ABSTRACT
OBJECTIV E To provide ideas for diagnosis and treatment of fungal endocarditis. METHODS The diagnosis and treatment of 1 case of aspergillus endocarditis participated by clinical pharmacists were analyzed. Clinical pharmacists suggested that blood macrogenomic next-generation sequencing （mNGS）detection and blood microbial culture should be performed to assist in the diagnosis of fungal endocarditis ；considering the mechanism ，target and safety of the drug ，it was suggested to use voriconazole combined with micafungin for antifungal treatment ；through combining with the patient ’s condition and weighing up the pros and cons ，the dose of micafungin was adjusted to 300 mg per day ；clinical pharmacists prevented ，evaluated and dealt with adverse drug reactions during treatment ，and also provided medication guidance and long-term follow-up for the patient after discharge. RESULTS The clinician adopted the advice of the clinical pharmacists. Aspergillus fumigatus was detected in blood mNGS，which bought time for early diagnosis and individualized treatment of the patient. After 1 month treatment of voriconazole combined with micafungin ，the patient ’s condition was well controlled. The alkaline phosphatase and γ-glutamyl transferase of the patient returned to normal after treatment with adenosylmethionine succinate. With the help of medication guidance ，education and discharge follow-up of clinical pharmacists ，the medication compliance of the patient was good and the condition was stable. CONCLUSIONS The clinical pharmacists participate in the diagnosis and treatment process of the patient ，formulate an individualized anti-infective treatment plan for the patient and achieve good results ，which reflect the professional ability and service level of the clinical pharmacist ，and provide ideas for the clinical treatment of fungal endocarditis.
ABSTRACT
Neonatal endocarditis is a rare but usually fatal disease. Fungal endocarditis is an uncommon complication of invasive fungal infections and is associated with a high burden of morbidity and mortality. It frequently occurs in premature infants. The majority of these infections are caused by Candida (60-70%) and Aspergillus species (20-25%). The diagnosis is difficult because the criteria that have suggested and used in adults are not readily applicable for neonates. The incidence of fungal endocarditis in a neonate is on the rise, reported in the last decade secondary to use of central venous lines, frequent use of broad-spectrum antibiotics and neonatal surgical interventions.
ABSTRACT
Fungal infective endocarditis of the prosthetic pulmonary valve in non immunocompromised host is growing phenomena attributed to the increased use of prosthetic materials. High mortality and neurovascular sequalae is commonly seen in such case if treatment is delayed. Often misdiagnosed as bacterial endocarditis due to closely resembling clinical features and lack of inexpensive and readily available laboratory tests, the diagnosis is often delayed. High index of suspicion and early surgical intervention is needed for early diagnosis and management
ABSTRACT
Objective To evaluate treatment strategies for fungal endocarditis after heart prosthetic valve surgery. Methods Two cases of severe fungal infection after heart prosthetic valves surgery were analyzed retrospectively, related literatures were reviewed.Results Two patients had fungal endocarditis after surgery,the valve function was affected,patients were hospitalized repeatedly after surgery.In case 1 ,fever occurred 45 days after cardiac sur-gery and patient was returned to the hospital for re-examination,emergency mitral valve replacement was performed under cardiopulmonary bypass,the postoperative vegetation culture suggested Aspergillus flavus.In case 2,the aortic wall vegetation was removed 5 months after heart surgery under cardiopulmonary bypass,pathology of post-operative vegetation suggested mucor.Two patients were promptly removed infection foci through surgery and trea-ted with standard antifungal agents,patient with Aspergillus infection died after rescue,and patient with mucor in-fection was cured,the latter was more powerful in antifungal therapy.Conclusion Prevention is the key to fungal endocarditis after heart prosthetic valve surgery,treatment should be prompt and effective,antifungal agents should be given in sufficient dose and course.