galactomannan and Endocarditis

Invasive aspergillosis, chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis are the clinical forms of aspergillosis. Although there is a great number of Aspergillus species, Aspergillus fumigatus-complex is the more frequent aetiological agent, regardless of clinical form or baseline condition. The increase in immunosuppressive agents and the higher use of corticosteroids in chronic obstructive pulmonary disease have led to aspergillosis becoming more prominent in recent years. Galactomannan detection and radiological diagnostic images complement the limitations of microbiology cultures in these patients. Voriconazole and liposomal amphotericin B are the gold standard in patients requiring therapy, and posaconazole, itraconazole, caspofungin and other echinocandins are effective alternatives. The prognosis depends of clinical forms and characteristics of the host, but it is particularly poor in the disseminated invasive forms.

Topics: Antifungal Agents; Aspergillosis; Aspergillus; Cross Infection; Drug Resistance, Multiple, Fungal; Endocarditis; Endophthalmitis; Fungemia; Galactose; Humans; Immunocompromised Host; Mannans; Neuroaspergillosis; Postoperative Complications; Pulmonary Aspergillosis; Radiography; Risk Factors; Salvage Therapy; Species Specificity; Vulnerable Populations

Native valve endocarditis caused by Aspergillus spp. is an uncommon disease with a high mortality rate. Generally, Aspergillus is isolated from affected valve in post-mortem or biopsy specimens. However, its isolation from blood cultures is exceedingly rare. We report a case of fungal endocarditis in a native mitral valve with the isolation of Aspergillus fumigatus both in valve vegetation and in blood culture bottles. The patient underwent valve replacement and antifungal treatment with voriconazole and caspofungin, but he died on post-operative day 45 with disseminated aspergillosis confirmed by necropsy. Paradoxically, galactomannan antigen detection in serum was negative. This is the third case of Aspergillus endocarditis with positive blood culture reported in the literature.

Topics: Amaurosis Fugax; Aneurysm, Infected; Antifungal Agents; Antigens, Fungal; Aspergillosis; Aspergillus fumigatus; Biomarkers; Caspofungin; Combined Modality Therapy; Echinocandins; Endocarditis; False Negative Reactions; Fatal Outcome; Fungemia; Galactose; Heart Valve Prosthesis Implantation; Humans; Infarction; Kidney; Lipopeptides; Male; Mannans; Mesenteric Arteries; Mesenteric Vascular Occlusion; Middle Aged; Mitral Valve; Peptides, Cyclic; Pulmonary Disease, Chronic Obstructive; Pyrimidines; Renal Artery; Triazoles; Voriconazole

Fungal endocarditis (FE) is an uncommon disease with a high risk of morbidity and mortality. Here, we evaluated the different methods for diagnosing this infection. Cardiac valve, vegetation, and embolic materials obtained during surgery were examined for fungal infections by direct smear and culture. At least two blood samples were inoculated at the bedside into BACTEC medium. Galactomannan, mannan Ag enzyme-linked immunosorbent assay, and real-time polymerase chain reaction (PCR) assay were performed with serum samples. Of 25 patients with suspected infective endocarditis (IE), 8 were found to have proven FE according to the direct culture results. The etiologic agents were Aspergillus niger (three cases), A. flavus (two cases), A. fumigatus (one case), and Candida albicans (two cases). Blood culture was positive in only 1 case. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the results from the galactomannan test were 83.3%, 84.2%, 62.5%, 94.1%, 5.3, and 0.2; these same values, obtained from real-time PCR, were 87.5%, 94.4%, 87.5%, 94.4%, 15.6, and 0.14, respectively. Because mannan antigen was positive in samples from only one patient, we opted not to calculate the sensitivity. However, the specificity value in 23 cases without IE caused by Candida spp. was 100%. Based on our results, both the galactomannan test and real-time PCR can serve as reliable, noninvasive tests for the diagnosis of FE, compared with culture, which is considered to be the gold standard.

Topics: Adolescent; Adult; Aged; Antigens, Fungal; Child, Preschool; Endocarditis; Female; Galactose; Humans; Immunoenzyme Techniques; Iran; Male; Mannans; Middle Aged; Mycoses; Real-Time Polymerase Chain Reaction; Reproducibility of Results; Sensitivity and Specificity; 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