title: Lomentospora prolificans endocarditis--case report and literature review.
abstract: BACKGROUND
  Lomentospora prolificans (formally Scedosporium prolificans) is an environmental mould with a global distribution. Endocarditis caused by L. prolificans is a rare but serious emerging disease in immunocompromised patients. Prior to this case there have only been eight cases reported in the literature. Diagnosis can be challenging and there are no evidence-based guidelines for treatment.
  
  
  METHODS
  We report a 75-year-old woman with ovarian carcinoma who presented with fever after chemotherapy. Repeated sterile site cultures remained negative until day 22 of admission, when Lomentospora prolificans was isolated from blood cultures. Following extensive investigations, including Fluoro-D-glucose positron emission tomography (FDG-PET) and transoephageal echocardiography (TOE), the patient was diagnosed with endocarditis complicated by cerebral emboli. The patient was considered unsuitable for surgical intervention and passed away five days after the fungus was isolated.
  
  
  CONCLUSIONS
  Endocarditis caused by Lomentospora prolificans is a rare but emerging condition, with limited treatment options and a high mortality. Awareness of the increasing incidence of Lomentospora prolificans infection, diagnosed often at an advanced stage, with potential for endocarditis may prompt earlier echocardiography or FDG-PET imaging. Further studies are needed to determine the optimal combination and duration of anti-fungal agents, used in conjunction with aggressive surgical excision where feasible.
authors.affiliation: Department of Infectious Diseases and Immunology, St George Hospital, Kogarah, NSW, 2217, Australia. melissa_kelly_@hotmail.com.
authors.forename: Melissa
authors.initials: M
authors.lastname: Kelly
authors.affiliation: Microbiology Department, South Eastern Area Sydney Laboratories, St George Hospital, Kogarah, NSW, 2217, Australia. Robert.Stevens@SESIAHS.HEALTH.NSW.GOV.AU.
authors.forename: Robert
authors.initials: R
authors.lastname: Stevens
authors.affiliation: Department of Infectious Diseases and Immunology, St George Hospital, Kogarah, NSW, 2217, Australia. pam.konecny@sesisahs.health.nsw.gov.au.|Department of Infectious Diseases and Immunology & St George Clinical School, Faculty of Medicine, University of New South Wales, St George Hospital, Kogarah, NSW, 2217, Australia. pam.konecny@sesisahs.health.nsw.gov.au.
authors.forename: Pamela
authors.initials: P
authors.lastname: Konecny
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging; D016190:Carboplatin / Q000627:therapeutic use; D004452:Echocardiography; D004696:Endocarditis / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010051:Ovarian Neoplasms / Q000188:drug therapy; D049268:Positron-Emission Tomography; D011859:Radiography; D021681:Scedosporium / Q000302:isolation & purification*
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin
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