Prosthetic valve fungal endocarditis due to histoplasmosis

Fungal endocarditis is associated with severe patient morbidity and mortality. Unfortunately, fungal endocarditis is difficult to diagnose because fungal pathogens are uncommonly isolated from routine blood cultures. Histopathological examination of surgically excised cardiac valves, peripheral embo...

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Bibliographic Details
Published inCanadian journal of cardiology Vol. 17; no. 3; p. 297
Main Authors Isotalo, P A, Chan, K L, Rubens, F, Beanlands, D S, Auclair, F, Veinot, J P
Format Journal Article
LanguageEnglish
Published England 01.03.2001
Subjects
Anti-Bacterial Agents
Biopsy
Bone Marrow - microbiology
Diagnosis, Differential
Drug Therapy, Combination - therapeutic use
Echocardiography
Endocarditis - diagnosis
Endocarditis - microbiology
Endocarditis - therapy
Heart Valve Prosthesis - adverse effects
Heart Valve Prosthesis - microbiology
Heart Valve Prosthesis Implantation - adverse effects
Heart Valve Prosthesis Implantation - instrumentation
Histoplasma - isolation & purification
Histoplasmosis - diagnosis
Histoplasmosis - microbiology
Histoplasmosis - therapy
Humans
Male
Middle Aged
Mitral Valve Insufficiency - surgery
Prosthesis-Related Infections - diagnosis
Prosthesis-Related Infections - microbiology
Prosthesis-Related Infections - therapy
Reoperation
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Summary:Fungal endocarditis is associated with severe patient morbidity and mortality. Unfortunately, fungal endocarditis is difficult to diagnose because fungal pathogens are uncommonly isolated from routine blood cultures. Histopathological examination of surgically excised cardiac valves, peripheral emboli and systemic ulcers may be useful in identifying pathogens as etiological agents of culture-negative endocarditis. The authors describe a 63-year-old man who had culture-negative endocarditis. Multiple echocardiograms showed progression of the vegetations with valve stenosis despite treatment with multiple antimicrobials. He had multiple peripheral emboli before surgery. Disseminated histoplasmosis was diagnosed by bone marrow culture. Yeast organisms consistent with histoplasma were shown in the vegetations of his excised mitral valve prosthesis. The patient was treated with amphotericin and has been doing well in the two years since his surgery. The diagnosis and management of fungal endocarditis are emphasized.
ISSN:0828-282X
1916-7075