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Candida Endocarditis

Candidal Endocarditis


Presentation

  • This case study illustrates an unusual presentation of candidal endocarditis with discussion of disease epidemiology, pathogenesis, diagnosis, and treatment.[ncbi.nlm.nih.gov]
  • Significance of this is that if severe eye lesions are present, this warrants combination therapy (i.e. Amphoterecin Flucytosine) and much longer course of therapy ( 6 weeks minimum).[errolozdalga.com]
  • Case Presentation: A 63-year-old man with a history of intravenous drug use (IVDU) and non-ischemic cardiomyopathy presented with one month of fevers, night sweats, and chest pain.[shmabstracts.com]
  • We review these five cases and discuss the clinical presentation and therapy for this disease in comparison with candidal prosthetic valve endocarditis.[paperity.org]
  • In August 1989, she presented to the hospital with pancytopenia, splenomegaly and renal failure.[cardiothoracicsurgery.biomedcentral.com]
Fever
  • Fever with chills supervened five days prior to admission. He had experienced rheumatic fever at the age of seven years, and seven years later he was found to have mitral stenosis and incompetence.[jamanetwork.com]
  • Six days after bone marrow infusion, the patient developed a fever and staphylococcal septicemia that subsided only after removal of the Hickman catheter. On day 14 after bone marrow infusion the FULL TEXT[annals.org]
  • Infective Endocarditis 211 Häufige Begriffe und Wortgruppen Beliebte Passagen Seite 304 - Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever[books.google.de]
  • Very rarely, the infection may become invasive spreading throughout the body, resulting in fevers along with other symptoms depending on the parts of the body affected.[icd.codes]
Weight Loss
  • Symptoms you might notice include fever, shortness of breath, fluid buildup in your arms or legs, tiny red spots on your skin, and weight loss.[icdlist.com]
  • loss without change in diet The American Heart Association recommends preventive antibiotics for people at risk for infectious endocarditis, such as those with: Certain birth defects of the heart Heart transplant and valve problems Man-made (prosthetic[medlineplus.gov]
  • Symptoms include: running a low-grade fever (less than 39.5 C or 103 F) muscle and joint aches and pains weight loss weakness night sweats nausea lack of appetite If the disease goes untreated for some time, further symptoms may appear: red spots on the[medbroadcast.com]
  • Case report A 38-year-old woman with a history of surgically corrected tetralogy of Fallot at the age of 11, and recent dental procedures, presented with fever, anorexia, weight loss and fatigue for one month and epigastric pain of recent onset.[elsevier.pt]
Anemia
  • Laboratory tests showed elevated C-reactive protein (CRP), anemia and thrombocytopenia. Blood cultures were negative.[elsevier.pt]
  • Specific Diagnostic Strategies Besides the non-specific hematologic and biochemical abnormalities classically related to infectious endocarditis (anemia, leucocytosis, elevated sedimentation rate, elevated LFTs and abnormal urinalysis) the following tools[msgercdoctorfungus.com]
  • Candida cholecystitis has a high mortality rate, and may extend into hepatosplenic infection in neutropenic patients secondary to aplastic anemia and acute leukemia.( 10 ) Splenectomy has been recommended as a curative treatment for isolated splenic infections[ispub.com]
  • It may cause fever, heart murmurs, petechiae, anemia, embolic phenomena, and endocardial vegetations. Vegetations may result in valvular incompetence or obstruction, myocardial abscess, or mycotic aneurysm.[merckmanuals.com]
Medication Noncompliance
  • She consistently denied using any intravenous drug or medication noncompliance. During this 7 year period, she enjoyed an active lifestyle including camping and fishing.[cardiothoracicsurgery.biomedcentral.com]
Hypoxemia
  • The patient was started on amphotericin B and flucytosine with significant improvement of his hypoxemia and leukocytosis.[shmabstracts.com]
Splenomegaly
  • In August 1989, she presented to the hospital with pancytopenia, splenomegaly and renal failure.[cardiothoracicsurgery.biomedcentral.com]
  • Clinical signs of endocarditis (new murmurs, splenomegaly, Osler's nodes, and retinal lesions) were absent.[nejm.org]
  • Classical signs such as digital clubbing, Osler's nodes and splenomegaly are uncommon. Therefore the diagnosis of AE is often delayed or misdiagnosed as bacterial endocarditis, fever of unknown origin or stroke.[aspergillus.org.uk]
  • Abdominal computed tomography (CT) revealed hepatomegaly and splenomegaly with splenic infarct, thought to result from septic embolism.[elsevier.pt]
Heart Disease
  • While the pathogenic mechanisms are not fully understood, infection is associated with underlying heart disease and is most often attributable to Candida species.[ncbi.nlm.nih.gov]
  • Diagnosis and Management of Adult Congenital Heart Disease, by Drs. Gatzoulis, Webb, and Daubeney, is a practical, one-stop resource designed to help you manage the unique challenges of treating long-term adult survivors of congenital heart disease.[books.google.de]
  • Diseases listed under high risk include: Prior endocarditis Unrepaired cyanotic congenital heart diseases Completely repaired congenital heart disease in their first 6 months Prosthetic heart valves Incompletely repaired congenital heart diseases Cardiac[en.wikipedia.org]
  • Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 64. Baddour LM, Wilson WR, Bayer AS, et al.[medlineplus.gov]
  • […] to acute staphylococcal illnesses of older men with degenerative heart diseases or intravascular devices.[journals.plos.org]
Heart Murmur
  • murmur , or a change in a past heart murmur.[medlineplus.gov]
  • murmurs paleness (pallor), especially in extremities internal bleeding under fingernails At other times, infection progresses very quickly.[medbroadcast.com]
