title: Successful surgical intervention for the management of endocarditis due to multidrug resistant Candida parapsilosis: case report and literature review.
abstract: Candida parapsilosis is an uncommon cause of invasive endocarditis. This pathogen induces severe complications and carries a high mortality rate. We describe a case of C. parapsilosis endocarditis in a 54-year-old man with a history of HIV and Hepatitis C infection who previously underwent prosthetic valve replacement due to bacterial endocarditis. The patient presented with prolonged febrile episodes and fungemia with repeat blood cultures positive for C. parapsilosis. The patient failed multiple regimens of antifungal therapy and the C. parapsilosis isolate progressively acquired resistance to a number of drugs. Due to the multidrug resistant nature of the isolate, replacement of the infected valve was required to resolve his fungemia, and the patient remained asymptomatic for two years. This case is unusual due to the multidrug resistant nature of the isolate requiring both combined medical and surgical intervention. A review of published reports indicates that endocarditis due to C. parapsilosis responds well to a combination of medical and surgical interventions; the latter is particularly suitable for immunocompromised hosts.
authors.affiliation: Department of Internal Medicine and Pediatrics, Albany Medical College, Albany, NY, USA. kumarj@mail.amc.edu
authors.forename: Jessica
authors.initials: J
authors.lastname: Kumar
authors.forename: Douglas
authors.initials: D
authors.lastname: Fish
authors.forename: Harold
authors.initials: H
authors.lastname: Burger
authors.forename: Barbara
authors.initials: B
authors.lastname: Weiser
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Ross
authors.forename: David
authors.initials: D
authors.lastname: Jones
authors.forename: Karl
authors.initials: K
authors.lastname: Robstad
authors.forename: Xiaojiang
authors.initials: X
authors.lastname: Li
authors.forename: Vishnu
authors.initials: V
authors.lastname: Chaturvedi
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*; D026141:Drug Resistance, Multiple, Fungal; D004696:Endocarditis / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*; D015658:HIV Infections / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents