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Fungal Endocarditis Due to Aspergillus oryzae: The First Case Reported in the Literature
Andrea Mazza1, Nicola Luciani2, Marco Luciani2
1Department of Cardiovascular Sciences, Catholic University of Sacred Heart, Rome, Italy. Electronic correspondence: andreamazza83@hotmail.it.
Abstract:
Infective endocarditis (IE) is a severe disease with high mortality and morbidity. Prosthetic valve endocarditis is a life-threatening complication which can occur in less than 10% of patients with valve prosthesis. A fungal etiology of IE is rare and accounts for only 2-4% of all case of endocarditis, but is associated with a higher mortality and morbidity. Herein is reported the first case of fungal endocarditis of aortic valve prosthesis due to Aspergillus oryzae in a 67-year-old caucasian man who nine years previously underwent mitral and aortic valve replacement with mechanical prostheses, and tricuspid annuloplasty for acute IE due to Enterococcus spp. Seven months previously, the patient also underwent a redo cardiac procedure to replace a mitral valve prosthesis with a new mechanical device due to a leakage. Aspergillus oryzae showed impressive growth with strong and unexpected virulence in both local and systemic settings.
Insights
This case report details the first instance of fungal endocarditis caused by Aspergillus oryzae in an aortic valve prosthesis. This rare fungal infection presented with severe virulence in a patient with a history of multiple cardiac surgeries.
Area of Science:
- Cardiology
- Infectious Diseases
- Mycology
Background:
- Infective endocarditis (IE) is a serious condition with significant mortality.
- Prosthetic valve endocarditis (PVE) is a rare but severe complication of valve replacement surgery.
- Fungal IE is uncommon (2-4% of cases) but carries a higher risk of mortality and morbidity.
Observation:
- A 67-year-old male with a history of mitral and aortic valve replacement developed PVE.
- The patient had undergone multiple cardiac procedures, including a recent mitral valve replacement due to leakage.
- The causative agent was identified as Aspergillus oryzae, a rare cause of fungal endocarditis.
Findings:
- This is the first reported case of Aspergillus oryzae causing fungal endocarditis on an aortic valve prosthesis.
- Aspergillus oryzae demonstrated aggressive growth and high virulence, affecting both local and systemic sites.
- The patient's complex surgical history likely predisposed him to this rare fungal infection.
Implications:
- Highlights the potential for rare fungal pathogens like Aspergillus oryzae to cause severe PVE.
- Underscores the importance of considering fungal etiologies in PVE, especially in immunocompromised or post-surgical patients.
- Suggests a need for increased awareness and potentially tailored diagnostic and treatment strategies for fungal PVE.