Invasive aspergillosis and endocarditis
| Autor: | F. Barde, M. Le Meur, S. Benhamida, Martial Thyrault, J. Lebut, N. Lau, Y. Bentoumi, K. Chevalier |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Antifungal Agents Adolescent medicine.medical_treatment Aspergillosis Gastroenterology Aspergillus fumigatus Internal medicine Internal Medicine Medicine Endocarditis Humans Abscess Lung biology business.industry Immunosuppression Middle Aged medicine.disease biology.organism_classification Kidney Transplantation IgA vasculitis medicine.anatomical_structure Mitral Valve Female business Rare disease |
| Zdroj: | La Revue de medecine interne. 42(10) |
| ISSN: | 1768-3122 |
| Popis: | Introduction Aspergillus fumigatus can cause a systemic infection called invasive aspergillosis causing pulmonary and extra-pulmonary damage. Aspergillus endocarditis (AE) is a relatively rare disease but can be life-threatening. Case reports We report here on five cases of endocarditis due to invasive aspergillosis: a 58-year-old man receiving immunosuppressive medication following a kidney graft, a 58-year-old man undergoing chemotherapy for chronic lymphocytic leukaemia, a 55-year-old man receiving corticosteroids for IgA vasculitis, a 52-year-old HIV-infected woman under no specific treatment and a 17-year-old boy under immunosuppressive therapy for auto-immune chronic neutropenia. Discussion Aspergillus accounts for 25–30% of fungal endocarditis and 0.25% to 8.5% of all cases of infectious endocarditis. Aspergillus endocarditis results from invasion of the lung arterioles by hyphae and blood dissemination. It is associated with a very high mortality rate (42–68%). Diagnosing Aspergillus endocarditis is mainly problematic because blood cultures are almost always negative, and fever may be absent. Immunosuppression, haematological malignancies, recent cardiothoracic surgery, negative blood cultures with endocarditis and/or systemic or pulmonary emboli are predictors of AE. In the setting of endocarditis, some clinical characteristics may raise early suspicions of aspergillosis rather than a non-fungal agent: no fever, vegetations affecting the mitral valve, non-valve or aortotomy sites, aortic abscess or pseudo-aneurysm. The identification of invasive aspergillosis is based on a chest CT scan, microscopy/culture or other serological and molecular tests. The treatment of Aspergillus endocarditis requires triazole antifungal drugs, and frequently additional surgical debridement. Conclusion Aspergillus endocarditis is rare but is associated with a very high mortality rate. Knowledge of its predictive factors and key clinical features can help to differentiate aspergillosis from non-fungal endocarditis and may enable improved survival rates. |
| Databáze: | OpenAIRE |
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