Non-surgical endocarditis by aspergillus with mould isolation in blood culture and negative galactomannan

J. Pemán,1 R. Ortí­z,1 F. Osseyran,2 C. Pérez-Bellés,1 M. Crespo,2 J. Garcí­a,2 J. Frasquet1 and M. Gobernado1

Author address: 

1Servicios de Microbiologí­a y Reanimación, Hospital Universitario La Fe,Valencia, Microbiology, Valencia, Spain and 2Servicios de Microbiologí­a y Reanimación, Hospital Universitario La Fe,Valencia, Critical Care, Valencia, Spain

Abstract: 

Introduction: Infectious endocarditis caused by Aspergillus spp. is rare and usually affects heart surgery or immune-suppressed patients. In the cases described in the literature, the isolation was obtained postmortem or from cultures of the valve and only in very few cases had the mould also been isolated in the blood culture. To our knowledge, this is the third case described of Aspergillus endocarditis in which the mould was isolated in the blood culture. Paradoxically, in he present case serum galactomannan antigen (GM) was negative. Clinical report: A 58-year-old male, ex-smoker of 2030 cigarettes day-1 without other toxic habits; diagnosed of chronic obstructive pulmonary disease in treatment with oxygen and inhaled b-agonist therapy and without history of immune-suppression. Before admission, he presented brief episodes of amaurosis fugax, embolism in lower members and abdominal pain which brought him to consultation in the Emergency Area of the hospital. After admission, several examinations were performed with the following results: (i) Echocardiogram: vegetation in the mitral valve, (ii) Abdominal Angio-CT: obstruction of a branch of the mesenteric artery and renal bilateral infarction areas, and (iii) Abdominal arteriography: mycotic aneurysm in the ileocecal branch of the mesenteric artery. Consequently, urgent valve replacement was indicated and a metallic prosthesis was implanted. The native valve and the vegetation were sent to the Microbiology Laboratory for microscopic examination and culture. In the Gram stain o the vegetation, branched structures were observed and confirmed as fungal by calcofluor white stain. Thus, antifungal therapy was started with voriconazole (250 mg day-1). In the vegetation culture a filamentous fungi was isolated and later identified as Aspergillus fumigatus. After surgery, the patient presented fever and A. fumigatus was also isolated from both blood and urine cultures even though two serum samples for GM were negative (OD
2005

abstract No: 

P048

Full conference title: 

2nd Trends in Medical Mycology
    • TIMM 2nd (2010)