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Histoplasma endocarditis: clinical and mycologic features and outcomes
Sabha Bhatti1, Leonid Vilenski, Robert Tight
1Department of Medicine, Aga Khan University Medical College, Karachi, Pakistan.
The Journal of Infection
|June 28, 2005
Summary
Histoplasma endocarditis, a fungal infection, often affects heart valves and requires prompt diagnosis and treatment. Amphotericin B therapy shows promise, but surgical intervention may be necessary.
Area of Science:
- Mycology
- Infectious Diseases
- Cardiology
Background:
- Infective endocarditis (IE) caused by Histoplasma capsulatum is a rare fungal infection.
- Understanding its clinical and microbiological features is crucial for diagnosis and management.
Observation:
- This study reviewed 43 cases of Histoplasma endocarditis, involving native and prosthetic valves.
- Systemic embolization occurred in 58% of cases, with diagnosis often delayed.
- Cardiac involvement typically affected mitral and/or aortic valves, usually in disseminated disease.
Findings:
- Antemortem diagnosis was best achieved through serology (antibody titers, urinary antigen) or cultures from non-blood specimens.
- Histopathology and immunofluorescent staining also aided diagnosis.
- Untreated cases were fatal; prolonged amphotericin B therapy, without surgery, was more effective than for Candida endocarditis.
Implications:
- Histoplasma endocarditis is an underrecognized cause of left-sided, blood culture-negative endocarditis.
- Accurate microbiologic diagnosis can be challenging.
- Amphotericin B is a key treatment, while the roles of azoles and secondary prophylaxis require further investigation. Surgical indications mirror those for bacterial endocarditis.