[Primary Aspergillus endocarditis. Apropos of a case and review of the international literature].
The authors report a case of primary aspergillus endocarditis with endophthalmitis and vertebral osteomyelitis. No underlying disease and no predisposing factors were found. Valve replacement plus combined antifungal chemotherapy proved to be effective as the patient is asymptomatic 18 months after the first symptoms. 48 cases of aspergillus endocarditis, without prior cardiac surgery have been reported in the literature. Aspergillus endocarditis was valvular or mural. Extracardiac dissemination was common but endophthalmitis and osteomyelitis were infrequent. In 11 cases, the diagnosis was made by histologic examination of embolectomy or ocular, skin biopsy tissue. All patients were febrile. Blood cultures showed no Aspergillus species. Clinical manifestations of endocarditis were described in less than fifty per cent of cases. Echocardiographic visualization of vegetations was obtained in 5 cases. Many patients experienced embolic phenomena. Mortality from Aspergillus endocarditis is extremely high (96%). Surgery is the main treatment, consisting of valve replacement. Antifungal chemotherapy should be combined. The proper duration and dosage and the combination of antifungal drugs have not been clearly defined.
Roux
J P
JP
Service de Chirurgie Cardio-Vasculaire B, Hôpital Cardiologie de Lille.
Koussa
A
A
Cajot
M A
MA
Marquette
F
F
Goullard
L
L
Gosselin
B
B
Pol
A
A
Warembourg
H
H
Soots
G
G
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004696:Endocarditis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole; D007654:Ketoconazole / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D005437:Flucytosine; D007654:Ketoconazole
Les endocardites aspergillaires primitives. A propos d'un cas et revue de la littérature mondiale.