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Published on: April 2, 2021
Candida prosthetic valve endocarditis cured by caspofungin therapy without valve replacement
R Rajendram1, N J Alp, A R Mitchell
1Department of Cardiology, John Radcliffe Hospital, Headington, Oxford, United Kingdom. rajkumarrajendram@doctors.org.uk
Summary
Late-onset Candida endocarditis in a patient with a mechanical mitral valve prosthesis was successfully treated with caspofungin. This antifungal therapy offers a viable option for patients unfit for valve replacement surgery.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Mycology
Background:
- Mechanical heart valves are susceptible to late-onset infective endocarditis.
- Candida species, particularly non-albicans Candida, pose a significant challenge in prosthetic valve endocarditis.
- Fungal endocarditis requires prompt diagnosis and effective treatment strategies.
Observation:
- A 64-year-old female patient presented with symptoms of late-onset prosthetic valve endocarditis.
- Blood cultures identified Candida glabrata and Candida krusei.
- Transesophageal echocardiography revealed vegetations on the mechanical mitral valve prosthesis.
Findings:
- The patient was deemed unsuitable for surgical valve replacement due to comorbidities.
- A 6-week course of intravenous caspofungin was administered.
- Clinical and microbiological resolution of the Candida endocarditis was achieved.
Implications:
- Intravenous caspofungin can be an effective therapeutic option for prosthetic valve endocarditis caused by Candida species in medically compromised patients.
- This case highlights the importance of considering fungal etiologies in prosthetic valve endocarditis.
- Successful non-surgical management may improve outcomes and reduce risks associated with cardiac surgery in select patient populations.
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