Candida parapsilosis endocarditis. Report of cases and review of the literature.

INTRODUCTION: Infective endocarditis (IE) due to Candida species is a rare disease representing about 1-2% of all IE cases and carries a high mortality rate. Given the rarity of the disease, there are no clear guidelines on the type and duration of antifungal therapy. Thus, long-term or even life-long antifungal treatment is commonly used. CASE REPORT: We report two patients with prosthetic valve C. parapsilosis IE and persistent candidemia that failed conservative treatment and ultimately developed heart failure. They underwent prosthetic valve replacement and prolonged antifungal treatment with favorable outcome. DISCUSSION: Candida IE commonly occurs in the setting of underlying malignancy, chronic liver disease, previous endocarditis, previous antimicrobial exposure, previous abdominal surgery, intravenous drug use, presence of a central venous catheter, and previous cardiac surgery. Both present patients had undergone a cardiac surgery and had a prosthetic heart valve, while one patient had an underlying autoimmune disease that could be associated with higher risk of IE. In both patients transthoracic ultrasound failed to diagnose IE. In our patients, conservative treatment alone was not enough to control the infection, thus, both patients underwent valve replacement and were subsequently treated with antifungals for 6 weeks. Furthermore, both patients were put on long-term antifungal suppression treatment. CONCLUSIONS: Given the absence of controlled randomized trials, the treatment of Candida endocarditis mostly relies on experts' opinion, and, thus, future studies focusing on the type and duration of antifungal treatment are required.

Mycobacterium avium Auricular Infection in an Apparent Immunocompetent Patient: A Case Report.

INTRODUCTION: Soft tissue infections with Mycobacterium avium complex are more likely to appear in immunocompromised patients. However, they may rarely arise in non-immunosuppressed individuals. AIM: To present the case of an ear infection with Mycobacterium avium in the absence of demonstrable immunosuppression. CASE REPORT: Clinical case description, blood tests, routine histology and tissue cultures. DISCUSSION: A female, apparent immunocompetent patient presented with a 6-month reddish, oedematous and painless lesion with fine scaling in the right ear. Histology showed numerous granulomas, composed of epithelioid histiocytes without central necrosis. Cultures grew Mycobacterium avium. An unusual accidental ear injury was the portal of microbial entry. The patient's lesion fully regressed after a 9-month course of antibiotics. CONCLUSION: Although M. avium infections are rare in immunocompetent patients, the possibility of such infections should be considered even in these subjects, when relevant clinical features and exposure to risk factors are present.