B and fluconazole was initiated after surgical treatment. Thereafter, the patient displayed a favorable clinical course. Candida parapsilosis endocarditis involving the native valves is extremely rare and associated with a very high mortality rate. Prompt surgical treatment and the aggressive use of antifungal agents are required to save the patient's life.

Topics: Aged; Amphotericin B; Antifungal Agents; Aortic Valve; Candida; Candidiasis; Endocarditis; Fluconazole; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Treatment Outcome

Infective endocarditis is an uncommon manifestation of infection with Histoplasma capsulatum. The diagnosis is frequently missed, and outcomes historically have been poor. We present 14 cases of Histoplasma endocarditis seen in the last decade at medical centers throughout the United States. All patients were men, and 10 of the 14 had an infected prosthetic aortic valve. One patient had an infected left atrial myxoma. Symptoms were present a median of 7 weeks before the diagnosis was established. Blood cultures yielded H. capsulatum in only 6 (43%) patients. Histoplasma antigen was present in urine and/or serum in all but 3 of the patients and provided the first clue to the diagnosis of histoplasmosis for several patients. Antibody testing was positive for H. capsulatum in 6 of 8 patients in whom the test was performed. Eleven patients underwent surgery for valve replacement or myxoma removal. Large, friable vegetations were noted at surgery in most patients, confirming the preoperative transesophageal echocardiography findings. Histopathologic examination of valve tissue and the myxoma revealed granulomatous inflammation and large numbers of organisms in most specimens. Four of the excised valves and the atrial myxoma showed a mixture of both yeast and hyphal forms on histopathology. A lipid formulation of amphotericin B, administered for a median of 29 days, was the initial therapy in 11 of the 14 patients. This was followed by oral itraconazole therapy, in all but 2 patients. The length of itraconazole suppressive therapy ranged from 11 months to lifelong administration. Three patients (21%) died within 3 months of the date of diagnosis. All 3 deaths were in patients who had received either no or minimal (1 day and 1 week) amphotericin B.

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Antigens, Fungal; Aortic Valve; Echocardiography, Transesophageal; Endocarditis; Heart Atria; Heart Valve Prosthesis Implantation; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Medical Records, Problem-Oriented; Middle Aged; Myxoma; Prosthesis-Related Infections; Treatment Outcome; United States

In recent decades the incidence of Candida endocarditis has increased dramatically. Despite the application of surgery and antifungal therapy, Candida endocarditis remains a life-threatening infection with significant morbidity and mortality. We report a 37-year-old male drug abuser presenting with high fever, chest pain, loss of appetite and cardiac failure. His echocardiography revealed mobile large tricuspid valve vegetations. Fungal endocarditis was confirmed by culturing of the resected vegetation showing mixed growth of Candida albicans and Candida tropicalis, although three consecutive blood cultures were negative for Candida species. Phenotypic identification was reconfirmed by sequencing of the internal transcribed spacer (ITS rDNA) region. The patient was initially treated with intravenous fluconazole (6 mg kg(-1) per day), followed by 2 weeks of intravenous amphotericin B deoxycholate (1 mg kg(-1) per day). Although MICs were low for both drugs, the patient's antifungal therapy combined with valve replacement failed, and he died due to respiratory failure.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candida tropicalis; Candidiasis; Coinfection; Deoxycholic Acid; DNA, Fungal; DNA, Ribosomal Spacer; Drug Combinations; Drug Users; Echocardiography; Endocarditis; Fatal Outcome; Fluconazole; Humans; Male; Molecular Sequence Data; Mycological Typing Techniques; Sequence Analysis, DNA; Substance-Related Disorders; Tricuspid Valve

Endocarditis caused by Candida dubliniensis is a rare event and limited to few case reports. In this report, the authors present a patient with a history of intravenous drug use and hepatitis C and endocarditis involving a prosthetic aortic valve. Also reviewed are the treatment guidelines for Candida sp. endocarditis.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Echinocandins; Endocarditis; Fluconazole; Humans; Lipopeptides; Male; Micafungin; Middle Aged

A 47-year-old man who had a pacemaker implanted 2 years earlier, recently developed a fever and had been on antibiotics for 2 months. He presented with pulmonary emboli, and underwent lead extraction and emboli removal. Histopathology demonstrated Aspergillus. Amphotericin B was continued postoperatively. This rare case of pacemaker lead endocarditis suggests that vigorous medical and surgical intervention can be curative.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Device Removal; Echocardiography, Transesophageal; Embolectomy; Endocarditis; Humans; Male; Middle Aged; Pacemaker, Artificial; Prosthesis-Related Infections; Pulmonary Embolism; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Buprenorphine; Candidiasis; Endocarditis; Endophthalmitis; Eye Infections, Fungal; Fatal Outcome; Flucytosine; Hepatitis C, Chronic; Heroin Dependence; Humans; Male; Mycoses; Pneumonia, Staphylococcal; Recurrence; Shock, Cardiogenic; Substance Abuse, Intravenous; Tricuspid Valve; Ultrasonography

Candida endocarditis is extremely rare in term neonates, and gall bladder involvement due to candidemia has never been reported amongst neonates and infants. A term, appropriate for gestational age neonate developed Candida tropicalis blood stream infection in second week of life. He was started on conventional amphotericin B. However, he failed to show any clinical improvement, and candidemia keep on persisting. Repeat sanctuary sites screening revealed multiple echogenic masses in heart (vegetations) and gall bladder. On changing the treatment to liposomal amphotericin B and fluconazole, he recovered clinically, echogenic masses in gall bladder disappeared, and intracardiac vegetations decreased in size.

Topics: Amphotericin B; Antifungal Agents; Candida tropicalis; Candidiasis; Endocarditis; Fluconazole; Gallbladder Diseases; Humans; Infant, Newborn; Male

A retrospective study of 35 case reports of Aspergillus endocarditis published between 2003 and 2009 was carried out. Fifteen percent of cases presented with a new cardiac murmur, 38% with an embolus. Eighty percent of cases involved the aortic or mitral valves. Seventy-four percent of cases involved patients with a history of prior surgery, 48% of these involved a heart valve, 20% had other cardiac surgery and 32% had non-cardiac surgery. Galactomannan testing was helpful diagnostically in four out of nine cases, but PCR testing was positive in six out of six cases. Overall mortality was 68%, all eight survivors had heart valve surgery apart from one - an 8-month-old child. Seven out of eight survivors received liposomal amphotericin B, three of these in combination with other antifungals. We need to think more about the possibility of Aspergillus endocarditis, particularly in immunocompromised patients with recent surgery. Galactomannan and PCR testing may be used more vigorously. Valve replacement, or at least vegetectomy, should be carried out in all patients. Liposomal amphotericin B, 3-5mg/kg/day, for at least 4 weeks is the treatment of choice. Oral voriconazole should be used for at least 2 years. Posaconazole may be an alternative, however there have been no prior cases reported to suggest its efficacy. The value of combination antifungal therapy is uncertain, but consideration should be given to the use of a second agent in addition to liposomal amphotericin. While further case reports on this condition will be helpful, more definitive management guidelines will depend on a prospective study.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Child; Child, Preschool; Endocarditis; Humans; Immunocompromised Host; Infant; Male; Middle Aged; Pyrimidines; Retrospective Studies; Surgical Procedures, Operative; Triazoles; Voriconazole; Young Adult

Fungal infections of the heart are increasingly described especially in immunocompromised patients. Cardiac involvement can present with myocarditis, pericarditis or endocarditis. Cryptococcal endocarditis is extremely rare, with only four reported cases in the literature. The prognosis, natural history and the optimal management for cryptococcal endocarditis are not well described because of paucity of cases. We report the case of a patient with prosthetic aortic valve endocarditis due to C. neoformans. The diagnosis was confirmed with transthoracic and transesophageal echocardiogram, blood cultures that were positive for C. neoformans and high titers of cryptococcal antigen in the serum. The patient was successfully treated with liposomal amphotericin without surgical intervention.

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Echocardiography; Endocarditis; Humans; Male

Topics: Amphotericin B; Antifungal Agents; Bioprosthesis; Candidiasis; Caspofungin; Drug Therapy, Combination; Echinocandins; Endocarditis; Heart Valve Prosthesis; Humans; Lipopeptides; Liposomes; Male; Middle Aged; Photosensitivity Disorders; Postoperative Complications; Prosthesis-Related Infections; Pyrimidines; Triazoles; Voriconazole

Systemic infection with Aspergillus is an opportunistic disease that affects mainly immunocompromised hosts, and is associated with a high mortality rate. It typically occurs in patients with several predisposing factors, but Aspergillus endocarditis of native valves is rare and experience in diagnosis and treatment is limited. We report a case of native valve endocarditis caused by Aspergillus. A 35-yr-old male patient who underwent pericardiocentesis four months previously for pericardial effusion of unknown etiology presented with right leg pain and absence of the right femoral artery pulse. Cardiac echocardiography revealed severe mitral insufficiency with large mobile vegetations, and computed tomographic angiography showed embolic occlusion of both common iliac arteries. We performed mitral valve replacement and thromboembolectomy, and Aspergillus was identified as the vegetation. We started intravenous amphotericin B and oral itraconazole, but systemic complications developed including superior mesenteric artery aneurysm and gastrointestinal bleeding. After aggressive management, the patient was discharged 78 days post surgery on oral itraconazole. He was well at 12 months post discharge but died in a traffic accident 13 months after discharge.

Topics: Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Endocarditis; Heart Valve Diseases; Humans; Itraconazole; Male; Postoperative Complications; Tomography, X-Ray Computed; Ultrasonography

The in vitro effects of flucytosine (5FC), liposomal amphotericin B (L-AmB), and micafungin (Mica) combinations against two Candida albicans strains that simulated 24-hour-old endocardial vegetations were studied. Mica was superior to 5FC or L-AmB, and the 5FC-L-AmB-Mica combination was superior to all other treatments for one strain but no different from the dual combination of L-AmB-Mica for the other strain.

