ABSTRACT
The case is presented of a native valve endocarditis caused by Candida sake in a 34-year-old farmer with no history of intravenous drug abuse or pre-existing valvular abnormality. The patient presented with septicemia and multiorgan dysfunction syndrome (MODS). Clinical and diagnostic work-up revealed findings of severe aortic regurgitation and large vegetations on the aortic valve. Preoperatively, the patient was treated for three weeks with amphotericin B; when the MODS had improved, open-heart surgery with valve replacement was performed. Intravenous amphotericin B was continued postoperatively for three more weeks; a subsequent decision was taken to administer lifelong suppressive antifungal therapy.
Subject(s)
Candidiasis , Endocarditis, Bacterial/microbiology , Adult , Amphotericin B/therapeutic use , Anti-Bacterial Agents/therapeutic use , Candidiasis/diagnostic imaging , Candidiasis/drug therapy , Echocardiography, Transesophageal , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/surgery , Humans , MaleABSTRACT
A 58-year-old woman who underwent mitral valve replacement and tricuspid valve repair developed severe acute systemic illness four weeks after surgery. Serial blood cultures grew Burkholderia cepacia at four to five days after incubation. Transthoracic echocardiography had confirmed a diagnosis of prosthetic valve endocarditis. The patient did not respond to empirical or culture-sensitive antibiotic therapy of endocarditis. Trimethoprim-sulfamethoxazole (TMP-SMX) therapy was only commenced at three weeks after the start of fever because of delayed presentation. Every effort should be made to identify this organism in the laboratory. When clinically indicated, early presumptive antibiotic therapy with TMP-SMX should be started.