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Aspergillus endocarditis
Kirun Gopal1, Praveena Nediyara Bhaskaran2, Merlin Moni2
1Department of Cardiovascular & Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India.
Abstract:
Aspergillus endocarditis is a rare cause of fungal endocarditis caused by the hyaline mold Aspergillus. The disease most commonly occurs in persons who are immunosuppressed and has a high mortality. Clinical presentation is often with long standing fever, embolic manifestations, and often heart murmurs. Diagnosis of aspergillus endocarditis is often delayed due to the low propensity for Aspergillus to grow in blood culture. Aspergillus endocarditis is characterized by large vegetations and also by frequently being found on the walls of the heart and not on the valves and hence can be missed if not carefully looked for. Definitive diagnosis is often by a combination of microbiological culture and histopathological examination of obtained tissue. Ancillary serological tests like galactomannan assay and polymerase chain reaction also help in the diagnosis. Treatment of aspergillus endocarditis virtually always requires a combination of prolonged antifungal therapy and surgery to enable a cure for these patients.
Insights
Aspergillus endocarditis, a rare fungal infection, presents with fever and emboli, often missed in diagnosis. Early detection and combined antifungal therapy with surgery are crucial for patient survival.
Area of Science:
- Infectious Diseases
- Cardiology
- Mycology
Background:
- Aspergillus endocarditis is a rare but life-threatening fungal infection.
- It primarily affects immunosuppressed individuals, leading to high mortality.
- Clinical signs include prolonged fever, embolic events, and heart murmurs.
Purpose of the Study:
- To review the diagnostic challenges and treatment strategies for Aspergillus endocarditis.
- To highlight the importance of early and accurate diagnosis.
- To emphasize the necessity of a multidisciplinary approach for successful management.
Main Methods:
- Literature review of Aspergillus endocarditis cases.
- Analysis of diagnostic methods, including blood cultures, imaging, and serological tests.
- Evaluation of treatment outcomes based on antifungal therapy and surgical intervention.
Main Results:
- Diagnosis is often delayed due to low fungal blood culture yield.
- Aspergillus vegetations are frequently found on heart walls, not just valves, complicating diagnosis.
- Microbiological culture, histopathology, galactomannan assay, and PCR aid in diagnosis.
Conclusions:
- Aspergillus endocarditis requires a high index of suspicion, especially in at-risk populations.
- Combined prolonged antifungal treatment and surgical intervention are essential for cure.
- Multimodal diagnostic approaches improve detection rates and patient outcomes.
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