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由……引起的人工瓣膜心内膜炎——一例罕见病例报告

Prosthetic valve endocarditis due to - a rare case report.

作者信息

Sharma Shivang, Samantaray Subhashree, Kumar Deepak, Meena Durga Shankar, Chaudhary Rahul, Jain Vidhi, Bohra Gopal Krishana, Garg Mahendra Kumar

机构信息

Department of General Medicine (Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

出版信息

Access Microbiol. 2023 Jan 24;5(1). doi: 10.1099/acmi.0.000462.v4. eCollection 2023.

Abstract

Fungal endocarditis is a rare and fatal condition most frequently caused by species of the genera and . Fever and changing heart murmur are the most common clinical manifestations. The diagnosis of fungal endocarditis is challenging, with prosthetic valve endocarditis being extremely difficult to diagnose. The optimal management of the condition still remains debatable. We present a case of prosthetic valve endocarditis caused by , managed empirically with liposomal amphotericin B, which was later shifted to combination therapy with high-dose echinocandin and fluconazole, but had a fatal outcome because the patient could not undergo timely surgical intervention. Treating endocarditis cases is difficult because of their biofilm production on native and prosthetic heart valves. A combined approach consisting of a high index of clinical suspicion, early diagnosis using serological markers followed by culture or PCR and prompt initiation of appropriate antifungals may aid in improving outcomes.

摘要

真菌性心内膜炎是一种罕见的致命疾病,最常见的病因是 属和 属的物种。发热和心脏杂音改变是最常见的临床表现。真菌性心内膜炎的诊断具有挑战性,人工瓣膜心内膜炎极难诊断。该病的最佳治疗方案仍存在争议。我们报告一例由 引起的人工瓣膜心内膜炎病例,最初经验性使用脂质体两性霉素B治疗,后来改为高剂量棘白菌素和氟康唑联合治疗,但因患者未能及时接受手术干预而导致死亡。治疗 心内膜炎病例很困难,因为它们会在天然心脏瓣膜和人工心脏瓣膜上形成生物膜。综合方法包括高度的临床怀疑指数、使用血清学标志物进行早期诊断,随后进行培养或PCR检测,并及时启动适当的抗真菌治疗,这可能有助于改善治疗结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e3b/9996159/1a1b11ccd5d8/acmi-5-462.v4-g001.jpg

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