Endemic Fungal Infective Endocarditis Caused by Coccidioides, Blastomyces and Histoplasma Species in the United States.

We describe a recent case of Coccidioides bioprosthetic aortic valve infective endocarditis successfully managed at our institution. This led us to perform a literature review of endemic fungal infective endocarditis in the United States caused by Coccidioides, Blastomyces, and Histoplasma. Symptoms preceded infective endocarditis diagnosis by several months. Patients with Coccidioides and Blastomyces infective endocarditis were younger with fewer comorbid conditions. Valvular involvement was relatively uncommon in Blastomyces infective endocarditis (27%). Fungemia was noted in patients with infective endocarditis due to Histoplasma (30%) and Coccidioides (18%). Mortality rates for infective endocarditis were high (Histoplasma, 46%; Coccidioides, 58%; Blastomyces, 80%); infective endocarditis was commonly diagnosed post-mortem (Coccidioides, 58%; Blastomyces, 89%). Most surviving patients with infective endocarditis (Histoplasma, 79%; Coccidioides, 80%) underwent valve surgery along with prolonged antifungal therapy. The two surviving patients with Blastomyces infective endocarditis received antifungal therapy without surgery.

Rhodococcus erythropolis septic arthritis.

A woman in her 50s presented with a 4-day history of left knee pain, erythema, swelling as well as malaise and rigours 1 month after undergoing a left knee meniscectomy. She was diagnosed with left native knee septic arthritis and underwent arthroscopic irrigation and debridement of the knee; cultures from synovial tissue grew Rhodococcus erythropolis. Rhodococcus spp are soil-dwelling and livestock-dwelling bacteria which occasionally cause disease in immunocompromised hosts. Infection in immunocompetent hosts is rare, and septic arthritis secondary to Rhodococcus erythropolis has not been reported previously.

Superimposed Neuroinvasive Coccidioidomycosis and West Nile Virus Infection.

A 58-year-old man with recently diagnosed coccidioidal meningitis presented to the ED with a five-day history of headache, photopsia, blurred vision, and worsening encephalopathy. His coccidioidal meningitis had responded well to fluconazole therapy, but three weeks later, he developed acute symptomatic worsening. Unfortunately, his clinical worsening coincided with Arizona's worst seasonal West Nile Virus (WNV) outbreak. He was ultimately found to have WNV neuroinvasive disease. Concurrent coccidioidal and WNV neuroinvasive diseases have not been described in the literature. Fortunately, he improved quickly to his normal baseline without neurologic deficits with supportive therapy for his WNV neuroinvasive disease and remains on lifelong antifungal therapy for coccidioidal meningitis.

Treatment of Recurrent Vulvovaginal Candidiasis With Ibrexafungerp.

Recurrent vulvovaginal candidiasis is a common disorder which causes significant morbidity among women worldwide, and treatment options are limited. Ibrexafungerp is a novel antifungal agent which was approved in 2021 for treatment of vulvovaginal candidiasis. We present a case of recurrent vulvovaginal candidiasis successfully treated with ibrexafungerp.