Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Pathology and Laboratory Medicine, Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran.
J Med Microbiol. 2013 Nov;62(Pt 11):1763-1767. doi: 10.1099/jmm.0.060954-0. Epub 2013 Aug 23.
In recent decades the incidence of Candida endocarditis has increased dramatically. Despite the application of surgery and antifungal therapy, Candida endocarditis remains a life-threatening infection with significant morbidity and mortality. We report a 37-year-old male drug abuser presenting with high fever, chest pain, loss of appetite and cardiac failure. His echocardiography revealed mobile large tricuspid valve vegetations. Fungal endocarditis was confirmed by culturing of the resected vegetation showing mixed growth of Candida albicans and Candida tropicalis, although three consecutive blood cultures were negative for Candida species. Phenotypic identification was reconfirmed by sequencing of the internal transcribed spacer (ITS rDNA) region. The patient was initially treated with intravenous fluconazole (6 mg kg(-1) per day), followed by 2 weeks of intravenous amphotericin B deoxycholate (1 mg kg(-1) per day). Although MICs were low for both drugs, the patient's antifungal therapy combined with valve replacement failed, and he died due to respiratory failure.
近几十年来，念珠菌性心内膜炎的发病率显著增加。尽管采用了手术和抗真菌治疗，念珠菌性心内膜炎仍然是一种危及生命的感染，具有显著的发病率和死亡率。我们报告了一例 37 岁男性药物滥用者，表现为高热、胸痛、食欲不振和心力衰竭。他的超声心动图显示移动性大型三尖瓣赘生物。通过切除的赘生物培养证实为真菌性心内膜炎，培养显示白念珠菌和热带念珠菌的混合生长，尽管连续三次血培养均未检出念珠菌属。表型鉴定通过内部转录间隔区（ITS rDNA）区域的测序得到重新确认。该患者最初接受氟康唑静脉滴注（6 mg/kg/天）治疗，随后静脉滴注两性霉素 B 脱氧胆酸盐 2 周（1 mg/kg/天）。尽管两种药物的 MIC 均较低，但患者的抗真菌治疗联合瓣膜置换术失败，他因呼吸衰竭而死亡。
