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Paecilomyces varioti endocarditis on a prosthetic aortic valve
Abstract:
Fungal endocarditis following prosthetic valve surgery has assumed increased importance as a cause of postoperative death. We present, to our knowledge, the first case of the fungus Paecilomyces varioti producing endocarditis on a prosthetic aortic valve. This seems to be an extremely indolent organism which exhibits an apparent response to antibiotic therapyl. In vitro evidence suggests that this fungus is sensitive to attainable serum levels of both 5-fluorocytosine and amphotericin B. However, after viewing the extracted valve and the devastating embolic phenomenon in our patient, we believe that medical therapy alone would not suffice. Thus we suggest that prompt valve replacement be performed in future cases.
Insights
Fungal endocarditis from Paecilomyces varioti on prosthetic aortic valves is rare but serious. Prompt valve replacement is recommended over solely relying on antifungal therapy.
Area of Science:
- Medical Mycology
- Cardiovascular Surgery
Background:
- Fungal endocarditis is a significant cause of mortality after prosthetic valve surgery.
- Prosthetic valve endocarditis requires timely diagnosis and effective treatment strategies.
Observation:
- A rare case of Paecilomyces varioti fungal endocarditis on a prosthetic aortic valve is presented.
- The organism demonstrated indolent behavior with a transient response to antibiotic therapy.
Findings:
- In vitro studies indicate sensitivity of Paecilomyces varioti to 5-fluorocytosine and amphotericin B.
- Despite in vitro sensitivity, the patient experienced severe embolic complications.
Implications:
- Medical management alone may be insufficient for fungal endocarditis on prosthetic valves.
- Prompt surgical intervention, including valve replacement, is crucial for favorable outcomes.