Topics: Amphotericin B; Antifungal Agents; Biofilms; Candida albicans; Drug Combinations; Echinocandins; Endocarditis; Flucytosine; Humans; Lipopeptides; Micafungin

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Cardiac Surgical Procedures; Contraindications; Diagnosis, Differential; DNA, Fungal; Echocardiography; Endocarditis; Follow-Up Studies; Humans; Infant; Liposomes; Male; Polymerase Chain Reaction

This manuscript reports on two very low birth weight premature infants with respiratory distress, receiving parenteral nutrition and broad-spectrum antibiotics for about 3 weeks, who developed Candida albicans sepsis associated with fungal mycoses and endocarditis, despite treatment with Amphotericin B and Caspofungin. On days 40 and 47, respectively, antifungal therapy was modified to liposomal Amphotericin B combined with Fluconazole 6 mg/kg/day for 4 weeks, resulting in complete resolution of the mycetomas. Our observations suggest that the combination of liposomal Amphotericin B with Fluconazole is able to result in complete resolution of cardiac mycetomas in preterm infants.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Drug Combinations; Endocarditis; Female; Fluconazole; Humans; Infant, Newborn; Infant, Premature; Liposomes; Male; Mycetoma

We report the first case of endogenous aspergillus endophthalmitis in an immunocompetent person with systemic aortic root aspergillus endocarditis.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus; Endocarditis; Endophthalmitis; Humans; Male

Cardiac mucormycosis is an exceedingly rare condition. This case report describes mucormycosis endocarditis in an immunocompromised patient with ulcerative colitis. His condition was further complicated by multiple septic emboli to the lungs. His management included surgical excision of the right atrial endocarditic vegetation and antifungal treatment with high-dose liposomal amphotericin B.

Topics: Adult; Amphotericin B; Antifungal Agents; Colitis, Ulcerative; Combined Modality Therapy; Endocarditis; Enterococcus faecium; Humans; Immunocompromised Host; Lung Diseases, Fungal; Male; Mucor; Mucormycosis; Ultrasonography

Topics: Adult; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Endocarditis; Female; Heart Valve Diseases; Humans; Infusions, Intravenous; Nephrotic Syndrome; Tricuspid Valve

While dematiaceous (dark-walled) fungi are ubiquitous in the environment, their involvement in invasive human infections has rarely been reported. However, these organisms have been identified as potential emerging pathogens, particularly among immunocompromised hosts. We describe a diabetic patient with Lecythophora mutabilis prosthetic valve endocarditis who was treated surgically, as well as with amphotericin B lipid complex and voriconazole, which were subsequently followed by prolonged voriconazole suppressive therapy. To the best of our knowledge, our patient is the first reported survivor of L. mutabilis prosthetic valve endocarditis.

Topics: Amphotericin B; Antifungal Agents; Aortic Valve; Ascomycota; Diabetes Complications; Drug Combinations; Endocarditis; Heart Valve Prosthesis; Humans; Male; Middle Aged; Molecular Sequence Data; Mycoses; Phosphatidylcholines; Phosphatidylglycerols; Prosthesis-Related Infections; Pyrimidines; Sequence Analysis, DNA; Treatment Outcome; Triazoles; Voriconazole

Candidal endocarditis is an uncommon and serious complication of invasive Candida infection in neonates. The aim of this study was to further characterise candidal endocarditis in neonates. Between 1995 and 2000, 56 patients were diagnosed with Candida bloodstream infections (CBSI) in the Neonatal Intensive Care Unit of Schneider Children's Medical Center of Israel. Five of them (9%) developed mycetoma of the right atrium. None of the patients had congenital heart disease or a central venous catheter in the right heart at the time of diagnosis. All were treated with amphotericin B alone or in combination with other antifungals, without surgical intervention. One patient died of the disease and one died later of polymicrobial sepsis and necrotizing enterocolitis. A review of the literature since 1980 yielded an additional 25 cases of candidal endocarditis. For the whole sample (n = 30) survival rate was 73.1%. Six of the 10 patients treated with antifungal agents and surgery survived (60%), compared with 13 of the 20 patients treated only medically (65%) (P = 1.0). Candida endocarditis in neonates differs from fungal endocarditis in adults in risk factors, clinical presentation and outcome. As the outcome of surgical and medical treatment are comparable, antifungal therapy alone may be a valid therapeutic option in high-risk cases.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Drug Therapy, Combination; Endocarditis; Enterocolitis; Fatal Outcome; Female; Fungemia; Heart Atria; Humans; Infant, Newborn; Mycetoma; Premature Birth; Review Literature as Topic; Risk Factors; Sepsis; Thinness; Thoracic Surgery; Treatment Outcome

Invasive aspergillosis is an emerging infection mainly affecting immunocompromised patients. This report details a case of Aspergillus fumigatus tricuspid native valve endocarditis complicated by recurrent septic pulmonary emboli in a young, non-intravenous drug user. He was treated by surgical resection of the posterior leaflet of the tricuspid valve and the vegetations, as well as by valvuloplasty, which was followed by a combination of liposomal amphotericin B and voriconazole as acute-phase therapy and voriconazole alone as suppression therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Combined Modality Therapy; Endocarditis; Heart Valve Diseases; Humans; Male; Pulmonary Embolism; Pyrimidines; Sepsis; Triazoles; Tricuspid Valve; Voriconazole

Native valve fungal endocarditis is an uncommon disease with a high mortality rate. We present the clinical features, histological findings and outcome of 2 patients with native valve Aspergillus endocarditis. Both patients had aplastic anaemia as a predisposing disease. The diagnosis was made by Duke's criteria in 1 case and by histology in the other. Surgery was precluded owing to profound thrombocytopenia. Both patients had fatal outcome despite administration of liposomal amphotericin beta.

Topics: Adolescent; Adult; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Caspofungin; Echinocandins; Endocarditis; Fatal Outcome; Female; Humans; Itraconazole; Lipopeptides; Male; Peptides, Cyclic

A 10-year-old patient with known coccidioidomycosis relapsed and had dysrrhythmias and a right atrial mass. Histopathology and culture after surgical removal revealed that this was a vegetative mass infected with Coccidioides spp. We believe that this is the first case of coccidioidal endocarditis to be reported.

Topics: Amphotericin B; Cardiac Surgical Procedures; Child; Coccidioides; Coccidioidomycosis; Combined Modality Therapy; Endocarditis; Follow-Up Studies; Fungemia; Heart Atria; Humans; Male; Risk Assessment; Severity of Illness Index; Treatment Outcome; Ultrasonography

The incidence of endocarditis produced by the so-called "opportunists" as a complication of prosthetic valve surgery is progressively increasing in frequency and gradually transforming the clinical picture habitually associated with this disease. Candida endocarditis is an unusual but severe complication caused by Candida albicans or other fungal species. This case and a review of the literature indicate that Candida endocarditis treated with amphotericin B and prosthetic valve replacement may recur months after treatment, and that late recurrent Candida endocarditis, which is difficult to diagnose and treat, may be best prevented by lifelong antifungal suppressive therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Bioprosthesis; Candida tropicalis; Candidiasis; Endocarditis; Female; Heart Valve Prosthesis; Humans; Mitral Valve; Review Literature as Topic

To describe the response of a child with persistent fungemia to caspofungin, a member of the echinocandin class of antifungals.. Descriptive case report.. Pediatric intensive care unit at a university teaching hospital.. A 3-yr-old female with persistent candidemia.. After >5 wks of persistent candidemia, caspofungin was added to an antifungal regimen that included amphotericin B and flucytosine.. The addition of caspofungin resulted in rapid clearance of the candidemia. The child recovered without evidence of further fungal infection or overt toxicity.. Caspofungin was administered safely in this pediatric patient and possibly contributed to her clinical improvement. Caspofungin may be considered in children with severe persistent fungal infections that are not responsive to standard therapy. More study in pediatric patients is necessary before recommending its general use.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Caspofungin; Child, Preschool; Drug Therapy, Combination; Echinocandins; Endocarditis; Female; Flucytosine; Fungemia; Humans; Lipopeptides; Peptides; Peptides, Cyclic

Conventional antifungal therapy for fungal endocarditis has been associated with a poor cure rate. Therefore, combined medical and surgical therapy has been recommended. However, new potent antifungal agents, such as echinocandins, could increase the medical options and, in some cases, avoid the need for surgery. We report a case of Candida endocarditis treated successfully without valve replacement with intravenous liposomal amphotericin B (total dose, 4 g) and intravenous caspofungin (a 100-mg loading dose followed by 50 mg per day for 8 weeks) as induction therapy and intravenous caspofungin (100 mg 3 times per week for 12 weeks) as maintenance therapy.

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Caspofungin; Drug Therapy, Combination; Echinocandins; Endocarditis; Female; Humans; Lipopeptides; Peptides, Cyclic

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Abscess; Candida albicans; Candidiasis; Caspofungin; Echinocandins; Endocarditis; Fluconazole; Heart Valve Prosthesis; Humans; Lipopeptides; Male; Peptides, Cyclic; Treatment Failure

Cerebrovascular stroke due to Candida (C.) parapsilosis native valve endocarditis (NVE) is rarely reported. Herein, we report a 53-year man with C. parapsilosis NVE and acute ischemic stroke. Diabetes mellitus and recent dental manipulation were the preceding events. Cranial magnetic resonance imaging study revealed occlusion of left common carotid artery, and infarcts of the pons and territory of the branch of left middle cerebral artery. With a total of 4,051 mg amphotericin B therapy and aortic valve replacement, the patient survived with right hemiplegia and dysarthria. In the English literature, there have been 12 patients with C. parapsilosis NVE including our patient over the past 25 years. Intravenous drug abuse was the most common predisposing factor for this infective disorder, followed by hematological malignancy and central venous catheterization. Fever and ischemic phenomenon of lower legs were the common clinical manifestations. Cerebrovascular stroke was present only in our case. Of these 12 patients, one administered fluconazole and miconazole therapy died, while 11 with amphotericin B therapy and one patient with fluconazole monotherapy survived.

Topics: Amphotericin B; Antifungal Agents; Aortic Valve; Brain; Candidiasis; Diabetes Complications; Endocarditis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radiography; Stroke; Tooth Extraction

Topics: Amphotericin B; Bacterial Infections; Causality; Drug Resistance, Microbial; Drug Resistance, Multiple; Endocarditis; Glycopeptides; Humans; Mycoses

Candida colliculosa, which grew in blood cultures of a 71-year-old retired man with fever of unknown origin that had lasted for 7 months, in conjunction with transthoracic echocardiography, demonstrating a 20-mm vegetation, superior to the tricuspid valve, herniating into the right atrial cavity. The finding led to the diagnosis of fungal endocarditis. Fluconazole, 600 mg daily, was commenced for 8 days; followed by amphotericin B, 1 mg/kg daily. On the fourth day of the amphotericin B treatment, the patient underwent replacement of the infected tricuspid valve. Even though the initial postoperative period was relatively uncomplicated, the patient died after a gross aspiration on the 67th day of his hospital stay, despite aggressive cardiovascular support and antimicrobial therapy. This is the first report of a native tricuspid valve fungal endocarditis due to C. colliculosa or Torulaspora delbrueckii, which is not known to be a human pathogen.

