ABSTRACT
Fungal endocarditis is a rare disease in infants, but it has been reported with increasing frequency among premature infants requiring neonatal intensive care. Congenital heart disease, pro- longed intravenous catheterization, the use of intravenous alimentation, broad-spectrum antibiotics administration and narcotic addiction are risk factors. Candida endocarditis is an unusual but severe complication of systemic candidiasis. Its occurrence has been related to the placement of a central venous catheter with its tip close to or within the right atrium and persistent candidemia. Embolization to major blood vessels is a common complication of Candida endocarditis and repeated pulmonary emboli are suspected to be cause of the repeated episodes of circulatory shock which finally leads to death. Thus, early diagnosis of Candida invasion and prevention of Candida endocarditis are essential for survival. We report a case of Candida endocarditis which was successfully managed with surgical removal and antifungal therapy. (J Korean Pediatr Soc 2000;43:832 836)
Subject(s)
Humans , Infant , Infant, Newborn , Anti-Bacterial Agents , Blood Vessels , Candida , Candidemia , Candidiasis , Catheterization , Catheters , Central Venous Catheters , Early Diagnosis , Endocarditis , Heart Atria , Heart Defects, Congenital , Infant, Premature , Intensive Care, Neonatal , Opioid-Related Disorders , Rare Diseases , Risk Factors , Shock , Tricuspid ValveABSTRACT
Case 1: A 39-year-old man underwent orthotopic heart transplantation on November 1994 for dilated cardiomyopathy. His postoperative course was unevenful and medications included daily cyclosporin A, Immuran and prednisone. On December 13.1994, he developed cough and sore throat. Chest radiographs revealed multiple patch growing lesions. Sputum fungus culture revealed Aspergillus Fumigatus. The patient was treated with daily infusion of amphotericin B. He remains well without evidence of relapse of Aspergillus, Case 2: This 39-year-old man had undergone orthotopic heart transplantation on November 16 1994 for dilated cardiomyopathy. In December 7.1994. he developed recurrent syncope. Chest radiographs revealed fungus ball like lesion on right lung field. On open lung biopsy and wedge resection of the mass was performed. Aspergillosis and CMV infection was demonstrated in the biopsy specimen. The patient was treated with conventional amphotericin B therapy for over 7weeks and Ganciclovir for over 2weeks. At the end of therapy chest X-ray showed only small residual scar in the area of previous mass.