Thermomyces lanuginosus Endocarditis and Review of Endocarditis due to Rare Molds

Ref ID: 18712

Author:

S. Sivagnanam, MD (Doctor of Medicine) – Infectious diseases and Microbiology registrar, S. Chen, MD, PhD – Infectious Diseases Physician and Microbiologist, C. Halliday, PhD – Senior hospital scientist, D. Packham, MD – Infectious Diseases physician

Author address:

Ctr. for Infectious Diseases and Microbiol., Sydney, Australia.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Infective endocarditis (IE) due to Thermomyces lanuginosus is rare. We report a patient who contracted T. lanuginosus IE at the time of valvular surgery for bacterial endocarditis. Despite antifungal therapy, she had multiple relapses, spinal osteomyelitis and aortic bifurcation embolism. Voriconazole and 3 cardiac surgeries have prolonged survival to 8 years but led to difficulties with therapeutic drug levels and drug toxicity. Absence of management guidelines prompted a review of the clinical aspects and management of rare mold IE. Methods: MEDLINE search was conducted for rare mold IE in humans from 1902-2012. Additional articles were identified by scanning the references. Pooled cases/reviews without clinical data, Aspergillus IE and disseminated mold infections were excluded. Demographics, risk factors, clinical features, treatment, drug side effects and outcomes were reviewed. Results: Results from 78 identified cases of rare mold IE are summarised. Fever was not a presenting feature in about 38% of cases. Major peripheral embolism occurred in 72%. Concurrent bacterial IE was documented in 3%. 65% had surgical management. 68% had antifungal therapy. 25% had side effects to antifungals. Duration of antifungal therapy ranged from few days to ongoing life-long therapy. Conclusions: Rare mold IE affects younger patients and mostly males. Risk factors (eg. valvular defects, immunosuppression) may not be present. Major peripheral embolism is common. Mortality rate is high and many cases relapse. Aggressive surgical management and prolonged therapy are required. Suppressive voriconazole therapy prolonged survival in our patient, but was fraught with difficulties in achieving therapeutic drug levels and managing side effects.

Abstract Number: M-1680

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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