  • Fever, changing/new heart murmurs, major peripheral embolisation (particularly femoral and cerebral), focal or generalised neurologic features, heart failure and dyspnoea are the most common clinical features.[aspergillus.org.uk]
  • Heart murmurs are found in up to 85% and new murmurs have been recently reported in 48% of patients.[patient.info]
  • Endocarditis should be suspected in patients with fever and no obvious source of infection, particularly if a heart murmur is present.[merckmanuals.com]
Janeway Lesion
  • Other signs can include: Small areas of bleeding under the nails ( splinter hemorrhages ) Red, painless skin spots on the palms and soles (Janeway lesions) Red, painful nodes in the pads of the fingers and toes (Osler nodes) Shortness of breath with activity[medlineplus.gov]
  • Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial haemorrhage, conjunctival haemorrhages and Janeway's lesions.[patient.info]
  • lesions), and splinter hemorrhages under the nails.[merckmanuals.com]
  • lesions (painless hemorrhagic cutaneous lesions on the palms and soles), intracranial hemorrhage, conjunctival hemorrhage, splinter hemorrhages, kidney infarcts, and splenic infarcts. [6] Immunologic phenomena: glomerulonephritis which allows for blood[en.wikipedia.org]
  • They include the following: Petechiae: Common, but nonspecific, finding Subungual (splinter) hemorrhages: Dark-red, linear lesions in the nail beds Osler nodes: Tender subcutaneous nodules usually found on the distal pads of the digits Janeway lesions[emedicine.medscape.com]
Night Sweats
  • Case Presentation: A 63-year-old man with a history of intravenous drug use (IVDU) and non-ischemic cardiomyopathy presented with one month of fevers, night sweats, and chest pain.[shmabstracts.com]
  • Symptoms include: running a low-grade fever (less than 39.5 C or 103 F) muscle and joint aches and pains weight loss weakness night sweats nausea lack of appetite If the disease goes untreated for some time, further symptoms may appear: red spots on the[medbroadcast.com]
  • Initially, symptoms of subacute bacterial endocarditis are vague: low-grade fever ( 39 C), night sweats, fatigability, malaise, and weight loss. Chills and arthralgias may occur. Symptoms and signs of valvular insufficiency may be a first clue.[merckmanuals.com]
  • sweats, rigors, anemia, spleen enlargement Cause [ edit ] Many microorganisms can cause infective endocarditis.[en.wikipedia.org]
  • Fever and chills are the most common symptoms; anorexia, weight loss, malaise, headache, myalgias, night sweats, shortness of breath, cough, or joint pains are common complaints as well.[emedicine.medscape.com]
Splinter Hemorrhage
  • Other signs can include: Small areas of bleeding under the nails ( splinter hemorrhages ) Red, painless skin spots on the palms and soles (Janeway lesions) Red, painful nodes in the pads of the fingers and toes (Osler nodes) Shortness of breath with activity[medlineplus.gov]
  • Subungual hemorrhages (ie, splinter hemorrhages) are linear and red. They are usually caused by workplace trauma to the hands and feet rather than by valvular infection.[emedicine.medscape.com]
  • hemorrhages under the nails.[merckmanuals.com]
  • hemorrhages, kidney infarcts, and splenic infarcts. [6] Immunologic phenomena: glomerulonephritis which allows for blood and albumin to enter the urine, [7] Osler's nodes (painful subcutaneous lesions in the distal fingers), Roth's spots on the retina[en.wikipedia.org]
  • They include the following: Petechiae: Common, but nonspecific, finding Subungual (splinter) hemorrhages: Dark-red, linear lesions in the nail beds Osler nodes: Tender subcutaneous nodules usually found on the distal pads of the digits Janeway lesions[emedicine.medscape.com]
Roth's Spots
  • Immunological phenomena: glomerulonephritis, Osler's nodes, Roth's spots and rheumatoid factor.[patient.info]
  • This finding is known as Roth spots. There may be small, pinpoint areas of bleeding on the surface of the eye or the eyelids.[medlineplus.gov]
  • Osler nodes and Roth spots arise from immune-mediated vasculitis. Patients may experience palpitations, ie, the symptoms of an immune-mediated myocarditis.[emedicine.medscape.com]
  • Retinal emboli can cause round or oval hemorrhagic retinal lesions with small white centers (Roth spots).[merckmanuals.com]
  • spots on the retina, positive serum rheumatoid factor Other signs may include night sweats, rigors, anemia, spleen enlargement Cause [ edit ] Many microorganisms can cause infective endocarditis.[en.wikipedia.org]
Conjunctival Petechiae
  • petechiae Janeway lesions Immunologic phenomena: Glomerulonephritis Osler nodes Roth spots Rheumatoid factor Microbiologic evidence of infection consistent with but not meeting major criteria Serologic evidence of infection with organisms consistent[merckmanuals.com]
Stroke
  • Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. ‎[books.google.es]
  • The difference in stroke rates was small (9.6% vs. 8.8%, p   .0005). Other predictors of mortality included: any neurological complication (23.3%), especially stroke (28.5%); ARF (27.1%); and MI (31.6%).[journals.plos.org]
  • Surgery to replace the heart valve is often needed when: The infection is breaking off in little pieces, resulting in strokes. The person develops heart failure as a result of damaged heart valves. There is evidence of more severe organ damage.[medlineplus.gov]
  • Brain damage after open heart surgery in patients with acute cardioembolic stroke. Stroke 1989;20:1305-1310 37. Matsushita K, Kuriyama Y, Sawada T.[dhm.mhn.de]
  • Stroke syndromes. Mesenteric or splenic abscess or infarction.[patient.info]
Neurologic Manifestation
  • Heiro M, Nikoskelainen J, Engblom E, Kotilainen E, Marttila R, et al. (2000) Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland. Arch Intern Med 160: 2781–7. View Article Google Scholar 22.[journals.plos.org]
Tingling
  • This case study describes a 41-year-old female complaining of acute onset of pain with numbness and tingling in both lower extremities.[ncbi.nlm.nih.gov]

