Aspergillus valve endocarditis in patients without prior cardiac surgery.
Aspergillus native valve endocarditis in patients who have not had cardiac surgery is uncommon. We report 3 cases and review 58 other adult patients reported in the English-language literature. Sixty-seven percent of the patients had underlying immunosuppression. The clinical features were fever (74%), embolic episodes (69%), a new or changing heart murmur (41%), and sudden visual loss (13%). Patients with mural endocarditis were more often immunosuppressed, especially due to solid organ transplants, but had lower frequency of heart murmurs and embolic episodes. Echocardiography revealed a vegetation in 78% of all the cases in which it was performed. Examination and culture of biopsy material often helped to establish a diagnosis of Aspergillus infection. Twenty-five patients had an antemortem diagnosis. These patients received a mean cumulative amphotericin B dose of 27 mg/kg. Twenty percent (3/15) of patients who received combined surgical and medical therapy survived, compared to none of those who received medical therapy alone (p = 0.08). Patients who survived were not immunosuppressed. We conclude that native valve aspergillus infective endocarditis is uniformly fatal without surgical intervention and antifungal therapy.
Gumbo
T
T
Department of Infectious Disease, Cleveland Clinic Foundation, OH 44195, USA.
Taege
A J
AJ
Mawhorter
S
S
McHenry
M C
MC
Lytle
B H
BH
Cosgrove
D M
DM
Gordon
S M
SM
D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006351:Heart Valves / Q000382:microbiology / Q000473:pathology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D011379:Prognosis
D000935:Antifungal Agents; D000666:Amphotericin B