epiglucan and Endocarditis

A case is reported of Candida glabrata infective endocarditis (IE) treated without surgical intervention. The study aim was to: (i) briefly discuss the outcomes of other documented cases of fungal IE managed medically with fluconazole; (ii) discuss the (1→3)-β-D-glucan assay and its previously studied role in the diagnosis of invasive fungal infections; and (iii) examine a possible application of the (1→3)-β-D-glucan assay to monitor response to antifungal treatment in patients with Candida endocarditis.. The serum Fungitell assay was used to trend (1→3)-β-D-glucan in a patient with Candida endocarditis to determine treatment effectiveness with fluconazole, to provide an appropriate end date for antifungal therapy, and to survey infection suppression while off treatment.. The (1→03)-β-D-glucan assay began trending downwards at 197 days into treatment with oral fluconazole. After 16 months of therapy, fluconazole was stopped due to transaminitis. (1→3)-β-Dglucan levels were checked six weeks after the discontinuation of treatment and were negative. The patient has now been off therapy for 21 weeks with no signs of clinical disease, and values remain negative.. The present case indicates that a trending (1→3)-β-D-glucan assay may have valuable application in monitoring treatment response and infection suppression for Candida endocarditis.

Topics: Aged; Antifungal Agents; beta-Glucans; Biomarkers; Candida glabrata; Candidiasis; Drug Monitoring; Endocarditis; Female; Fluconazole; Humans; Predictive Value of Tests; Proteoglycans; Time Factors; Treatment Outcome

Disseminated Scedosporium prolificans infection occurs mainly in immunocompromised patients. The mortality rate is high, as the fungus is resistant to most antifungal agents. Here, we present the case of a 66-year-old female with acute myeloid leukemia who developed infective endocarditis caused by S. prolificans infection during induction chemotherapy. Her 1,3-β-D-glucan levels were elevated and computed tomography revealed bilateral sinusitis and disseminated small nodular masses within the lungs and spleen; it nonetheless took 6 days to identify S. prolificans by blood culture. The patient died of multi-organ failure despite the combined use of voriconazole and terbinafine. Autopsy revealed numerous mycotic emboli within multiple organs (caused by mitral valve vegetation) and endocarditis (caused by S. prolificans). The geographic distribution of this infection is limited to Australia, the United States, and southern Europe, particularly Spain. The first Japanese case was reported in 2011, and four cases have been reported to date, including this one. Recently, the incidence of S. prolificans-disseminated infection in immunocompromised patients has increased in Japan. Therefore, clinicians should consider S. prolificans infection as a differential diagnosis when immunocompromised patients suffer disseminated infections with elevated 1,3-β-D-glucan levels.

Topics: Aged; Antifungal Agents; beta-Glucans; Endocarditis; Female; Humans; Induction Chemotherapy; Leukemia, Myeloid, Acute; Multiple Organ Failure; Mycoses; Naphthalenes; Proteoglycans; Scedosporium; Terbinafine; Voriconazole

Limited data exist on Candida endocarditis (CE) outcome in the era of new antifungals. As early diagnosis of CE remains difficult, non-culture-based tools need to be evaluated. Through the French prospective MYCENDO study (2005-2007), the overall characteristics and risk factors for death from CE were analysed. The contribution of antigen detection (mannan/anti-mannan antibodies and (1,3)-β-d-glucans) and molecular tools was evaluated. Among 30 CE cases, 19 were caused by non-albicans species. Sixteen patients (53%) had a predisposing cardiac disease, which was a valvular prosthesis in ten (33%). Nine patients (30%) were intravenous drug users; none of them had right-sided CE. Among the 21 patients who were not intravenous drug users, 18 (86%) had healthcare-associated CE. Initial therapy consisted of a combination of antifungals in 12 of 30 patients (40%). Thirteen patients (43%) underwent valve replacement. The median follow-up was 1 year after discharge from hospital (range, 5 months to 4 years) and hospital mortality was 37%. On univariate analysis, patients aged ≥60 years had a higher mortality risk (OR 11, 95% CI 1.2-103.9; p 0.024), whereas intravenous drug use was associated with a lower risk of death (OR 0.12, 95% CI 0.02-0.7; p 0.03). Among 18 patients screened for both serum mannan/anti-mannan antibodies and (1,3)-β-d-glucans, all had a positive result with at least one of either test at CE diagnosis. Real-time PCR was performed on blood (SeptiFast) in 12 of 18, and this confirmed the blood culture results. In conclusion, CE prognosis remains poor, with a better outcome among younger patients and intravenous drug users. Detection of serum antigens and molecular tools may contribute to earlier CE diagnosis.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antibodies, Fungal; Antifungal Agents; Antigens, Fungal; Aortic Valve; beta-Glucans; Candida; Candidiasis; Child; DNA, Fungal; Endocarditis; Female; Fluconazole; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Proteoglycans; Risk Factors; Substance Abuse, Intravenous; Treatment Outcome; Young Adult

A 66-year-old male with ischaemic cardiomyopathy and chronic lymphocytic leukemia developed signs of severe systemic inflammatory response syndrome. Serial blood cultures were negative and a SeptiFast test detected the presence of Aspergillus fumigatus DNA. Afterwards, detection of galactomannan and 1,3-β-D-glucan showed a positive result. Autopsy revealed the presence of branched fungal structures suggestive of Aspergillus.

Topics: Aged; Aspergillosis; Aspergillus fumigatus; Autopsy; beta-Glucans; Cardiomyopathies; DNA, Fungal; Endocarditis; Fatal Outcome; Galactose; Histocytochemistry; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Mannans; Microscopy; Proteoglycans