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Potential benefit of combination antifungal therapy in Aspergillus endocarditis

Kate Lennard1, Aiveen Bannan2, Peter Grant3

  • 1Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.

BMJ Case Reports
|June 14, 2020
PubMed

Insights

Aspergillus endocarditis (AE) is a serious fungal infection. Dual antifungal therapy, combined with surgery, may improve survival rates in patients with AE.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Mycology

Background:

  • Aspergillus endocarditis (AE) presents a significant challenge with high mortality rates exceeding 60%.
  • Optimal antifungal treatment strategies for AE remain incompletely defined.
  • Surgical intervention is typically considered essential for AE management.

Observation:

  • A case of prosthetic aortic valve AE complicated by cerebral emboli was successfully treated.
  • The patient received combined liposomal amphotericin B and voriconazole for 7 weeks, followed by suppressive azole therapy.
  • The patient demonstrated positive outcomes at 18-month follow-up.

Findings:

  • A literature review of AE cases (1950-2010) indicated higher survival with multiple antifungal agents versus monotherapy.
  • An updated literature review corroborated these findings, supporting dual antifungal therapy for AE.
  • Combination antifungal therapy demonstrated efficacy in the presented case.

Implications:

  • Dual antifungal therapy should be strongly considered for patients diagnosed with Aspergillus endocarditis.
  • Aggressive combined medical and surgical management may improve outcomes in AE.
  • Further research into optimal antifungal regimens for AE is warranted.
Keywords:
infectionsinfectious diseases

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