[Native valve Aspergillus fumigatus endocarditis with blood culture positive and negative for galactomannan antigen. Case report and literature review].
Native valve endocarditis caused by Aspergillus spp. is an uncommon disease with a high mortality rate. Generally, Aspergillus is isolated from affected valve in post-mortem or biopsy specimens. However, its isolation from blood cultures is exceedingly rare. We report a case of fungal endocarditis in a native mitral valve with the isolation of Aspergillus fumigatus both in valve vegetation and in blood culture bottles. The patient underwent valve replacement and antifungal treatment with voriconazole and caspofungin, but he died on post-operative day 45 with disseminated aspergillosis confirmed by necropsy. Paradoxically, galactomannan antigen detection in serum was negative. This is the third case of Aspergillus endocarditis with positive blood culture reported in the literature.
Pemán
Javier
J
Servicio de Microbiología, Hospital Universitario La Fe, Avenida de Campanar 21, 46009 Valencia, Spain. peman_jav@gva.es
Ortiz
Rebeca
R
Osseyran
Faisa
F
Pérez-Bellés
Carmen
C
Crespo
Marisa
M
Chirivella
Melitina
M
Frasquet
Juan
J
Quesada
Anastasio
A
Cantón
Emilia
E
Gobernado
Miguel
M
D020757:Amaurosis Fugax / Q000209:etiology; D000785:Aneurysm, Infected / Q000209:etiology / Q000382:microbiology; D000935:Antifungal Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000097:blood*; D001228:Aspergillosis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D001232:Aspergillus fumigatus / Q000276:immunology / Q000302:isolation & purification*; D015415:Biomarkers; D000077336:Caspofungin; D003131:Combined Modality Therapy; D054714:Echinocandins; D004696:Endocarditis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D005188:False Negative Reactions; D017809:Fatal Outcome; D016469:Fungemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005690:Galactose / Q000031:analogs & derivatives; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007238:Infarction / Q000209:etiology / Q000382:microbiology; D007668:Kidney / Q000098:blood supply; D055666:Lipopeptides; D008297:Male; D008351:Mannans / Q000097:blood*; D008638:Mesenteric Arteries / Q000382:microbiology; D008641:Mesenteric Vascular Occlusion / Q000209:etiology / Q000382:microbiology; D008875:Middle Aged; D008943:Mitral Valve / Q000382:microbiology*; D010456:Peptides, Cyclic / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D011743:Pyrimidines / Q000627:therapeutic use; D012077:Renal Artery / Q000382:microbiology; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D000946:Antigens, Fungal; D015415:Biomarkers; D054714:Echinocandins; D055666:Lipopeptides; D008351:Mannans; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; C012990:galactomannan; D000077336:Caspofungin; D065819:Voriconazole; D005690:Galactose