Roux J P, Koussa A, Cajot M A, Marquette F, Goullard L, Gosselin B, Pol A, Warembourg H, Soots G
Service de Chirurgie Cardio-Vasculaire B, Hôpital Cardiologie de Lille.
Ann Chir. 1992;46(2):110-5.
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.
作者报告了一例原发性曲霉菌性心内膜炎合并眼内炎和脊椎骨髓炎的病例。未发现潜在疾病和诱发因素。瓣膜置换术联合抗真菌化疗被证明是有效的，因为患者在出现最初症状18个月后没有症状。文献中报道了48例未经心脏手术的曲霉菌性心内膜炎病例。曲霉菌性心内膜炎为瓣膜性或壁性。心外播散很常见，但眼内炎和骨髓炎很少见。11例通过栓子切除术或眼部、皮肤活检组织的组织学检查确诊。所有患者均发热。血培养未发现曲霉菌。不到50%的病例描述了心内膜炎的临床表现。5例通过超声心动图观察到赘生物。许多患者出现栓塞现象。曲霉菌性心内膜炎的死亡率极高（96%）。手术是主要治疗方法，包括瓣膜置换术。应联合抗真菌化疗。抗真菌药物的适当疗程、剂量及联合用药尚未明确界定。
