Isotalo P A, Chan K L, Rubens F, Beanlands D S, Auclair F, Veinot J P
Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada.
Can J Cardiol. 2001 Mar;17(3):297-303.
Fungal endocarditis is associated with severe patient morbidity and mortality. Unfortunately, fungal endocarditis is difficult to diagnose because fungal pathogens are uncommonly isolated from routine blood cultures. Histopathological examination of surgically excised cardiac valves, peripheral emboli and systemic ulcers may be useful in identifying pathogens as etiological agents of culture-negative endocarditis. The authors describe a 63-year-old man who had culture-negative endocarditis. Multiple echocardiograms showed progression of the vegetations with valve stenosis despite treatment with multiple antimicrobials. He had multiple peripheral emboli before surgery. Disseminated histoplasmosis was diagnosed by bone marrow culture. Yeast organisms consistent with histoplasma were shown in the vegetations of his excised mitral valve prosthesis. The patient was treated with amphotericin and has been doing well in the two years since his surgery. The diagnosis and management of fungal endocarditis are emphasized.
真菌性心内膜炎与患者的高发病率和死亡率相关。不幸的是，真菌性心内膜炎难以诊断，因为在常规血培养中很少分离出真菌病原体。对手术切除的心脏瓣膜、外周栓子和全身溃疡进行组织病理学检查，可能有助于确定病原体是培养阴性的心内膜炎的病因。作者描述了一名患有培养阴性心内膜炎的63岁男性。多次超声心动图显示，尽管使用了多种抗菌药物治疗，但赘生物仍随瓣膜狭窄进展。他在手术前有多个外周栓子。通过骨髓培养诊断为播散性组织胞浆菌病。在他切除的二尖瓣人工瓣膜的赘生物中发现了与组织胞浆菌一致的酵母样生物体。该患者接受了两性霉素治疗，自手术以来的两年里情况良好。文中强调了真菌性心内膜炎的诊断和管理。
