Acute Lower Limb Ischemia Complicating Endocarditis due to Candida parapsilosis in a Drug Abuser

doi:10.1007/BF02017417

Annals of Vascular Surgery

Volume 8, Issue 6, November 1994, Pages 591-594

https://doi.org/10.1007/BF02017417 Get rights and content

Acute ischemia due to arterial embolism occurred in the right leg of a male drug abuser who had developed fungal endocarditis as a result of Candida parapsilosis. Transesophageal echocardiography aided in the diagnosis. The patient was successfully treated with fibrinolysis and surgery. The clinical features and management of this serious condition have been reviewed in the literature.

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There are more references available in the full text version of this article.

Cited by (15)

A meta-analysis of medical versus surgical therapy for Candida endocarditis
2005, Journal of Infection
The optimal management of Candida infective endocarditis (IE) is unknown.
We reviewed all 879 cases of Candida IE reported from 1966–2002 in the peer-reviewed literature to better understand the role of medical and surgical therapies. This review included 163 patients from 105 reports that met our inclusion criteria: 31 cases treated with antifungal monotherapy, 25 cases treated with medical antifungal combination therapy, and 107 cases treated with adjunctive surgical plus medical antifungal therapy. We also used meta-analytic techniques to evaluate 22 observational case-series (72 patients) of the 105 reports with two or more patients with definite Candida IE.
We found that in patients who underwent adjunctive surgery there was a lower reported proportion of deaths [prevalence odds ratio (POR)=0.56; 95% confidence interval (CI)=0.16, 1.99)]. Higher mortality was noted in patients treated prior to 1980 (POR=2.03; 95% CI=0.55, 7.61), treated with antifungal monotherapy (POR=1.49; 95% CI=0.39, 5.81), infected with Candida parapsilosis (POR=1.51; 95% CI=0.41, 5.52), or with left-sided endocarditis (POR=2.36; 95% CI=0.55, 10.07).
Medical antifungal therapy of Candida IE is poorly characterized, and recent antifungal developments lend promise for those patients who cannot undergo surgery.
Bilateral popliteal embolism secondary to the fungal infection of the scar tissue resulting from aortotomy
2002, Angiologia
The infection of an aortotomy scar is a very infrequent clinical entity, and even more so if it has a fungal origin.
A 66-year-old male who visited the casualty department because of a high temperature, hypotension and acute ischemia in both lower limbs, 24 hours after presentation. Notable pathological antecedents included the replacement of an aortic valve with a mechanical valve 17 years earlier. Diagnostic arteriography showed a bilateral embolic occlusion of the distal popliteal artery and the patient was submitted to a bilateral popliteal thromboembolectomy, with remission of the acute ischemic syndrome. Anatomopathological analysis of the clots revealed hyphae that were compatible with Aspergillus sp. Treatment was begun with endovenous amphotericin B and valve replacement. During the course of the operation, the presence of vegetation was detected at the site of the earlier aortotomy. During the post-operative period following cardiac surgery the patient died from an acute myocardial infarction.
We report an infrequent form of aortitis, which entails diagnostic and therapeutic difficulties, and which is usually accompanied by high mortality rates.
La infección de una cicatriz de aortotomía es una entidad clínica muy poco frecuente, más aún si es de origen fúngico.
Varón de 66 años que acudió a urgencias por fiebre, hipotensión e isquemia aguda de ambos miembros inferiores, de 24 horas de evolución. Entre sus antecedentes patológicos destacaba la sustitución valvular aórtica hacía 17 años por una válvula mecánica. La arteriografía diagnóstica mostró la oclusión embólica bilateral de la poplítea distal, y se le practicó una tromboembolectomía poplítea bilateral con remisión del síndrome isquémico agudo. El análisis anatomopatológico de los émbolos mostró hifas compatibles con Aspergillus sp. Se inició el tratamiento con anfotericina B endovenosa y sustitución de la válvula. En el acto operatorio, se detectó la presencia de una vegetación sobre la aortotomía previa. En el postoperatorio de la cirugía cardíaca el paciente falleció por un infarto agudo de miocardio.
Se presenta una forma infrecuente de aortitis, que lleva implícitas dificultades diagnósticas y terapéuticas, y que habitualmente se acompaña de altas tasas de mortalidad.
A infecção de uma cicatriz de aortotomia é uma entidade clínica muito pouco frequente, mais ainda se for de origem fúngica.
Homem de 66 anos de idade que recorreu às urgências por febre, hipotensão e isquemia aguda de ambos os membros inferiores, com 24 horas de evolução. Entre os seus antecedentes patológicos destacavamse a substituição valvular aórtica há 17 anos por uma válvula mecânica. A arteriografia diagnóstica mostrou a oclusão embólica bilateral da popliteia distal, e realizouse uma tromboembolectomia popliteia bilateral com remissão da síndroma isquémica aguda. A análise anatomopatológica dos êmbolos mostrou hifas compatíveis com Aspergillus sp. Iniciou-se tratamento com anfotericina B endovenosa e substituição da válvula. No acto operatório, detectou-se apresença de uma vegetação sobre a aortotomia prévia. No pós-operatório da cirurgia cardíaca, o doente faleceu por um enfarte agudo do miocárdio.
Apresenta-se uma forma rara de aortite, que leva implícitas dificuldades de diagnóstico e de terapêutica, e que habitualmente é acompanhada por elevadas taxas de mortalidade.
Candida parapsilosis endocarditis in an intravenous drug abuser: an autopsy report
2018, Cardiovascular Pathology
Candida parapsilosis is a rare cause of endocarditis, which is seen to affect the native valves in patients who are known intravenous drug abusers or following contamination during surgery for prosthetic valves. We discuss a unique constellation of autopsy findings in a 35-year-old chronic opium abuser who presented with left-sided weakness followed by low-grade fever. He was diagnosed to have C. parapsilosis native valve endocarditis with septic emboli involving the myocardial vessels, left middle cerebral artery, spleen, and common iliac artery. In addition, autopsy highlighted a right basal ganglia infarct, focal segmental glomerulonephritis, and talc granulomatosis in the lungs and liver.
Insidious onset of intermittent claudication as the primary manifestation of infective endocarditis
2017, International Journal of General Medicine
Candida parapsilosis Endocarditis Presenting on Native Valve with Cerebrovascular Accident and Myocardial Infarction
2015, Infectious Diseases in Clinical Practice
Candida parapsilosis endocarditis: A comparative review of the literature
2007, European Journal of Clinical Microbiology and Infectious Diseases

