amphotericin-b and Heart-Valve-Diseases

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

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

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

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

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

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

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

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

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

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

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

Candida has become the most prevalent cerebral mycosis at autopsy, indicating a significant incidence coupled with inadequate eradication. Of 29 patients with systemic candidiasis, 48 percent (14 of 29) also had central nervous system involvement. Of these patients, however, only 21 percent (three of 14) had antemortem diagnosis, and only one of these three patients remains alive; the two patients with antemortem diagnosis who died had a meningeal form that, although easier to document on the basis of cerebrospinal fluid examination, is now distinctly rarer than other forms of the disease in adults. The lone surviving patient was treated with amphotericin B for endocarditis and mycotic aneurysms of the cerebral vessels. One clue to central nervous system candidal infection was the striking correlation between cardiac and cerebral involvement; 80 percent of patients with myocardial or valve infection also had central nervous system candidiasis. Most forms of immunosuppression represent a risk factor for both the systemic and cerebral mycoses. Neuropathologically, there is a spectrum of disease entities associated with Candida, including two previously unrecognized lesions reported herein: fungus balls of both white and gray matter and mycotic aneurysms secondary to Candida parapsilosis. Other parenchymal presentations include thrombosis, vasculitis, abscess, hemorrhage, and demyelination. For drug therapy such as amphotericin B to be more effective, earlier diagnosis of these parenchymal infections must be sought.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Candidiasis; Central Nervous System Diseases; Female; Heart Diseases; Heart Valve Diseases; Humans; Male; Middle Aged

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

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

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: Adult; Amphotericin B; Aortic Valve; Candidiasis; Endocarditis, Bacterial; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male