Aspergillus native valve infective endocarditis (IE) in patients without prior cardiac surgery is uncommon. We report three cases treated at our institution and reviewed 36 other adult cases reported in the English literature. All cases met Von Reyn criteria for definitive IE (histologic and/or positive cultures from explanted valves or embolic sites at surgery or post-mortem examination). 40% of the 39 patients were receiving corticosteroid therapy or had an underlying malignancy (37%). The most common signs and symptoms of IE were fever (76%), embolic phenomena (76%), a new or changing heart murmur (54%), weight loss (16%) and sudden visual loss (13%). Echocardiography was performed in 20 patients and revealed vegetations in 75%. The most common species isolated were A. fumigatus (18 pts), A. flavus (6 pts) and Aspergillus (not speciated) in 28% (11 pts). 5% (2 pts) had Aspergillosis sp. isolated from blood cultures and 37% (3/8) had a positive Aspergillus serology by complement fixation. An antemortem diagnosis of Aspergillus IE was made in 54% (21pts); all received amphotericin B and 61% (11 pts) underwent valvular surgery (including all 3 of our cases). 27% (3/11) surgically treated patients survived compared with none (0/10) treated with medical therapy alone. We conclude that native valve Aspergillus IE is uncommon, often presents with signs of embolic phenomena, and is uniformly fatal without surgical treatment.
Full conference title:
37th Annual Meeting of the Infectious Diseases Society of America (IDSA), November 18-21.
- IDSA 37th