Topics: Aged; Amphotericin B; Candida; Candidiasis; Endocarditis; Fluconazole; Humans; Male; Tricuspid Valve

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

Fungal prosthetic valve endocarditis is particularly serious, and is usually a result of nosocomial candidaemia. This report describes a patient with Candida albicans prosthetic valve endocarditis in whom surgery was believed to be contraindicated. After 45 d of amphotericin B, treatment was continued with fluconazole daily with a follow-up of 16 months, with no recurrent or adverse effects.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Drug Therapy, Combination; Endocarditis; Fluconazole; Heart Valve Prosthesis; Humans; Male; Prognosis; Prosthesis-Related Infections; Risk Assessment; Treatment Outcome

TWO CASES: Candida albicans prosthetic valve endocarditis (PVE) is a rare entity with serious complications. We report two cases of Candida albicans PVE, confirmed by culture of the prosthetic valve. The first patient died twenty days after surgery with cerebral bleeding secondary to multiple mycotic aneurysms, the second patient was still alive eight months following a Saint-Jude aortic valve replacement and prolonged antifungal therapy. The difficulty of diagnosis and management are discussed.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Drug Therapy, Combination; Endocarditis; Fatal Outcome; Female; Flucytosine; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Prosthesis-Related Infections

We report a preterm infant with 30 weeks of gestation, that received broad spectrum antimicrobials during the first days of life. At nine days of life, the infant appeared with abdominal distension and hematochezia. A systolic murmur with changing auscultatory features also appeared. An echocardiography showed an atrial vegetation. A yeast, that was identified as the emergent pathogen Saccharomyces cerevisiae appeared in two blood cultures. Treatment with amphotericin B was started, the dose was adjusted calculating the minimal inhibitory concentration of amphotericin B, and measuring plasma levels of the antimicrobial. Therefore the minimal effective dose was prescribed, avoiding its deleterious effects. After 14 days of antifungal therapy, a new echocardiography showed a reduction in the size of the atrial vegetation. At 35 days, it disappeared and amphotericin B was discontinued. On the outpatient follow up, the infant has shown a normal growth and a normal cardiac auscultation.

Topics: Amphotericin B; Antifungal Agents; Endocarditis; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Mycoses; Saccharomyces cerevisiae

Fungal endocarditis is an exceedingly rare complication of indwelling central venous catheters in adults. Here we describe what appears to be the first case of a right atrial thrombus superinfected with the yeast Torulopsis (Candida) glabrata and attached to an indwelling superior vena cava catheter that was not used for parenteral nutrition. A large vegetation-like mass adherent to the catheter tip was visualized by transesophageal echocardiography in a patient who presented with signs of septic pulmonary embolism. Following open-heart surgery, the definitive diagnosis was established by histopathologic examination of the surgical specimen.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Catheters, Indwelling; Echocardiography, Transesophageal; Endocarditis; Equipment Contamination; Female; Humans; Middle Aged; Thrombosis

Candida parapsilosis endocarditis in association with prosthetic heart valves is rare. We report the first two cases of C. parapsilosis endocarditis on the Toronto stentless porcine valve (TSPV) and the first reported case of successful elimination of infection without lifelong antifungal therapy.

Topics: Aged; Aged, 80 and over; Amphotericin B; Animals; Antifungal Agents; Candida; Candidiasis; Endocarditis; Fluconazole; Flucytosine; Heart Valve Prosthesis; Humans; Male; Middle Aged; Swine

In vitro time-kill studies and a rabbit model of endocarditis and pyelonephritis were used to define the impact that the order of exposure of Candida albicans to fluconazole (FLC) and amphotericin B (AMB), as sequential and combination therapies, had on the susceptibility of C. albicans to AMB and on the outcome. The contribution of FLC-induced resistance to AMB for C. albicans also was assessed. In vitro, AMB monotherapy rapidly killed each of four C. albicans strains; FLC alone was fungistatic. Preincubation of these fungi with FLC for 18 h prior to exposure to AMB decreased their susceptibilities to AMB for 8 to >40 h. Induced resistance to AMB was transient, but the duration of resistance increased with the length of FLC preincubation. Yeast sequentially incubated with FLC followed by AMB plus FLC (FLC-->AMB+FLC) showed fungistatic growth kinetics similar to that of fungi that were exposed to FLC alone. This antagonistic effect persisted for at least 24 h. Simultaneous exposure of C. albicans to AMB and FLC [AMB+FLC(simult)] demonstrated activity similar to that with AMB alone for AMB concentrations of > or =1 microg/ml; antagonism was seen using an AMB concentration of 0.5 microg/ml. The in vitro findings accurately predicted outcomes in our rabbit infection model. In vivo, AMB monotherapy and treatment with AMB for 24 h followed by AMB plus FLC (AMB-->AMB+FLC) rapidly sterilized kidneys and cardiac vegetations. AMB+FLC(simult) and FLC-->AMB treatments were slower in clearing fungi from infected tissues. FLC monotherapy and FLC-->AMB+FLC were both fungistatic and were the least active regimens. No adverse interaction was observed between AMB and FLC for the AMB-->FLC regimen. However, FLC-->AMB treatment was slower than AMB alone in clearing fungi from tissues. Thus, our in vitro and in vivo studies both demonstrate that preexposure of C. albicans to FLC reduces fungal susceptibility to AMB. The length of FLC preexposure and whether AMB is subsequently used alone or in combination with FLC determine the duration of induced resistance to AMB.

Topics: Amphotericin B; Animals; Antifungal Agents; Area Under Curve; Candida albicans; Endocarditis; Fluconazole; Heart; Kidney; Kidney Function Tests; Male; Microbial Sensitivity Tests; Pyelonephritis; Rabbits; Time Factors

Infection remains as the most serious complication and represents a significant threat to patients during long-term mechanical circulatory support. Fungal infection is a particularly worrisome complication and left ventricular assist device (LVAD) endocarditis does pose a serious threat.. One hundred and sixty-five patients underwent TCI Heartmate LVAD implantation between July 1991 and December 1999 at our institution. Detailed medical records were kept prospectively for all patients, and a variety of infection-related endpoints were analyzed on patients with fungal LVAD endocarditis.. Thirty-seven patients (22%) developed fungal infections during LVAD support. Five (3%) of those met our criteria for the diagnosis of fungal LVAD endocarditis. Microbial portals of entry were identifiable in all cases. Infections were managed successfully in 4 patients (80%).. The successful management of fungal LVAD endocarditis currently requires early recognition of potentially nonspecific signs and symptoms, and timely institution of antifungal therapy. In some cases with device-specific manifestations of LVAD endocarditis, device removal and replacement is necessary. In patients with clinical manifestations of sepsis and fungal driveline site or pocket infections without positive blood culture, urgent transplantation may be the appropriate management. In the setting of shortage in the donor supply, device removal and replacement is necessary.

Topics: Amphotericin B; Combined Modality Therapy; Device Removal; Drug Therapy, Combination; Endocarditis; Fluconazole; Heart-Assist Devices; Humans; Mycoses; Prosthesis Design; Prosthesis-Related Infections; Reoperation; Risk Factors

A 72-year-old man was treated for fungal tricuspid valve endocarditis (TVE) with significant tricuspid valvular regurgitation and severe congestive heart failure caused by Candida parapsilosis. The patient had received hyperalimentation and antibiotic therapy for three months through a central venous catheter after the surgical treatment of ileus. The patient was treated medically with amphotericin B and fluconazole because of high surgical risk due to severe pulmonary emphysema, and he responded well. Although TVE caused by C. parapsilosis is rare, we should consider this possibility in patients receiving long-term hyperalimentation and antibiotic therapy using a central venous catheter.

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Catheterization, Central Venous; Echocardiography; Endocarditis; Fluconazole; Heart Failure; Humans; Male; Time Factors; Tricuspid Valve; Tricuspid Valve Insufficiency

A 56-year-old woman, with underlying rheumatic heart disease status post mitral valve replacement, presented with fever, low back pain radiating to right leg, and congestive heart failure. Magnetic resonance imaging detected an L5-S1 spinal epidural abscess. A vegetation on prosthetic mitral valve was found by transesophageal echocardiography. Cultures of epidural aspirate, surgical specimen, and blood all grew Candida albicans. She received surgical drainage of the spinal epidural abscess and i.v. amphotericin B 1 mg/kg/day for eight weeks. Clinical symptoms improved gradually and she was discharged without neurologic sequelae. She remained well and continued to lead an active life two years after discharge.

Topics: Amphotericin B; Candida albicans; Candidiasis; Endocarditis; Epidural Abscess; Female; Fluconazole; Follow-Up Studies; Heart Valve Prosthesis; Humans; Lumbar Vertebrae; Middle Aged; Spondylolisthesis; Treatment Outcome

Fungal endocarditis in children is most commonly a complication of palliative or curative surgery for congenital heart disease, rheumatic valvulitis and prolonged indwelling central venous and umbilical catheters. We describe here the case of a 3-y-old patient with chronic diarrhoea and prolonged total parenteral alimentation who developed severe C. tropicalis endocarditis and was treated successfully using a liposomal preparation of amphotericin-B (AmBisome) without surgical intervention.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Child, Preschool; Chronic Disease; Diarrhea; Drug Carriers; Echocardiography; Endocarditis; Heart Atria; Humans; Liposomes; Male; Treatment Outcome

All cases of infective endocarditis occurring from January 1990 to December 1996 at our institution were reviewed, with a special focus on fungal endocarditis. Five critically ill children with fungal endocarditis and eleven children with bacterial endocarditis were recorded. The proportion of fungal endocarditis in our series was 5/16 (31%) and Candida albicans (4/5) was the most common fungal pathogen. Only one patient required heart surgery because of a loose patch but all the others were treated only by medical management for cure. The hospital survival rate was 80% (4/5) and the overall long-term survival rate was 60% (3/5) with only one death directly related to fungal infection.. Despite the small number of cases, a sole medical approach including amphotericin B and long-term fluconazole prophylaxis for the treatment of fungal endocarditis in critically ill children seems to offer an alternative to surgical treatment which may be kept for failure of medical treatment.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Child; Child, Preschool; Endocarditis; Female; Fungemia; Heart Defects, Congenital; Humans; Male; Postoperative Complications; Retrospective Studies; Switzerland; Treatment Outcome

We report a case of Candida parapsilosis prosthetic heart valve infective endocarditis in a 67-year-old man. The infection was successfully treated with liposomal amphotericin B (AmBisome) and flucytosine. Surgical replacement of the infected valve was necessary. Recurrence was prevented with oral fluconazole 400mg daily as maintenance therapy. The patient remained well after 2 years of follow-up.

