[A case of candida endocarditis with consecutive measurement of serum mannan and D-arabinitol concentrations]
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1First Department of Internal Medicine, School of Medicine, Kanazawa University.
Abstract:
We encountered a case of an 83-year-old patient with candida endocarditis. He had been diagnosed as having aortic regurgitation with moderately calcified aortic valve 5 years previously, and had received medication. He was admitted to our hospital because of pancreatic cancer. He had high fever from the time of his admission and antibiotics produced no effect. Candida albicans was detected in arterial blood culture. We also detected antibody against Candida albicans, and investigated serum mannan and the D-arabinitol creatinine ratio several times. We performed echo-cardiographic examination and recorded a vegetation at the aortic valve. Rising antibody titers against Candida albicans, mannan antigenemia and an elevated creatinine ratio were also observed. So we concluded that these examinations were also effective in the diagnosis of candida infection. Finally, this patient died of cerebral hemorrhage and was autopsied. Macroscopic findings showed mass-like vegetation involving the aortic valve, and microscopic findings showed candida organisms scattered within the vegetation.
Insights
This case study highlights a fatal Candida endocarditis infection in an elderly patient with pancreatic cancer. Diagnostic tests including antibody titers, mannan antigenemia, and D-arabinitol creatinine ratio proved effective in identifying the fungal infection.
Area of Science:
- Infectious Diseases
- Cardiology
- Mycology
Background:
- Elderly patient with pre-existing aortic regurgitation and calcified aortic valve.
- Presented with pancreatic cancer and persistent high fever unresponsive to antibiotics.
Observation:
- Candida albicans was identified in arterial blood cultures.
- Echocardiography revealed aortic valve vegetation.
- Elevated antibody titers against Candida albicans, mannan antigenemia, and an increased D-arabinitol creatinine ratio were observed.
Findings:
- The diagnostic investigations, including serological markers and imaging, were effective in diagnosing invasive candidiasis.
- Autopsy confirmed mass-like vegetation on the aortic valve with scattered Candida organisms.
Implications:
- This case underscores the importance of considering fungal endocarditis in febrile patients with risk factors.
- The study validates the effectiveness of combined diagnostic approaches for Candida infection.
- Early and accurate diagnosis of fungal endocarditis is crucial for patient management.