Aspergillus endocarditis in France: contribution of molecular diagnostic tools and recent antifungal

S. River, O. Lortholary, A. Lefort

Abstract: 

Objectives: The Aspergillus endocarditis (EA) are difficult to diagnose and associated with a greater than 80% mortality. The aim is to better describe this infection in the era of new diagnostic and therapeutic tools.

Methods: Eight cases were identified through the monitoring of fungal infections in France (National Reference Center Mycology and Antifungals, CNRMA) between 2005 and 2011.

Results: Six of 8 patients were immunocompromised (including 4 transplanted organ), the other 2 who developed the EA with the waning of heart surgery (without any predisposing factor). Five had embolic complications at diagnosis.

Blood cultures were positive in 1/8 cases. Mark galactomannan (GM) in serum, performed at diagnosis in 6 patients was the 1 st element for a Aspergillus etiology in 5 cases, allowing the initiation of suitable antifungal treatment before the culture results. A negativity on treatment was observed in 4 patients.

Culture valves allowed the identification of the species in 6 cases: A. fumigatus (n = 4), A. flavus (n = 3) and A.ustus (n = 1). PCR panfongique on heart tissue was positive for Aspergillus sp. 2 in cases where it was performed.

Five patients died within a median of 3 months (4 days - 6 months), 4 of which had been operated since the diagnosis. Death due to EA in any case.

Three patients living more than 4 years of follow up, of which 2 were operated at diagnosis (but indicated challenged surgery to risk too high mortality in the 3 rd case). Prolonged medical treatment with voriconazole was associated in 3 cases. One patient relapsed at 6 months with the waning of the judgment of voriconazole, whose recovery has healing without further surgery.

Conclusion: This study shows the severity of the EA and the factors that favor. GM is an important tool for the diagnosis and monitoring. A strategy with early surgery associated with voriconazole now allows a near survival of 40%.

2011

Full conference title: 

Réunion Interdisciplinaire de Chimiothérapie Anti Infectieuse
    • RICAI 31st (2011)