Polymerase chain reaction aids in the diagnosis of an unusual case of Aspergillus niger endocarditis in a patient with acute myeloid leukaemia

• Published in: The Journal of infection Vol. 47; no. 4; pp. 344 - 347
• Main Authors: McCracken, D, Barnes, R, Poynton, C, White, P.L, Işik, N, Cook, D
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.11.2003; Elsevier
• Subjects: Aspergillosis - diagnosis; Aspergillosis - microbiology; Aspergillus niger; Aspergillus niger - isolation & purification; Biological and medical sciences; Cardiology. Vascular system; DNA, Fungal - analysis; Endocardial and cardiac valvular diseases; Endocarditis; Endocarditis - diagnosis; Endocarditis - microbiology; Fatal Outcome; Heart; Human viral diseases; Humans; Infectious diseases; Leukaemia; Leukemia, Myeloid, Acute - complications; Male; Medical sciences; Middle Aged; Polymerase Chain Reaction - methods; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Niger; Africa; Aspergillus niger; Endocarditis; Leukaemia; Mycosis; Cardiovascular disease; Pulmonary aspergilloma; Fungi; Heart disease; Endocardial disease; Bacteria; Micrococcales; Tropical medicine; Fungi Imperfecti; Diagnosis; Disseminated; Public health; Thallophyta; Enterococcus; Human; Immunopathology; Lung disease; Occupational disease; Respiratory disease; Acute; Postmortem; AIDS; Malignant hemopathy; Immune deficiency; Fever; Virology; Infection; Polymerase chain reaction; Streptococcaceae; Viral disease; DNA; Aspergillosis; Bacteriosis; Molecular biology; Occupational medicine; Acute myelocytic leukemia
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/S0163-4453(03)00084-7

Endocarditis secondary to Aspergillus niger has not been described in a leukaemic patient. We describe a case of A. niger endocarditis in a patient with acute myeloid leukaemia and refractory fever. The microbiological cause of his endocarditis was initially misdiagnosed because he fulfilled the Duke criteria for enterococcal endocarditis. A polymerase chain reaction test utilizing pan-fungal primers detected a product from an Aspergillus sp. The DNA was subsequently sequenced and was found to have 100% homology with A. niger. A postmortem revealed fungal endocarditis secondary to disseminated aspergillosis, without evidence of bacterial endocarditis. The patient was found to have a lung aspergilloma that was possibly occupationally acquired, and may have been long standing.