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: Reprint requests: Pascual Lozano, MD, Division of Angiology and Vascular Surgery, Hospital Son Dureta, C Andrea Doria 55, 07014 Palma de Mallorca, Spain.

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References (14)

Septic embolism complicating infective endocarditis

J Vasc Surg

Candida endocarditis with saddle embolism: A successful surgical intervention

Ann Thorac Surg

Septic peripheral embolization from bacterial and fungal endocarditis

Ann Vasc Surg

Acute aortic occlusion secondary to Aspergillus endocarditis in an intravenous drug abuser

Ann Vasc Surg

Detection of the source of arterial emboli by transesophageal echocardiography: A case report

J Vasc Surg

Saddle embolism complicating Candida parapsilosis aortic valve endocarditis: Cure with aortic valve replacement and prompt extraction of multiple fungal emboli

J Vasc Surg

Emboli artérielle des membres au cours des endocardites infectieuses sur valves natives

Presse Med

Cited by (15)

A meta-analysis of medical versus surgical therapy for Candida endocarditis

Bilateral popliteal embolism secondary to the fungal infection of the scar tissue resulting from aortotomy

Candida parapsilosis endocarditis in an intravenous drug abuser: an autopsy report

Insidious onset of intermittent claudication as the primary manifestation of infective endocarditis

Candida parapsilosis Endocarditis Presenting on Native Valve with Cerebrovascular Accident and Myocardial Infarction

Candida parapsilosis endocarditis: A comparative review of the literature