title: Endocarditis due to a co-infection of Candida albicans and Candida tropicalis in a drug abuser.
abstract: In recent decades the incidence of Candida endocarditis has increased dramatically. Despite the application of surgery and antifungal therapy, Candida endocarditis remains a life-threatening infection with significant morbidity and mortality. We report a 37-year-old male drug abuser presenting with high fever, chest pain, loss of appetite and cardiac failure. His echocardiography revealed mobile large tricuspid valve vegetations. Fungal endocarditis was confirmed by culturing of the resected vegetation showing mixed growth of Candida albicans and Candida tropicalis, although three consecutive blood cultures were negative for Candida species. Phenotypic identification was reconfirmed by sequencing of the internal transcribed spacer (ITS rDNA) region. The patient was initially treated with intravenous fluconazole (6 mg kg(-1) per day), followed by 2 weeks of intravenous amphotericin B deoxycholate (1 mg kg(-1) per day). Although MICs were low for both drugs, the patient's antifungal therapy combined with valve replacement failed, and he died due to respiratory failure.
authors: Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors: Shirinsadat Hashemi
authors: SH
authors: Fesharaki
authors: Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors: Iman
authors: I
authors: Haghani
authors: Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors: Bita
authors: B
authors: Mousavi
authors: Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors: Melika Laal
authors: ML
authors: Kargar
authors: Department of Pathology and Laboratory Medicine, Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran.
authors: Mohammadali
authors: M
authors: Boroumand
authors: Department of Pathology and Laboratory Medicine, Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran.
authors: Maryam Sotoudeh
authors: MS
authors: Anvari
authors: Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran.
authors: Kyomars
authors: K
authors: Abbasi
authors: Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.|Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands.
authors: Jacques F
authors: JF
authors: Meis
authors: Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors: Hamid
authors: H
authors: Badali
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002176:Candida albicans / Q000302:isolation & purification*; D041022:Candida tropicalis / Q000302:isolation & purification*; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D060085:Coinfection / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D003840:Deoxycholic Acid / Q000627:therapeutic use; D004338:Drug Combinations; D055030:Drug Users; D004452:Echocardiography; D004696:Endocarditis / Q000382:microbiology* / Q000473:pathology*; D017809:Fatal Outcome; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D016533:Mycological Typing Techniques; D017422:Sequence Analysis, DNA; D019966:Substance-Related Disorders / Q000150:complications*; D014261:Tricuspid Valve / Q000473:pathology / Q000601:surgery
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer; D004338:Drug Combinations; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D015725:Fluconazole