Topics: Aged; Amphotericin B; Antifungal Agents; Aortic Valve; C-Reactive Protein; Candida; Candidiasis; Drug Therapy, Combination; Echocardiography; Endocarditis; Flucytosine; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Pacemaker, Artificial

We compared the efficacies of fluconazole (Flu), amphotericin B (AmB), and 5-fluorocytosine (5FC) monotherapies with the combination of Flu plus 5FC and Flu plus AmB in a rabbit model of Candida albicans endocarditis, endophthalmitis, and pyelonephritis. The dose of Flu used was that which resulted in an area under the concentration-time curve in rabbits equivalent to that seen in humans who receive Flu at 1,600 mg/day, the highest dose not associated with central nervous system toxicity in humans. Quantitative cultures of heart valve vegetations, the choroid-retina, vitreous humor, and kidney were conducted after 1, 5, 14, and 21 days of therapy. All untreated controls died within 6 days of infection; animals treated with 5FC monotherapy all died within 18 days. In contrast, 93% of animals in the other treatment groups appeared well and survived until they were sacrificed. At day 5, the relative decreases in CFU per gram in the vitreous humor were greater in groups that received Flu alone and in combination with 5FC or AmB than in groups receiving AmB or 5FC monotherapies (P < 0. 005) but were similar thereafter. In the choroid-retina, 5FC was the least-active drug. However, there were no differences in choroidal fungal densities between the other treatment groups. On days 5 and 14 of therapy, fungal densities in kidneys of AmB recipients were lower than those resulting from the other therapies (P < 0.001 and P < or = 0.038, respectively) and AmB-plus-Flu therapy was antagonistic; however, all therapies for fungal pyelonephritis were similar by treatment day 21. While fungal counts in cardiac valves of Flu recipients were similar to those of controls on day 5 of therapy and did not change from days 1 to 21, AmB therapy significantly decreased valvular CFUs versus Flu at days 5, 14, and 21 (P < 0.005 at each time point). 5FC plus Flu demonstrated enhanced killing in cardiac vegetations compared with Flu or 5FC as monotherapies (P < 0. 03). Similarly, the combination of AmB and Flu was more active than Flu in reducing the fungal density in cardiac vegetations (P < 0.03). However, as in the kidney, AmB plus Flu demonstrated antagonism versus AmB monotherapy in the treatment of C. albicans endocarditis (P < 0.05, P = 0.036, and P < 0.008 on days 5, 14, and 21, respectively).

Topics: Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Creatinine; Endocarditis; Endophthalmitis; Fluconazole; Flucytosine; Kidney; Male; Microbial Sensitivity Tests; Myocardium; Pyelonephritis; Rabbits; Survival Analysis; Time Factors; Vitreous Body

Fungal endocarditis is a highly fatal condition. Fungal prosthetic valve endocarditis is an uncommon but serious infection. Patients require surgery and long-term antifungal therapy. However, recurrence is quite common and eradication of infection is difficult. Liposomal amphotericin is considered to be better than the conventional preparation. It is hypothesized that incorporation of liposome-encapsulated amphotericin inside artificial/prosthetic cardiac valves would result in better tissue concentration of the drug at site of infection and probable prevention of recurrence. The cost of making the same might be considerable but would likely be cost-effective in the long run due to lowered mortality and prevention of recurrence.

Topics: Amphotericin B; Antifungal Agents; Drug Carriers; Endocarditis; Heart Valve Prosthesis; Humans; Liposomes; Models, Biological; Mycoses; Recurrence

We report a case of Aspergillus flavus endocarditis in a 6-year-old boy with stage IV neuroblastoma with no pre-existing cardiac disease. The infection was successfully treated with high-dose liposomal amphotericin (AmBisome) once daily. Recurrence was prevented with itraconazole oral solution once daily as maintenance therapy. Adjunctive surgery was not required. The patient's cardiac function was uncompromised, but subsequent death from progressive neuroblastoma prevented long-term follow-up.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Child; Endocarditis; Fatal Outcome; Humans; Male; Neuroblastoma

Medical cure of fungal prosthetic valve endocarditis (PVE) is rarely reported. We describe a patient with C. tropicalis PVE in whom surgery was believed to be contraindicated. A huge tricuspid valvular vegetation was identified by two-dimensional transthoracic echocardiography. After a total of 2 g of amphotericin B, she continued with fluconazole daily with a follow-up of fifteen months. Our patient represents the first case of long term survival of C. tropicalis PVE successfully managed without surgery.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Endocarditis; Female; Fluconazole; Heart Valve Prosthesis; Humans; Middle Aged; Prosthesis-Related Infections

Topics: Amphotericin B; Animals; Antifungal Agents; Aortic Valve; Aortic Valve Insufficiency; Candida albicans; Candidiasis; Drug Resistance, Microbial; Endocarditis; Fluconazole; Humans; Postoperative Complications

Although there are an increasing number of new antifungal agents available, the morbidity and mortality due to invasive mycoses remain high. The high rates of polyene toxicities and the development of azole resistance have raised the issue of using antifungal agents of these classes in combination, despite theoretical concerns regarding antagonism between such agents. This study was designed to evaluate the in vivo efficacy of combined therapy with amphotericin B and fluconazole against Candida albicans. Two distinct animal models were used in this study: a neutropenic-mouse model of hematogenously disseminated candidiasis and the infective-endocarditis rabbit model. Treatment efficacy was assessed by determining reductions in mortality as well as decreases in tissue fungal densities. In the neutropenic-mouse model, amphotericin B, as well as combination therapy, significantly prolonged survival compared to untreated controls (P < 10(-5) and P = 0.001, respectively). The fungal densities in the kidneys of neutropenic mice were significantly reduced with either amphotericin B monotherapy or amphotericin B-fluconazole combined therapy compared to those of controls (P < 10(-6)). Fluconazole monotherapy also reduced fungal densities in the kidneys; however, this decrease was not statistically significant (P = 0.17). In contrast, treatment with either fluconazole alone or combined with amphotericin B (but not amphotericin B monotherapy) significantly decreased fungal densities in the brain (P = 0.025). In the rabbit endocarditis model, amphotericin B monotherapy or combined therapy significantly decreased fungal densities in cardiac vegetations (P < 0.01 versus the controls). Although no significant antagonism was seen when fluconazole was given in combination with amphotericin B, combination therapy did not augment the antifungal activity of amphotericin B.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Disease Models, Animal; Drug Synergism; Drug Therapy, Combination; Endocarditis; Female; Fluconazole; Male; Mice; Mice, Inbred BALB C; Neutropenia; Rabbits

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

A patient with recurrent fungal endocarditis on prosthetic mitral valve is presented. Candida parapsilosis was the causative agent. The patient was treated medically with conventional amphotericin during the first episode. When the disease recurred conventional amphotericin B was used again, but had to be stopped because of severe side effects. Treatment was continued with amphotericin B colloidal dispersion, followed by fluconazole for 8 months. The patient is healthy 16 months after discontinuation of fluconazole. Medical treatment of fungal endocarditis on prosthetic valves can be successful in selected cases.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Endocarditis; Female; Fluconazole; Heart Valve Prosthesis; Humans; Middle Aged; Prosthesis-Related Infections; Recurrence

To evaluate and compare in vivo the protective efficacy of unilamellar liposomal amphotericin B (L-AmB) with that of deoxycholate amphotericin B (D-AmB) in experimental endocarditis.. In the rabbit model of experimental Aspergillus fumigatus endocarditis, two doses of each antifungal agent (1.5 mg/kg each) were administered intravenously at 4 hours and at 30 minutes before challenge with an inoculum of A. fumigatus. Three days later, the animals were sacrificed, and the aortic vegetations were analyzed.. All 19 animals that did not receive chemoprophylaxis acquired endocarditis. In contrast, endocarditis developed in 2 of 10 animals pretreated with D-AmB (P < 0.01) and 3 of 8 animals pretreated with L-AmB (P < 0.01). Both D-AmB and L-AmB prevented the development of endocarditis due to A. fumigatus and decreased the concentration of fungi in the aortic vegetations by more than 1 log10.. In the rabbit experimental model of Aspergillus endocarditis, D-AmB and L-AmB were equally effective in reducing the incidence of the infection and the tissue burden of fungi.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Cholagogues and Choleretics; Deoxycholic Acid; Disease Models, Animal; Endocarditis; In Vitro Techniques; Liposomes; Male; Rabbits

Fungal endocarditis has emerged as an important complication of patients undergoing cardiovascular surgery. Our patient had no past history of cardiac surgery, intravenous drug abuse or immunosuppressive therapy. He had received broad-spectrum antibiotics for varying periods, which might have predisposed him to this infection. The diagnosis was based on the demonstration of hyaline, septate branched fungal elements in the infected valvular tissue and isolation of Aspergillus flavus in culture. The delay in establishing the ante-mortem diagnosis because of repeatedly negative blood cultures, presence of disseminated intravascular coagulopathy and rapidly deteriorating kidney function were the major factors contributing to his poor prognosis and death, despite surgical removal of infected valves and antifungal therapy. This is the first report of endocarditis due to A. flavus from the Middle East.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Endocarditis; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve; Ultrasonography

Amphotericin B (AmB) and fluconazole, administered intraperitoneally for 7 days, were compared in a rabbit model for Candida albicans endocarditis. When given early, AmB was more effective than fluconazole for reducing CFU counts in vegetations (P < 0.01) and kidneys. Forty-eight hours after the last dose, AmB was still detected in all vegetations whereas fluconazole was detected in only one case.

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Colony Count, Microbial; Endocarditis; Fluconazole; Heart; Injections, Intraperitoneal; Kidney; Rabbits

Amphotericin B (1 mg/kg of body weight, intravenous) and fluconazole (100 mg/kg, intraperitoneal) were compared in the prophylaxis of experimental Candida endocarditis caused by drug-susceptible, non-C. albicans strains C. tropicalis and C. parapsilosis. Neither antifungal agent was effective at preventing endocarditis due to either Candida strain when either agent was administered in a single-dose regimen (1 h prior to fungal challenge); the prophylactic efficacy of both agents increased substantially when a second prophylactic dose was given (24 h postchallenge). The excellent prophylactic efficacy of fluconazole, a fungistatic agent, underscores the importance of microbistatic mechanisms in endocarditis prophylaxis.

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Drug Administration Schedule; Endocarditis; Fluconazole; Microbial Sensitivity Tests; Rabbits

A 10-month-old infant girl presented with Aspergillus fumigatus endocarditis localized to a Gore-Tex patch used as part of the repair for double-outlet right ventricle. A new liposomal preparation of amphotericin B combined with surgical vegectomy resulted in a successful outcome with no evidence of disease recurrence at 15 months' follow-up. Echocardiography provided an optimal modality for ongoing evaluation of therapeutic outcome.

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Combined Modality Therapy; Debridement; Double Outlet Right Ventricle; Endocarditis; Female; Humans; Infant; Liposomes; Postoperative Complications

In the quest for safer and more effective antifungal agents, amphotericin B (AMB) has been placed in a variety of lipid preparations. In this study, we examined the efficacy of amphotericin B lipid complex (ABLC) on experimental cryptococcal meningitis and disseminated candidosis. This formulation is relatively safe compared to the parent compound, and therefore doses ten times greater than the commercial amphotericin B deoxycholate can be given to rabbits. Although at equal doses the ABLC preparation is less potent than AMB, a higher dose of ABLC was rapidly fungicidal in the contexts of both a central nervous system infection with Cryptococcus neoformans during immune suppression, and a heart and kidney infection with Candida albicans. Rapid sterilization of tissue should be a goal of antifungal drug therapy, particularly in the immune compromised host. From these studies, this AMB lipid formulation has the ability to produce rapid fungicidal activity in vivo, but it requires higher doses than AMB deoxycholate. Clinical trials in humans must examine carefully the therapeutic-toxic ratio in dose-escalation protocols to determine the optimal dosage strategy for this agent.

Topics: Amphotericin B; Animals; Blood Vessels; Candidiasis; Colony Count, Microbial; Cryptococcus neoformans; Deoxycholic Acid; Drug Combinations; Endocarditis; Kidney; Liposomes; Male; Meningitis, Cryptococcal; Rabbits

Fungal endocarditis is considered an absolute indication for valve replacement surgery. We describe the successful medical treatment of recurrent Candida parapsilosis candidemia with sequential treatment with amphotericin B and fluconazole in a patient with probable prosthetic valve endocarditis. Because of the presumed effectiveness of amphotericin B and fluconazole in the treatment of this patient, medical therapy should be considered as potentially useful in the treatment of recurrent C parapsilosis fungemia or endocarditis or both.

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Endocarditis; Fluconazole; Fungemia; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Recurrence

A case of Candida parapsilosis endocarditis observed 16 months after BMT is reported. The patient, a 35-year-old female with CML, suffered from Candida parapsilosis fungemia on day +22 after BMT. In spite of treatment with amphotericin B, fluconazole and catheter withdrawal, the same yeast was isolated > 1 year later from a vegetation on an old rheumatic mitral valve. Although the patient remained in complete cytogenetical and hematological remission, in vitro tests showed reduced phagocytic and chemotactic capacity of neutrophils and monocytes. This case stresses the need of prolonged therapy for patients with candidemia after BMT.

Topics: Adult; Amphotericin B; Bone Marrow Transplantation; Candida; Candidiasis; Endocarditis; Female; Fluconazole; Fungemia; Heart Valve Diseases; Humans; Mitral Valve; Recurrence

Amphotericin B and fluconazole were compared for the treatment of experimental Candida endocarditis caused by Candida tropicalis and C. parapsilosis. Rabbits received no therapy, amphotericin B (1 mg/kg of body weight per day intravenously), or fluconazole (100 mg/kg/day intraperitoneally) for either 11 or 21 days. Against both species, amphotericin B and fluconazole were equally effective overall; however, amphotericin B was more rapidly fungicidal than fluconazole in vivo against C. tropicalis.

Topics: Amphotericin B; Animals; Candida; Candidiasis; Endocarditis; Female; Fluconazole; Heart; Injections, Intravenous; Microbial Sensitivity Tests; Rabbits

A 40-year-old man with aortic stenosis and disseminated histoplasmosis did not respond to treatment with itraconazole. Though there was no haemodynamic deterioration, valvar regurgitation, or embolic phenomena a presumptive diagnosis of infective endocarditis was made. This was confirmed at aortic valve replacement. Antifungal treatment was continued for 18 months after valve replacement and serological tests for Histoplasma became progressively more negative during a three year follow up.

Topics: Adult; Amphotericin B; Aortic Valve; Aortic Valve Stenosis; Combined Modality Therapy; Deglutition Disorders; Endocarditis; Follow-Up Studies; Heart Valve Prosthesis; Histoplasmosis; Humans; Itraconazole; Male; Weight Loss

A case is described of a 49-year-old man with rheumatic aortic valve disease who developed endocarditis seven years after valvular replacement. Trichosporon beigelii was isolated from the blood, a peripheral thrombus, and the removed prosthesis. After two valve prosthesis replacements and prolonged antifungal therapy, the patient survived for four years, but eventually died as a consequence of multiple septic complications due to the same organism. To the authors' knowledge, this is the longest survival time of any reported case of Trichosporon prosthetic valve endocarditis.

Topics: Amphotericin B; Endocarditis; Fluconazole; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mycoses; Prognosis; Prosthesis-Related Infections; Spain; Time Factors; Trichosporon

Few infants have been reported who survived fungal endocarditis; all have required both surgical and intensive antifungal therapy. We describe three infants, two weighing less than 1000 gm, who survived Candida endocarditis without surgery. Two had Candida parapsilosis, an agent not previously reported as a cause of neonatal endocarditis. All three infants were treated with amphotericin B and 5-flucytosine. Despite administration of 44, 38, and 48 mg/kg amphotericin B, respectively, no nephrotoxicity was noted; 5-flucytosine therapy was stopped in one infant because of thrombocytopenia. One infant died of an unrelated cause 6 months later; there was no evidence of Candida or endocarditis at autopsy. The other two infants are thriving 2 and 3 years after the completion of antifungal therapy; no remaining evidence of endocarditis is present on echocardiography. We conclude that antifungal therapy without surgery is an option for Candida endocarditis in critically ill infants.

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Endocarditis; Female; Flucytosine; Humans; Infant; Male

A 34-year-old man, a heavy drinker, was admitted with a high fever and hematuria two months previously. Surgery was performed for acute sever pancreatitis and postoperatively antibiotics were administered with intravenous hyperalimentation. After discharge he was readmitted and infective endocarditis was strongly suspected because of high fever, hematuria, Osler's nodes, Janeway's lesions, splinter hemorrhages and mitral regurgitation. Penicillin G in combination with Gentamycine therapy was started on the first hospital day. On the second hospital day, blood culture revealed Candida tropicalis so Miconazole therapy was commenced. On the forth hospital day, he underwent surgery for replacement of a mitral prosthesis with a prosthetic valve because he had embolus in the radial artery. Despite intensive antifungal therapy, he showed no improvement in clinical symptoms. Then we changed the antifungal drug from Miconazole to Amphotericin B and 5-fluorocytosine. On the 109th hospital day, his clinical symptoms improved. Antifungal therapy was halted and at present 10 months later, he is healthy.

Topics: Adult; Amphotericin B; Candida; Candidiasis; Drug Therapy, Combination; Endocarditis; Flucytosine; Heart Valve Prosthesis; Humans; Male; Mitral Valve

A 74-year-old man who had a weight loss of 7 kg in three months, with fever up to 38 degrees C and anaemia (Hb 9.4 g/dl) began to have pain and blue discoloration of fingers II-V of the right hand. Echocardiography demonstrated vegetation on the aortic valve cusps and blood culture grew Aspergillus fumigatus, indicating Aspergillus endocarditis. There were no predisposing factors. Valve replacement was contraindicated because of the age of the patient, the presence of peripheral arterial disease, and previous myocardial infarction. Treatment was started with amphotericin B i.v. (dosage increasing to 50 mg daily) and 1.5 g daily of flucytosine by mouth, to a total of 1.1 g amphotericin B and 41.5 g flucytosine in five weeks. During this time there was a gradual decrease in symptoms and the valve vegetations. Nine months later there has been no recurrence.

Topics: Aged; Amphotericin B; Amputation, Surgical; Aortic Valve; Aspergillosis; Aspergillus fumigatus; Combined Modality Therapy; Dermatomycoses; Drug Therapy, Combination; Endocarditis; Fingers; Flucytosine; Hand Dermatoses; Heart Valve Diseases; Humans; Male

We have reported a case of fungal native valve endocarditis due to Aspergillus sp in which cure was effected by medical therapy alone. An infected sternectomy wound from a previous aortic valve replacement was considered a contraindication to surgery.

Topics: Aged; Amphotericin B; Aspergillosis; Endocarditis; Heart Valve Prosthesis; Humans; Male; Mitral Valve

Endocarditis is an uncommon complication of disseminated candidiasis among premature infants, but has been recently reported to be almost uniformly fatal. The lone previously documented survivor required extensive surgical resection as well as prolonged systemic antifungal therapy. The present report details a premature infant who recovered from Candida endocarditis with medical therapy alone.

Topics: Amphotericin B; Candidiasis; Endocarditis; Flucytosine; Humans; Infant, Newborn; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Male

The efficacy of cilofungin (LY121019) for aortic valve endocarditis caused by Candida albicans in rabbits was studied. Vegetation titers were similar for cilofungin-treated and untreated rabbits. No rabbit survived beyond 5 days in either group. All rabbits given amphotericin B survived, and titers were reduced. Cilofungin was ineffective in this model.

