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   Table of Contents     
LETTER TO EDITOR  
Year : 2015  |  Volume : 7  |  Issue : 1  |  Page : 48-50
Candida endocarditis: The insidious killer


1 Department of Microbiology, Velammal MedicalCollege Hospital and Research Institute, Madurai, Tamil Nadu, India
2 Department of Cardiology, Velammal MedicalCollege Hospital and Research Institute, Madurai, Tamil Nadu, India

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Date of Web Publication5-Feb-2015
 

How to cite this article:
Ganesan V, Kumar G, Ponnusamy SS. Candida endocarditis: The insidious killer. J Global Infect Dis 2015;7:48-50

How to cite this URL:
Ganesan V, Kumar G, Ponnusamy SS. Candida endocarditis: The insidious killer. J Global Infect Dis [serial online] 2015 [cited 2019 Sep 22];7:48-50. Available from: http://www.jgid.org/text.asp?2015/7/1/48/150894


Sir,

Candida endocarditis is one of the most serious manifestations of candidiasis and a common cause of fungal endocarditis in more than 50% of cases.

A 63-year-old male patient, known case of pulmonary obstructive disease associated with diabetes and hypertension, came with a history of drowsiness for last 10 days. He underwent three abdominal surgeries during previous 8 months for sigmoid volvulus with intestinal obstruction. Fifteen days back, he had urinary incontinence and was catheterized at a local hospital.

On examination, patient was pale, febrile, conscious, drowsy, dehydrated, and hypotensive. Other systemic examinations did not reveal any abnormality. Blood glucose was 204 mg/dl and HbA1c was 42 mmol/mol. His renal profile was within normal range.Hematologicalinvestigation showed moderate microcytic hypochromic anemia with mild neutrophilia and normal platelets, and a raisederythrocyte sedimentation rate (ESR) value(65 mm/h). Abdomen ultrasonography showed findings suggestive of acute pyelonephritis. Urine culture yielded growth of three bacterial species. He was treated with intravenous broad-spectrum antibiotics. Liver function tests showed elevated enzymes, decreased total protein (5.8 g/dl), albumin 2.5 g/dl, total cholesterol 94 mg/dl, and high density lipoprotein (HDL) 22 mg/dl.

CT Brain showed evidence of right posterior cerebral artery territory infarct. There was no evidence of intracerebral hemorrhage or mass lesion. Five days after admission, new systolic murmur was heard during auscultation. Transthoracic echocardiography showed large vegetation (14 × 12 mm) attached to anterior mitral leaflet and small nodule attached to posterior mitral leaflet [Figure 1]. Moderate to severe mitral regurgitation was seen. Blood culture grew Candidas pecies. Conventional amphotericin B infusion was started. Patient had persistent fever spikes and developed embolic complications. CT aorto-iliac angiography showed complete occlusion of right distal external iliac artery and common femoral arteries of both limbs. Patient's condition did not improve and was taken to a different hospital. He died of fungal sepsis on the seventh day.

The diagnosis of fungal endocarditis should be aggressively pursued in patients having

  • Valvular disease,
  • Unexplained neurologic signs,
  • Peripheral embolization, often involving major vessels supplying the brain, extremities, and the gastrointestinal tract, and
  • Recently documented but untreated fungemia.


Diagnostic tests should include blood culture for fungi, laboratory mycologic examination of accessible emboli, echocardiography, and appropriate fungal antigen and nucleic acid diagnostic tests.

Patients with Candida endocarditis can develop other complications of candidemia, including endophthalmitis, vertebral osteomyelitis, and meningitis. Thus, all patients should be examined for signs of other complications of candidemia. The surgical excision of infected material may be critically important in patients with relatively resistant organisms, systemic emboli, valvular dysfunction, or factors preventing adequate medical therapy such as drug intolerance or significant renal dysfunction. For those infected with susceptible Candida isolates, antifungal treatment with lipid-associated amphotericin B or an echinocandin is the first line of choice.

Relapsing fungal endocarditis is seen in as many as 30-40% of patients who survive to complete short-term therapy. [1],[2] Long-term oral fluconazole therapy is appropriate after prolonged intravenous therapy. [3] In an international multicenter prospective cohort study that included 33 cases of Candida endocarditis that were treated between 2000 and 2005, the mortality rate was 30%. [4] This is substantially lower than the earlier mortality estimates of approximately 50%. [5]

Fungal endocarditis is a rare illness that deserves attention. Because of advances in medical and surgical techniques, emerging complications like fungal endocarditis can threaten the success of novel therapies.

 
   References Top

1.
Baddour LM. Long-term suppressive therapy for Candida parapsilosis-induced prosthetic valve endocarditis. Mayo Clin Proc 1995;70:773-5.  Back to cited text no. 1
    
2.
Fernández-Guerrero ML, Verdejo C, Azofra J, de Górgolas M. Hospital-acquired infectious endocarditis not associated with cardiac surgery: An emerging problem. Clin Infect Dis 1995;20:16-23.  Back to cited text no. 2
    
3.
Nasser RM, Melgar GR, Longworth DL, Gordon SM. Incidence and risk of developing fungal prosthetic valve endocarditis after nosocomial candidemia. Am J Med 1997;103:25-32.  Back to cited text no. 3
    
4.
Baddley JW, Benjamin DK Jr, Patel M, Miró J, Athan E, Barsic B, et al.; International Collaboration on Endocarditis-Prospective Cohort Study Group (ICE-PCS). Candida infective endocarditis. Eur J Clin Microbiol Infect Dis 2008;27:519-29.  Back to cited text no. 4
    
5.
Ellis ME, Al-Abdely H, Sandridge A, Greer W, Ventura W. Fungal endocarditis: Evidence in the world literature, 1965-1995. Clin Infect Dis 2001;32:50-62.  Back to cited text no. 5
    

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Correspondence Address:
Vithiya Ganesan
Department of Microbiology, Velammal MedicalCollege Hospital and Research Institute, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.150894

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
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