Workup

  • Serial blood cultures demonstrated no growth, and a workup for culture-negative endocarditis was initiated. A subsequent transesophageal echocardiogram noted an absence of the previously seen tricuspid lesion.[shmabstracts.com]
  • Echinocandins do not reliably penetrate the urine. 2) Candidemia: Significance of blood cultures, Clinical Presentation and Workup, and Risk Factors Blood cultures are insensitive for candidemia (as opposed to bacteremia - more sensitive).[errolozdalga.com]
  • […] consistent with IE Echocardiogram results consistent with IE but not meeting major echocardiographic criteria A definitive clinical diagnosis can be made based on the following: 2 major criteria 1 major criterion and 3 minor criteria 5 minor criteria See Workup[emedicine.medscape.com]
Elevated Sedimentation Rate
  • Specific Diagnostic Strategies Besides the non-specific hematologic and biochemical abnormalities classically related to infectious endocarditis (anemia, leucocytosis, elevated sedimentation rate, elevated LFTs and abnormal urinalysis) the following tools[msgercdoctorfungus.com]
Candida
  • While the pathogenic mechanisms are not fully understood, infection is associated with underlying heart disease and is most often attributable to Candida species.[ncbi.nlm.nih.gov]
  • Candidiasis moniliasis, thrush, candida paronychia, candida endocarditis, bronchomycosis, mycotic vulvovaginitis, candiosis. 141 Mortality for Candida endocarditis is high (67%), with a lower mortality in younger patients with a history of IV drug use[medical-dictionary.thefreedictionary.com]
  • Candida infection on its own can cause a number of non-Candida.[festivalcinemanuovo.eu]
  • Candida urinary tract infections: The Everything Candida Diet Book Improve Your Immunity; When it comes to yeast infections, which are caused by an overgrowth of candida fungus,[ecostress.eu]
  • Kuhn DM, Chandra J, Mukherjee PK, et al. (2002) Comparison of biofilms formed by Candida albicans and Candida parapsilosis on bioprosthetic surfaces. Infect Immun 70(2):878–888 PubMed CrossRef 15.[springermedizin.de]
Blood Culture Positive
  • The criteria combine the clinical, microbiologic, pathologic, and echocardiographic characteristics of a specific case [2] : Major blood culture criteria for IE include the following: Two blood cultures positive for organisms typically found in patients[emedicine.medscape.com]

