Kelly Melissa, Stevens Robert, Konecny Pamela
Department of Infectious Diseases and Immunology, St George Hospital, Kogarah, NSW, 2217, Australia.
Microbiology Department, South Eastern Area Sydney Laboratories, St George Hospital, Kogarah, NSW, 2217, Australia.
BMC Infect Dis. 2016 Jan 29;16:36. doi: 10.1186/s12879-016-1372-y.
Lomentospora prolificans (formally Scedosporium prolificans) is an environmental mould with a global distribution. Endocarditis caused by L. prolificans is a rare but serious emerging disease in immunocompromised patients. Prior to this case there have only been eight cases reported in the literature. Diagnosis can be challenging and there are no evidence-based guidelines for treatment.
We report a 75-year-old woman with ovarian carcinoma who presented with fever after chemotherapy. Repeated sterile site cultures remained negative until day 22 of admission, when Lomentospora prolificans was isolated from blood cultures. Following extensive investigations, including Fluoro-D-glucose positron emission tomography (FDG-PET) and transoephageal echocardiography (TOE), the patient was diagnosed with endocarditis complicated by cerebral emboli. The patient was considered unsuitable for surgical intervention and passed away five days after the fungus was isolated.
Endocarditis caused by Lomentospora prolificans is a rare but emerging condition, with limited treatment options and a high mortality. Awareness of the increasing incidence of Lomentospora prolificans infection, diagnosed often at an advanced stage, with potential for endocarditis may prompt earlier echocardiography or FDG-PET imaging. Further studies are needed to determine the optimal combination and duration of anti-fungal agents, used in conjunction with aggressive surgical excision where feasible.
多育赛多孢（曾用名多育足分支霉）是一种广泛分布于全球的环境霉菌。多育赛多孢引起的心内膜炎在免疫功能低下患者中是一种罕见但严重的新发疾病。在此病例之前，文献中仅报道过8例。诊断可能具有挑战性，且尚无基于证据的治疗指南。
我们报告一名75岁卵巢癌女性患者，化疗后出现发热。反复进行的无菌部位培养在入院第22天之前均为阴性，之后从血培养中分离出多育赛多孢。经过包括氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）和经食管超声心动图（TOE）在内的广泛检查，患者被诊断为心内膜炎并发脑栓塞。患者被认为不适合手术干预，在分离出真菌五天后死亡。
多育赛多孢引起的心内膜炎是一种罕见但新发的疾病，治疗选择有限且死亡率高。认识到多育赛多孢感染发病率不断上升，且常于晚期诊断，并有发生心内膜炎的可能，可能会促使更早地进行超声心动图或FDG-PET成像检查。需要进一步研究以确定抗真菌药物的最佳联合使用及疗程，在可行的情况下结合积极的手术切除。
