Pelemiš Mijomir, Stevanović Goran, Lavadinović Lidija, Matić Snežana, Milošević Ivana, Korać Miloš, Pelemiš Svetislav, Nedeljković Milan, Prostran Milica
Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Bulevar oslobodjenja 16, 11000, Belgrade, Serbia.
J Cardiothorac Surg. 2013 Feb 22;8:29. doi: 10.1186/1749-8090-8-29.
Disseminated fungal infections are still rare conditions, mostly caused by Candida spp. during immunosuppression. Infection of immunocompetent individuals is uncommon. Endocarditis is a rare manifestation during candidaemia, mostly in patients with prosthetic valves. Affection of previously unaltered valves is uncommon.
We presented a case of a young, previously healthy female patient with endocarditis, caused by Candida parapsilosis. The initial symptom, fever, was present four months before hospital admittance. She was febrile without other symptoms and during observation in a local hospital. After her condition deteriorated, she was transferred to the Institute for infectious and tropical diseases, Belgrade. Clinical findings on admission include petechial skin rash and moderate hepatosplenomegaly. Newly developed systolic murmur was noted, and Candida parapsilosis was isolated in multiple blood cultures. Echocardiography revealed 15 × 14 mm vegetations on the right aortic vellum. She was treated with antifungal drugs (fluconasole, liposomal amphotericin B), and the affected valve was successfully replaced. The same strain of Candida parapsilosis was isolated from the intraoperative material of the valve. There were no markers of immunosuppression or other conditions which could affect the immune system.
After a prolonged period of treatment she was successfully cured, and she received a long-term intermittent suppressive fluconasole therapy for the time being.
播散性真菌感染仍然是罕见病症，主要由念珠菌属在免疫抑制期间引起。免疫功能正常个体感染并不常见。心内膜炎是念珠菌血症期间的罕见表现，主要见于人工瓣膜患者。累及先前未改变的瓣膜并不常见。
我们报告一例年轻、既往健康的女性心内膜炎患者，由近平滑念珠菌引起。最初症状发热，在入院前四个月出现。她发热但无其他症状，在当地医院观察期间。病情恶化后，她被转至贝尔格莱德传染病和热带病研究所。入院时的临床发现包括瘀点皮疹和中度肝脾肿大。注意到新出现的收缩期杂音，多次血培养分离出近平滑念珠菌。超声心动图显示右主动脉瓣叶有15×14毫米的赘生物。她接受了抗真菌药物（氟康唑、脂质体两性霉素B）治疗，受累瓣膜成功置换。从瓣膜的术中材料中分离出相同菌株的近平滑念珠菌。没有免疫抑制或其他可能影响免疫系统的状况的标志物。
经过长时间治疗，她成功治愈，目前接受长期间歇性氟康唑抑制治疗。