Treatment

  • Management of his antifungal treatment was guided by newly developed serological methods. Close liaison between microbiologist and clinician is essential for the management of this serious condition.[ncbi.nlm.nih.gov]
  • This case study illustrates an unusual presentation of candidal endocarditis with discussion of disease epidemiology, pathogenesis, diagnosis, and treatment.[ncbi.nlm.nih.gov]
  • […] sup][5] Treatment guidelines for native valve Candida endocarditis strongly recommended surgical treatment within 1 week, combined with antifungal treatment consisting of liposomal amphotericin B or caspofungin for 6-8 weeks, with or without additional[medical-dictionary.thefreedictionary.com]
  • Conclusion Current guidelines for the treatment of candida endocarditis recommend surgical treatment followed by long term antifungal therapy although the cure rate by all treatments is low.[cardiothoracicsurgery.biomedcentral.com]
  • Combined surgical and clinical treatment was associated with a lower mortality. Few patients received the newer antifungal agents, and it would appear that more experience is required for their use in the treatment of C. parapsilosis endocarditis.[springermedizin.de]

Prognosis

  • The prognosis following both spontaneous rupture of the oesophagus (Boerhaave's syndrome) and candidal endocarditis is poor. Antifungal treatment for the latter has, in the past, been empirical.[ncbi.nlm.nih.gov]
  • Clinical observations, with special reference to factors influencing prognosis, Rev. Infect.[books.google.de]
  • Abstract Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality despite treatment.[elsevier.pt]
  • Considering the potential severity of the presentation, we worked closely with two medical specialists to ensure the best possible visual prognosis.[reviewofoptometry.com]

Etiology

  • The predominant etiologic agents are bacteria followed by fungi. Fungal endocarditis (FE) is an uncommon occurrence and the most severe form of IE.[omicsonline.org]
  • ., An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis, Science, 244, 362, 1989. ‎[books.google.de]
  • Candida albicans is the most common etiological agent for this rare but increasingly frequent condition.[elsevier.pt]
  • Although Candida albicans represents the main etiology of FE, C. parapsilosis is the most common non-albicans species.[springermedizin.de]

Epidemiology

  • This case study illustrates an unusual presentation of candidal endocarditis with discussion of disease epidemiology, pathogenesis, diagnosis, and treatment.[ncbi.nlm.nih.gov]
  • CRC Press, 13.03.2007 - 388 Seiten The first up-to-date source on the subject in more than a decade, this authoritative and all-encompassing guide summarizes the latest findings on the epidemiology, pathogenesis, pathophysiology, clinical manifestations[books.google.de]
  • Organization of medical conditions provides a brief overview of the basic disease process, epidemiology, pathophysiology, signs and symptoms, laboratory findings, and currently accepted medical therapy of each disorder.[books.google.de]
  • Perlroth J, Choi B, Spellberg B (2007) Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol 45(4):321–346 PubMed CrossRef 1.[springermedizin.de]
  • The epidemiology of Candida glabrata and Candida albicans fungemia in Treatment of severe Candida infections in high-risk patients in Germany: consensus. Post Nasal Drip Clear Candida Albicans and Yeast Infections Naturally with CandiBella.[festivalcinemanuovo.eu]
Sex distribution
Age distribution

Pathophysiology

  • CRC Press, 13.03.2007 - 388 Seiten The first up-to-date source on the subject in more than a decade, this authoritative and all-encompassing guide summarizes the latest findings on the epidemiology, pathogenesis, pathophysiology, clinical manifestations[books.google.de]
  • Organization of medical conditions provides a brief overview of the basic disease process, epidemiology, pathophysiology, signs and symptoms, laboratory findings, and currently accepted medical therapy of each disorder.[books.google.de]
  • References: [1] [2] [3] [4] Pathophysiology Clinical features Local mucocutaneous Oropharyngeal ( oral thrush ) Pseudomembranous candidiasis White plaque in the oral cavity that can be scraped off, giving way to red, inflamed, or bleeding areas.[amboss.com]
  • […] in 2011. 1.5–3% incidence 1 year after prosthetic valve replacement; 3–6% 5 years postreplacement Increasing incidence of cardiovascular device–related infections due to higher frequency of implantable devices, especially in the elderly Etiology and Pathophysiology[unboundmedicine.com]
  • Pathophysiology of Candidiasis Image : “Microscopic image (200-fold magnification) of Candida albicans ATCC 10231, grown on cornmeal agar medium with 1% Tween80.” by Y tambe – Y tambe’s file.[lecturio.com]

Prevention

  • Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. ‎[books.google.es]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.de]
  • Prevention of bacterial endocarditis. ‎ Seite 200 - A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). ‎ Bibliografische Informationen[books.google.de]
  • Perioperative amphotericin B therapy and lifelong use of oral antifungal agents for suppression was recommended to prevent recurrent endocarditis .[omicsonline.org]

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