Topics: Amphotericin B; Animals; Antifungal Agents; Aortic Valve; Candida albicans; Candidiasis; Echinocandins; Endocarditis; Half-Life; Heart Valve Diseases; Microbial Sensitivity Tests; Peptides; Peptides, Cyclic; Rabbits

The prognosis following both spontaneous rupture of the oesophagus (Boerhaave's syndrome) and candidal endocarditis is poor. Antifungal treatment for the latter has, in the past, been empirical. A patient who survived both these conditions is described, his case demonstrating some of the major risk factors for candidal endocarditis. Management of his antifungal treatment was guided by newly developed serological methods. Close liaison between microbiologist and clinician is essential for the management of this serious condition.

Topics: Adult; Amphotericin B; Antigens, Fungal; Candida; Candidiasis; Endocarditis; Esophagus; Humans; Male; Rupture

Candidal endocarditis can develop if candidemia occurs during Swan-Ganz catheterization. Candida endocarditis may persist for many months and is fatal unless the infected valve is resected. Herein is reported the first case of rupture of a mycotic pulmonary artery aneurysm caused by chronic candidal endocarditis. The endocarditis followed Swan-Ganz catheterization and aneurysm progressed despite appropriate medical and surgical therapy.

Topics: Amphotericin B; Aneurysm, Infected; Candidiasis; Catheterization, Swan-Ganz; Endocarditis; Humans; Male; Middle Aged; Pulmonary Artery; Rupture, Spontaneous; Time Factors

Topics: Amphotericin B; Arthritis, Infectious; Endocarditis; Exophiala; Humans; Male; Middle Aged; Mitosporic Fungi; Mycoses

The efficacy of amphotericin B, 5-fluorocytosine and itraconazole was compared for the treatment of experimental rabbit Aspergillus fumigatus endocarditis. Therapy with amphotericin B or 5-fluorocytosine, at dosages of 3.0 and 35 mg/kg body weight respectively, failed to eradicate aspergillus from the cardiac vegetations in all but one of the animals tested; none of these animals survived for longer than nine treatment days. When similar doses of amphotericin and 5-fluorocytosine were administered concomittantly, 30% of the animals had sterile vegetations. Itraconazole at 2.5 and 3.5 mg/kg body weight was not successful; all the animals tested had infected vegetations and did not survive beyond nine days of therapy. In contrast, itraconazole at 5.0 mg/kg sterilised the endocardial vegetations and all these animals survived for 14 days. It is concluded that itraconazole may be useful in the treatment of aspergillus endocarditis.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Endocarditis; Flucytosine; Itraconazole; Ketoconazole; Microbial Sensitivity Tests; Rabbits

Tricuspid valve Candida albicans endocarditis developed in a multiple-organ transplant recipient six months after successful treatment of Candida peritonitis. She has had no recurrence or valvular incompetence two years after valve-sparing debridement of the vegetation and prolonged therapy with amphotericin B. This is the second report of long-term success following valve-sparing debridement for tricuspid valve Candida endocarditis. In selected patients without annular involvement or gross valve destruction, excision of the fungal vegetation may allow for long-term cure and a competent valve.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Combined Modality Therapy; Debridement; Endocarditis; Female; Humans; Ketoconazole; Kidney Transplantation; Pancreas Transplantation; Time Factors; Tricuspid Valve

Aspergillus endocarditis is associated with a very high mortality. Of approximately 67 cases reported in the English language literature, there have been only two known survivors. This report describes a patient with Aspergillus flavus endocarditis after mitral valve annuloplasty who recovered with combined surgical and antifungal therapy. This is the first successfully treated case due to A. flavus and the first involving an annuloplasty ring.

Topics: Amphotericin B; Aspergillosis; Aspergillus flavus; Combined Modality Therapy; Cytosine; Endocarditis; Female; Flucytosine; Heart Valve Prosthesis; Humans; Middle Aged; Mitral Valve; Mitral Valve Prolapse; Postoperative Complications

Topics: Amphotericin B; Candidiasis; Endocarditis; Female; Humans; Middle Aged; Mitral Valve Stenosis

Wangiella dermatitidis is an infrequently encountered dematiacious fungus that usually causes localized infections of the skin and subcutaneous tissues. This report presents the first well-documented case of natural valve infection caused by this organism as it occurred in intravenous drug abuser. His course has been complicated by relapsing infection of two aortic prostheses and dissemination to the vertebral spine. Treatment with a combination of amphotericin B, rifampin, and ketoconazole has arrested the progression of his infection. The microbiologic features and existing clinical information regarding this fungus are reviewed and in vitro susceptibility data for the present isolate are presented.

Topics: Adult; Amphotericin B; Aortic Valve; Drug Therapy, Combination; Endocarditis; Heart Valve Diseases; Heroin Dependence; Humans; Ketoconazole; Male; Mitosporic Fungi; Mycoses; Recurrence; Reoperation; Rifampin

Amphotericin B and N-D-ornithyl amphotericin B methyl ester were compared for therapeutic efficacies against experimentally induced cryptococcal meningitis and Candida albicans endocarditis with pyelonephritis in rabbits. Antifungal activity of the two polyenes in vitro was similar for the yeasts used in these experiments. N-D-ornithyl amphotericin B methyl ester gave a slightly higher concentration in serum than amphotericin B did, but both drugs had similar elimination curves, and penetration into the cerebrospinal fluid was poor for both. Despite these similarities between the two polyenes, amphotericin B was much more effective than N-D-ornithyl amphotericin B methyl ester in the treatment of cryptococcal meningitis in rabbits. For C. albicans endocarditis, both polyenes had similar cure rates, but in vitro measurement of fungicidal activity in serum did not predict treatment outcome. For C. albicans pyelonephritis, both polyenes showed efficacy; because higher doses of the less toxic methyl ester could be used, it sterilized the urinary tract more often than amphotericin B. These studies indicate that in vivo and in vitro experiments may be needed to predict the results of treatment with polyenes.

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Cryptococcosis; Endocarditis; Kinetics; Meningitis; Microbial Sensitivity Tests; Mycoses; Pyelonephritis; Rabbits; Yeasts

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Endocarditis; Flucytosine; Humans; Intracranial Embolism and Thrombosis; Leukemia, Myeloid; Lung Diseases, Fungal; Male; Middle Aged

Topics: Amphotericin B; Antibodies; Candida; Candidiasis; Endocarditis; Humans; Immunoelectrophoresis; Monitoring, Physiologic; Serologic Tests

We have described an elderly man with no known underlying predisposing systemic or valvular disease who had mitral valve infection and endophthalmitis due to Aspergillus fumigatus. Two-dimensional echocardiography was valuable in detecting fungal vegetations.

Topics: Aged; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Bioprosthesis; Drug Therapy, Combination; Echocardiography; Endocarditis; Flucytosine; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Mitral Valve

Progressive disseminated histoplasmosis (PDH) is a rare consequence of infection with Histoplasmia capsulatum. Usually fatal if untreated, PDH generally is cured by appropriate amphotericin B treatment. Of 31 persons with uncomplicated PDH treated with amphotericin B, we found that relapse occurred in five (16%) after an interval of up to nine years after initial therapy. Review of these five cases and 31 additional relapsing cases from the literature indicates that fungal endocarditis or endarteritis without surgical treatment, underlying lymphoreticular neoplasm, and amphotericin B dosage of less than 2 g appear to be associated with relapse of PDH.

Topics: Aged; Amphotericin B; Antifungal Agents; Endocarditis; Histoplasmosis; Humans; Imidazoles; Ketoconazole; Leukemia, Lymphoid; Lymphoma, Non-Hodgkin; Male; Middle Aged; Piperazines; Recurrence; Retrospective Studies; Time Factors

In a patient with spondylodiscitis secondary to cardiac valve prosthesis infection with endocarditis the fungus Drechslera longirostrata, which had not yet been known to cause mycoses, was isolated from cultures of prosthetic material and an intervertebral disc. The cardiac prosthesis had to be replaced and the vertebral lesion, which extended along 3 lumbar segments and was destructive enough to produce neurological disorders, required surgical immobilization of the spine. The disc infection was cured after combined administration of amphotericin B and ketoconazole, both drugs having proved unsuccessful when given alone. Infections caused by rare opportunistic fungi are becoming increasingly common and are difficult to diagnose since immunological methods are inapplicable. In some resistant or extremely severe fungal infections antifungal agents can be used in combinations for their synergistic effects, with subsequent reduction of dosage and potential side-effects. Combinations must be based on in vitro sensitivity tests.

Topics: Adult; Amphotericin B; Antifungal Agents; Endocarditis; Female; Heart Valve Prosthesis; Humans; Imidazoles; Ketoconazole; Mitosporic Fungi; Mycoses; Piperazines; Postoperative Complications; Spondylitis

Topics: Adolescent; Adult; Aged; Amphotericin B; Endocarditis; Female; Histoplasmosis; Humans; Male; Middle Aged

Topics: Adult; Amphotericin B; Candidiasis; Cytosine; Drug Therapy, Combination; Endocarditis; Female; Flucytosine; Heart Valve Prosthesis; Humans; Imidazoles; Ketoconazole; Mitral Valve; Piperazines; Recurrence

Topics: Adolescent; Adult; Aged; Amphotericin B; Aspergillus; Candida albicans; Cardiomyopathies; Child; Child, Preschool; Cryptococcus; Endocarditis; Endocardium; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Mycoses; Myocarditis; Myocardium; Pericardium

Topics: Adrenal Glands; Adult; Aged; Amphotericin B; Bone and Bones; Bone Marrow; Central Nervous System; Child; Child, Preschool; Digestive System; Endocarditis; Female; Hepatomegaly; Histoplasmosis; Humans; Infant; Kidney; Larynx; Lung; Lymphatic System; Male; Middle Aged; Oropharynx; Retrospective Studies; Splenomegaly; Sulfonamides; Tennessee

Endocarditis is a rare manifestation of disseminated Histoplasma capsulatum infection. A 22-year-old man presented with a seven month history of fever, weight loss, and progressive aortic insufficiency. The diagnosis of H. capsulatum was suggested by a diagnostic rise in complement fixation titers and positive echocardiographic findings. The diagnosis was confirmed prior to surgery by positive bone marrow culture. Progressive congestive heart failure necessitated replacement of the aortic valve which subsequently grew H. capsulatum. In this case, a combination of amphotericin B therapy and valve replacement was curative.

