Endocarditis due to Candida albicans in an immunocompromised patient: A case report.

BACKGROUND: Fungal endocarditis is a low-frequency disease with a challenging diagnosis, as it can be mistaken with bacterial endocarditis. Fungal endocarditis causes higher mortality rates in immunocompromised patients. In the clinical practice, the endocarditis caused by fungi represents up to 10% of all infectious endocarditis cases and has a mortality rate of nearly 50%. CASE REPORT: Here we present the case of a 53-year-old woman under corticosteroid therapy with a history of rheumatic heart disease, aortic valve replacement, and rheumatoid arthritis, who presented with fungal endocarditis caused by Candida albicans. Even though the patient received 3 years of antifungal prophylaxis with fluconazole, had valve replacement surgery, and received intensive care, the patient finally worsened and died. CONCLUSIONS: Comorbidities and corticosteroid therapy predisposed the patient to acquire fungal endocarditis. This case highlights the importance of implementing procedures for the isolation and identification of fungi, and for carrying out antifungal-susceptibility testing, as well as establishing surveillance programs to identify infection-causing species and drug resistance patterns in hospitals. Moreover, designing and upgrading the algorithm for infectious endocarditis is the key to future improvements in diagnosis.

Endocarditis due to Candida albicans in an immunocompromised patient: A case report / Endocarditis por Candida albicans en una paciente inmunocomprometida: presentación de un caso

Case report: Here we present the case of a 53-year-old woman under corticosteroid therapy with a history of rheumatic heart disease, aortic valve replacement, and rheumatoid arthritis, who presented with fungal endocarditis caused by Candida albicans. Even though the patient received 3 years of antifungal prophylaxis with fluconazole, had valve replacement surgery, and received intensive care, the patient finally worsened and died. Conclusions: Comorbidities and corticosteroid therapy predisposed the patient to acquire fungal endocarditis. This case highlights the importance of implementing procedures for the isolation and identification of fungi, and for carrying out antifungal-susceptibility testing, as well as establishing surveillance programs to identify infection-causing species and drug resistance patterns in hospitals. Moreover, designing and upgrading the algorithm for infectious endocarditis is the key to future improvements in diagnosis.(AU)

Antecedentes: La endocarditis fúngica es una enfermedad de baja incidencia cuyo diagnóstico puede ser complicado al confundirse con la endocarditis bacteriana. La endocarditis fúngica se asocia a mayor mortalidad en pacientes inmunocomprometidos. En la práctica clínica, la endocarditis fúngica representa hasta el 10% de las endocarditis infecciosas, con una mortalidad de aproximadamente el 50%. Caso clínico: Mujer de 53 años con endocarditis fúngica por Candida albicans en tratamiento con corticosteroides por antecedentes de fiebre reumática, prótesis de válvula aorta y artritis reumatoide. A pesar de 3 años de profilaxis antifúngica con fluconazol, un nuevo reemplazo valvular y cuidados intensivos, la paciente finalmente empeora y muere. Conclusiones: Las comorbilidades y la toma de corticosteroides predispusieron a la paciente a adquirir una endocarditis fúngica. Esto resalta la importancia de implementar procedimientos de aislamiento, identificación del hongo y pruebas de sensibilidad a los antifúngicos, así como establecer programas de vigilancia para identificar especies causantes de infecciones y patrones de resistencia en hospitales. Además, diseñar y actualizar el algoritmo para un mejor diagnóstico de las endocarditis infecciosas es una cuestión clave.