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Endocarditis due to Aspergillus flavus
Z U Khan1, S C Sanyal, E Mokaddas
1Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
Abstract:
Fungal endocarditis has emerged as an important complication of patients undergoing cardiovascular surgery. Our patient had no past history of cardiac surgery, intravenous drug abuse or immunosuppressive therapy. He had received broad-spectrum antibiotics for varying periods, which might have predisposed him to this infection. The diagnosis was based on the demonstration of hyaline, septate branched fungal elements in the infected valvular tissue and isolation of Aspergillus flavus in culture. The delay in establishing the ante-mortem diagnosis because of repeatedly negative blood cultures, presence of disseminated intravascular coagulopathy and rapidly deteriorating kidney function were the major factors contributing to his poor prognosis and death, despite surgical removal of infected valves and antifungal therapy. This is the first report of endocarditis due to A. flavus from the Middle East.
Insights
Fungal endocarditis, a serious complication, can occur without typical risk factors. Aspergillus flavus infection led to a fatal outcome despite treatment, highlighting diagnostic challenges.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Cardiovascular Surgery
Background:
- Fungal endocarditis is an increasing concern in patients after cardiovascular surgery.
- This case involved a patient without typical risk factors like prior surgery, drug abuse, or immunosuppression.
- Prolonged broad-spectrum antibiotic use may have contributed to the fungal infection.
Observation:
- Diagnosis relied on identifying fungal elements in valvular tissue and culturing Aspergillus flavus.
- Repeatedly negative blood cultures delayed ante-mortem diagnosis.
- The patient presented with disseminated intravascular coagulopathy and worsening kidney function.
Findings:
- Aspergillus flavus was identified as the causative agent of endocarditis.
- Despite valve surgery and antifungal therapy, the patient's prognosis was poor.
- This is the first reported case of Aspergillus flavus endocarditis in the Middle East.
Implications:
- Highlights the importance of considering fungal endocarditis in atypical presentations.
- Emphasizes diagnostic challenges, especially with negative blood cultures.
- Underscores the critical role of early diagnosis and targeted antifungal therapy in improving outcomes.