Topics: Adult; Amphotericin B; Aortic Valve; Complement Fixation Tests; Echocardiography; Endocarditis; Heart Murmurs; Heart Valve Diseases; Histoplasmosis; Humans; Liver; Male; Skin Tests

A patient is reported who had Histoplasma capsulatum endocarditis, a rare form of disseminated histoplasmosis. He also had disseminated intravascular coagulopathy and defects in cell-mediated immune responses to Histoplasma antigens. Prompt etiologic diagnosis was made by stain of tissue from a mouth ulcer and confirmed by culture of the organism from blood. An echocardiogram compared to a previous normal echocardiogram indicated changes consistent with a vegetation. Histologic examination of the resected valve demonstrated organisms. Amphotericin B administration (3.4 g) plus an aortic valve replacement resulted in cure.

Topics: Adult; Amphotericin B; Disseminated Intravascular Coagulation; Endocarditis; Female; Heart Failure; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged

Penicillium endocarditis involving an aortic valvular tissue prosthesis (Ionescu-Shiley) was successfully managed. This is the fourth reported case of Penicillium endocarditis, and the first survivor. A review of the literature shows that this fungus is ubiguitous though rarely pathogenic. The management of this rare type of infection is outlined.

Topics: Adult; Amphotericin B; Aortic Valve; Bioprosthesis; Endocarditis; Heart Valve Prosthesis; Humans; Male; Mycoses; Penicillium; Postoperative Complications

Topics: Adult; Amphotericin B; Aortic Valve; Candidiasis; Endocarditis; Flucytosine; Humans; Male

Initial intensive combined chemotherapy, with late re-operation when indicated, appears to give better results than immediate excision of the infected valve. The combination chemotherapy used in this series was amphotericin B (up to 100 mg/patient/day) and flucytosine (up to 12 g/patient/day). Serious side effects attributed to this chemotherapy were extremely rare. Candida infections were the most common and the Aspergillus infections were uniformly fatal. Embolectomies and excisions of large mycotic aneurysms were generally successful. Re-operation for late valve malfunction was common and yielded satisfactory results.

Topics: Amphotericin B; Endocarditis; Flucytosine; Heart Valves; Humans; Mycoses; Postoperative Complications; Transplantation, Homologous

The new therapeutic methods based on antibiotics, corticosteroids and immunosuppressors and the new medicosurgical techniques (catheters, monitoring in intensive-care units, open-heart surgery) modify the host, favorise the adaptation and introduction f endogenous and exogenous yeast-like fungi and thus create a new pathology characterized by deep visceral or septicemic infections due to yeasts belonging to the genera Candida, Torulopsis, Cryptococcus, Trichosporon, Rhodotorula, and Saccharomyces. The pathological aspects are analyzed and therapy is suggested in the light of new findings on polyenes (nystatine, amphotericine B), 5-fluorocytosine, imidazole, derivatives (miconazole, econazole) considering their association in function of synergy or antagonism possibilities.

Topics: Amphotericin B; Candida; Candidiasis; Cryptococcosis; Dermatomycoses; Endocarditis; Flucytosine; Humans; Iatrogenic Disease; Imidazoles; Lung Diseases, Fungal; Mycoses; Nystatin; Osteitis; Sepsis; Urinary Tract Infections

A heroin addict with asymmetric septal hypertrophy and persistent fungemia with Candida parapsilosis was treated with amphotericin B and flucytosine (5-fluorocytosine). The diagnosis of endocarditis was based on the subsequent development of a murmur of mitral regurgitation and echocardiographic evidence of prolapse of the posterior leaflet of the mitral valve. Cure was effected with antifungal therapy alone. Thus, when the diagnosis of fungal endocarditis is made early in its course, open-heart surgery may not be needed. To investigate the relative frequency of isolation of C parapsilosis from particular sites, a mycologic survey was conducted in our hospital. Among the isolates of yeasts, C parapsilosis represented 8.0, 17.1, and 26.7 percent of those from all cultured sites, from contaminated intravenous catheters, and from cultures of blood, respectively. Since this trend to cluster in cases of fungemia was not seen with other yeasts, C parapsilosis appears to be more invasive than other species of Candida.

Topics: Adult; Amphotericin B; Candida; Candidiasis; Endocarditis; Flucytosine; Humans; Male

A patient is presented in whom a left atrial myxoma was found to be infected with Histoplasma capsulatum. Histoplasmosis has not been previously associated with this tumor, nor has any fungus without preceding bacterial endocarditis and long-term antibiotic therapy. The clinical course in foru previously reported cases of bacterially infected myxoma is reviewed. There have been 18 prior cases of Histoplasma endocarditis and in two the patients have survived. Their clinical presentation and response to therapy are also reviewed, and pertinent therapeutic conclusions drawn. The role of echocardiography in this patient's evaluation and the ultimate successful therapy are discussed.

Topics: Amphotericin B; Echocardiography; Endocarditis; Female; Heart Atria; Heart Neoplasms; Histoplasmosis; Humans; Middle Aged; Myxoma

Endocarditis caused by Candida albicans was induced in rabbits after insertion of a catheter across the aortic valve. The mean survival time of 34 rabbits was 26 days. Only 7% of temperature recordings taken were elevated. Candida was recovered from only 9% of blood cultures taken. Precipitating and agglutinating serum antibody was detected after 12 days of infection. Antibody titers rose progressively until death in rabbits with endocarditis, whereas titers peaked early and subsequently decreased in animals that received an intravenous injection of C. albicans without precatheterization. Three groups of rabbits were treated for 6 days with amphotericin B, 5-fluorocytosine, or the two durgs in combination. Amphotericin B alone reduced the mean titer of organisms from log10 8.79 +/- 1.46 to log 10 3.1 +/- 1.9 colony-forming units/g. 5-Fluorocytosine was less effective (mean titer after 6 days of therapy was log10 7.4 +/- 0.33 colony-forming units/g). The addition of 5-fluorocytosine to amphotericin B did not increase the rate at which Candida cells were eradicated from the vegetations. These in vivo results corrleated with the failure to demonstrate an increased rate of fungicidal activity in vitro with the two drugs.

Topics: Agglutinins; Amphotericin B; Animals; Antibodies, Fungal; Aortic Valve; Candida albicans; Candidiasis; Cytosine; Disease Models, Animal; Endocarditis; Flucytosine; Kidney; Rabbits

Candida endocarditis is a serious condition which should be suspected in any patient with signs and symptoms compatible with bacterial endocarditis when cultures are negative. It should be managed by a medical-surgical approach which combines resection of all infected heart tissue and repair of any preexisting heart defects with appropriate antifungal therapy. Mycotic aneurysms should be treated by ligation of the vessel above and below the aneurysm, resection of the aneurysm, and implementation of appropriate antifungal or antibacterial therapy. Revascularization is not always necessary. When required, an extra-anatomic approach is preferable to placing a graft through the bed of the aneurysm.

Topics: Adult; Amphotericin B; Aneurysm, Infected; Candidiasis; Endocarditis; Humans; Male; Surgical Wound Infection

Successful treatment of fungal endocarditis is being described with increasing frequency. Two patients, previously reported as free of disease by two different groups of investigators, subsequently died in our institutions with evidence of continued disease. Both patients had been receiving antifungal chemotherapy at the time their case histories were reported. The lack of clinical signs and symptoms in fungal endocarditis, the suppression of manifestations of infection by chemotherapy, and the uncertain reliability of laboratory aids led us to suggest guidelines in reporting results of therapuetic regimens. These include avoidance of terms implying cure in patients who are concurrently maintained on chemotherapy, indication of attempts to evaluate fungemia, and minimum follow-up of 1-2 years' duration. The potential utility of serologic studies is illustrated by the course of one of these patients.

Topics: Adult; Amphotericin B; Aortic Valve Stenosis; Candidiasis; Cytosine; Endocarditis; Flucytosine; Heart Valves; Heroin Dependence; Humans; Male; Miconazole; Middle Aged; Prostheses and Implants; Recurrence; Surgical Wound Infection

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

A patient suffering from Candida endocarditis presented with a gangrenous foot. In addition to arterial embolism, occult mycotic aneurysms were found by arteriography. Clinical cure was achieved with a combination of chemotherapy and valvular débridement, but viable Candida persisted in an easily removable embolus. Occult peripheral vascular lesions may be a continuing source of Candida sepsis in some patients.

Topics: Adult; Amphotericin B; Aneurysm, Infected; Aortography; Arterial Occlusive Diseases; Arteritis; Candidiasis; Drug Therapy, Combination; Endocarditis; Female; Flucytosine; Gangrene; Humans; Mitral Valve Insufficiency

A case of Torulopsis glabrata endocarditis occurring in a patient 14 months after aortic homograft valve replacement is reported. The infection was not controlled by amphotericin B which led to progressive renal impairment. Re-operation was delayed by the development of multiple infarctions due to coronary emboli. The infection was subsequently eradicated by oral treatment with the newer antifungal agent, 5-fluorocytosine, but death of the patient eventually occurred from an arrhythmia related to the persisting myocardial failure consequent upon episodes of transmural infarction. Current evidence favours the use of early re-operation in all cases of endocarditis in addition to aggressive chemotherapy with a combined regime of amphotericin B and 5-fluorocytosine. Clinical pharmacology of 5-fluorocytosine is briefly discussed.

Topics: Amphotericin B; Aortic Valve; Aortic Valve Stenosis; Autopsy; Candida; Candidiasis; Cytosine; Endocarditis; Flucytosine; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Postoperative Complications; Transplantation, Homologous

Case reports from a group of 15 patients with Candida endocarditis seen and treated at the Los Angeles-University of Southern California Medical Center between 1960 and 1974, together with a survey of other reported cases, serve to re-emphasize the importance of early diagnosis of this disease and lead to certain conclusions regarding its treatment. With medical or surgical treatment alone, the mortality for Candida endocarditis is 82 per cent. With surgery and medical treatment combined, the mortality is 20 percent. It is important to institute medical treatment as soon as diagnosis of Candida endocarditis is made and surgery must be performed as soon as possible, preferably within 24 to 48 hours or, at most, a few days after the patient has left the hospital. Close observation of the patient after discharge is important.

