Ioannou Petros, Volosyraki Maria, Mavrikaki Vasiliki, Papakitsou Ioanna, Mathioudaki Anna, Samonis George, Kofteridis Diamantis P
MD, MSc, PhD, Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes crossroad, Heraklion, PC 71110, Crete, Greece.
MD, Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes crossroad, Heraklion, PC 71110, Crete, Greece.
Germs. 2020 Sep 1;10(3):254-259. doi: 10.18683/germs.2020.1214. eCollection 2020 Sep.
Infective endocarditis (IE) due to species is a rare disease representing about 1-2% of all IE cases and carries a high mortality rate. Given the rarity of the disease, there are no clear guidelines on the type and duration of antifungal therapy. Thus, long-term or even life-long antifungal treatment is commonly used.
We report two patients with prosthetic valve IE and persistent candidemia that failed conservative treatment and ultimately developed heart failure. They underwent prosthetic valve replacement and prolonged antifungal treatment with favorable outcome.
IE commonly occurs in the setting of underlying malignancy, chronic liver disease, previous endocarditis, previous antimicrobial exposure, previous abdominal surgery, intravenous drug use, presence of a central venous catheter, and previous cardiac surgery. Both present patients had undergone a cardiac surgery and had a prosthetic heart valve, while one patient had an underlying autoimmune disease that could be associated with higher risk of IE. In both patients transthoracic ultrasound failed to diagnose IE. In our patients, conservative treatment alone was not enough to control the infection, thus, both patients underwent valve replacement and were subsequently treated with antifungals for 6 weeks. Furthermore, both patients were put on long-term antifungal suppression treatment.
Given the absence of controlled randomized trials, the treatment of endocarditis mostly relies on experts' opinion, and, thus, future studies focusing on the type and duration of antifungal treatment are required.
由[具体菌种]引起的感染性心内膜炎（IE）是一种罕见疾病，约占所有IE病例的1%-2%，死亡率很高。鉴于该疾病的罕见性，关于抗真菌治疗的类型和持续时间尚无明确指南。因此，通常采用长期甚至终身抗真菌治疗。
我们报告了两名人工瓣膜IE和持续性念珠菌血症患者，他们的保守治疗失败，最终发展为心力衰竭。他们接受了人工瓣膜置换术和延长的抗真菌治疗，结果良好。
IE通常发生在潜在恶性肿瘤、慢性肝病、既往心内膜炎、既往抗菌药物暴露、既往腹部手术、静脉药物使用、中心静脉导管存在以及既往心脏手术的背景下。两名现患患者均接受过心脏手术且有人工心脏瓣膜，而一名患者有潜在的自身免疫性疾病，这可能与IE的较高风险相关。在两名患者中，经胸超声均未能诊断出IE。在我们的患者中，仅保守治疗不足以控制感染，因此，两名患者均接受了瓣膜置换术，随后接受了6周的抗真菌治疗。此外，两名患者均接受了长期抗真菌抑制治疗。
鉴于缺乏对照随机试验，[具体菌种]心内膜炎的治疗主要依赖专家意见，因此，需要未来开展关注抗真菌治疗类型和持续时间的研究。