Topics: Adult; Amphotericin B; Autopsy; Blood Urea Nitrogen; Candida; Candida albicans; Candidiasis; Endocarditis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Care; Species Specificity; Therapeutic Irrigation

The normal levels of commensal yeasts in patients undergoing open-heart surgery are established and the effect of antifungal prophylaxis is assessed. Mouth swabs and feces were taken for culture from patients on admission to hospital and 1,2, and 3 weeks postoperatively. Eighty-seven patients who received normal treatment and 50 patients who were given oral and topical antifungal prophylaxis commencing 12 days before hospitalization were studied. Yeast pathogens, mainly Candida albicans, were isolated from 42 (48.3 per cent) of the normal group on admission. There was a marked increase in the incidence and quantities of yeasts isolated from patients in the immediate postoperative period. The incidence and levels of yeasts in patients receiving antifungal prophylaxis was considerably reduced both on admission and postoperatively. The risk of Candida sepsis in open-heart surgery patients with high levels of commensal yeasts is discussed and the possibility of routine antifungal prophylaxis raised.

Topics: Administration, Oral; Amphotericin B; Candida; Candida albicans; Candidiasis; Cardiac Surgical Procedures; Endocarditis; Evaluation Studies as Topic; Fascia Lata; Feces; Female; Heart Valve Diseases; Humans; Male; Mouth; Nystatin; Pessaries; Tablets; Transplantation, Homologous

Topics: Amphotericin B; Candidiasis; Endocarditis; Heart Valves; Humans

Topics: Amphotericin B; Candidiasis; Endocarditis; Flucytosine; Humans

Fungal endocarditis occurs in heroin addicts, patients who have undergone cardiovascular surgery, and patients who are treated for prolonged periods with intravenous fluids and broad spectrum antibiotics. The organisms associated with endocardial infection differ in each of these groups. Candida parapsilosis is the fungal species most commonly isolated from narcotics addicts, Aspergillus species are most frequently found in patients after cardiovascular surgery, and Candida albicans occurs most frequently in patients who have received prolonged courses of intravenous fluids and antibiotics. Despite the availability of antifungal antibiotics and surgery, over 80% of patients with documented fungal endocarditis die of this infection. Thus, early diagnosis of fungal invasion and prevention of established endocardial infection are essential. Antifungal therapy and/or careful followup should be considered in patients in whom "transient fungemia" is documented by blood culture and serological and untrasonic techniques should be further evaluated as a means of early diagnosis.

Topics: Adolescent; Adult; Aged; Amphotericin B; Aspergillosis; Candida; Candidiasis; Cardiac Surgical Procedures; Endocarditis; Female; Fever; Flucytosine; Heart Valve Prosthesis; Heroin Dependence; Humans; Male; Middle Aged; Mycoses; Postoperative Complications

A case of Candida albicans endocarditis is described in which treatment with 5-fluorocytosine was started after aortic valve replacement, but relapse followed discontinuance of treatment. At a second operation the aortic valve was replaced under 5-fluorocytosine cover and treatment was continued with both 5-fluorocytosine and amphotericin-B. No resistance to 5-fluorocytosine developed, and the candida infection was eradicated. The patient is well 22 months after his operation.

Topics: Amphotericin B; Aortic Valve; Candidiasis; Endocarditis; Flucytosine; Heart Valve Prosthesis; Humans; Male; Middle Aged

The bacteriological spectrum of infective endocarditis is very different when the disease occurs spontaneously from when it follows shortly after cardiac surgery or is associated with narcotic abuse or haemodialysis. It is therefore suggested that two categories of the illness, naturally occurring and extraneous, are recognized. The great majority of cases of naturally occurring infective endocarditis are caused by organisms highly sensitive to penicillin. Oral therapy is nearly always effective in such cases and amoxycillin given with probenecid is recommended as the regime of choice. Extraneous infective endocarditis is most often caused by staphylococci, with Gram-negative bacilli and fungi also quite frequent infecting agents. Intravenous and oral therapy with a variety of antibiotics is discussed in the management of this group.

Topics: Adolescent; Adult; Aged; Amoxicillin; Amphotericin B; Aneurysm, Infected; Anti-Bacterial Agents; Bacteria; Cardiac Surgical Procedures; Child; Cloxacillin; Endocarditis; Endocarditis, Bacterial; Erythromycin; Fusidic Acid; Gentamicins; Humans; Kanamycin; Middle Aged; Probenecid; Renal Dialysis; Staphylococcal Infections

Topics: Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Cardiac Surgical Procedures; Child; Child, Preschool; Endocarditis; Female; Fever; Heart Auscultation; Heart Valve Prosthesis; Humans; Infant; Male; Middle Aged; Postoperative Complications; Preoperative Care

A case of Candida albicans endocarditis is reported. The endocarditis occurred in a patient with a chronic illness who received intermittent glucose total intravenous nutrition for approximately 10 weeks. The patient developed severe aortic insufficiency with his valvular endocarditis and required emergency aortic valve replacement. Aggressive surgery and medical treatment appear to be the treatment of choice for these critically ill patients.

Topics: Administration, Oral; Amphotericin B; Aortic Valve; Aortic Valve Insufficiency; Candida albicans; Candidiasis; Endocarditis; Glucose; Heart Valve Prosthesis; Heart Ventricles; Humans; Male; Parenteral Nutrition; Solutions; Therapeutic Irrigation; Thrombosis

Topics: Adult; Amphotericin B; Aortic Valve; Blood; Candida; Candidiasis; Culture Media; Endocarditis; Heart Valve Prosthesis; Heroin Dependence; Humans; Male; Time Factors

The third reported case of prosthetic valvular endocarditis caused by the fungus Paecilomyces is presented. The clinical course of the patient is discussed. The distinctive morphology of the fungus is described, together with the histologic and cytologic features found in the excised prosthetic valve and in the tissues at autopsy. Prosthetic valvular endocarditis presents a serious antibiotic and surgical problem in therapy. Despite antifungal antibiotics and valve replacement this patient died as a result of metastatic cerebral microabscesses and subarachnoid hemorrhage.

Topics: Amphotericin B; Autopsy; Brain Abscess; Candidiasis; Cytosine; Endocarditis; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitosporic Fungi; Subarachnoid Hemorrhage

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; Aortic Valve; Aspergillosis; Aspergillus; Drug Therapy, Combination; Endocarditis; Flucytosine; Heart Valve Prosthesis; Humans; Male; Middle Aged; Species Specificity

Topics: Adult; Aminohydrolases; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Cell-Free System; Cytosine; Drug Resistance, Microbial; Endocarditis; Female; Flucytosine; Heroin Dependence; Humans; Imidazoles; Recurrence; Trityl Compounds

Topics: Amphotericin B; Candida; Candidiasis; Endocarditis; Female; Flucytosine; Heart Valve Prosthesis; Humans; Middle Aged; Mitral Valve; Statistics as Topic; Surgical Wound Infection; Time Factors

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

Topics: Amphotericin B; Candida albicans; Candidiasis; Endarteritis; Endocarditis; Female; Heart Ventricles; Humans; Infant; Microscopy, Electron; Mycoses; Parenteral Nutrition; Pulmonary Artery; Pulmonary Embolism; Recurrence; Tricuspid Valve

Topics: Adolescent; Adult; Aged; Amphotericin B; Candida albicans; Candidiasis; Child; Child, Preschool; Endocarditis; Esophagitis; Female; Humans; Laryngitis; Male; Meningitis; Middle Aged; Pneumonia; Stomatitis; Vaginitis

Topics: Adolescent; Adult; Aged; Amphotericin B; Anemia; Child; Endocarditis; Female; Histoplasma; Histoplasmosis; Humans; Infant; Larynx; Liver; Male; Meningitis; Middle Aged; Mouth; Prospective Studies; Thrombocytopenia; Urine

Topics: Amphotericin B; Aortic Valve; Aortic Valve Stenosis; Candida; Candidiasis; Cytosine; Endocarditis; Heart Valve Prosthesis; Humans; Male; Middle Aged; Transplantation, Homologous

Topics: Adult; Amphotericin B; Aortic Valve Insufficiency; Benzene Derivatives; Candidiasis; Endocarditis; Female; Flucytosine; Follow-Up Studies; Heart Septal Defects, Ventricular; Heart Valve Prosthesis; Heroin; Humans; Imidazoles; Male; Mitral Valve Insufficiency; Oxacillin; Pacemaker, Artificial; Radiography, Thoracic; Substance-Related Disorders; Tricuspid Valve Insufficiency

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

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Blood Urea Nitrogen; Candida; Candidiasis; Cryptococcosis; Cryptococcus; Cytosine; Drug Resistance, Microbial; Endocarditis; Fluorine; Heart Valve Prosthesis; Humans; Male; Meningitis; Middle Aged; Postoperative Complications

Topics: Adenoma; Adrenal Gland Neoplasms; Amphotericin B; Candidiasis; Cushing Syndrome; Diabetes Mellitus; Endocarditis; Female; Humans; Hydrocortisone; Hypertension; Infant

Topics: Amphotericin B; Endocarditis; Female; Heart Valve Prosthesis; Humans; Middle Aged; Mitral Valve; Mycoses; Saccharomyces; Sepsis

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

Topics: Agar; Amphotericin B; Candida; Candidiasis; Endocarditis; Fluorescent Antibody Technique; France; Humans; Immunodiffusion; Immunoelectrophoresis; Nystatin; Precipitins; Sepsis

Topics: Adult; Amphotericin B; Candida; Culture Media; Endocarditis; Heart Valve Prosthesis; Heart-Lung Machine; Humans; Hypertonic Solutions; Male

Topics: Adult; Amphotericin B; Candidiasis; Endocarditis; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male

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

Topics: Amphotericin B; Cryptococcosis; Diabetes Complications; Endocarditis; Humans; Male; Middle Aged

Topics: Amphotericin B; Candidiasis; Child; Endocarditis; Female; Humans

Topics: Amphotericin B; Anti-Bacterial Agents; Chloramphenicol; Colistin; Drug Resistance; Drug Resistance, Microbial; Endocarditis; Endocarditis, Bacterial; Enterobacter aerogenes; Enterobacteriaceae; Erythromycin; Escherichia coli Infections; Kanamycin; Penicillin G; Penicillins; Proteus Infections; Pseudomonas Infections; Ristocetin; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Adrenal Cortex Hormones; Amphotericin B; Candida; Candidiasis; Endocarditis; Endocarditis, Bacterial; Humans; Pathology; Penicillins; Streptomycin; Toxicology

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Chloramphenicol; Endocarditis; Endocarditis, Bacterial; Humans; Kanamycin; Penicillins; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Endocarditis

Topics: Amphotericin B; Antifungal Agents; Endocarditis; Histoplasma; Histoplasmosis; Humans