PDF(Pubmed)
Abstract：
Trichosporon spp. endocarditis is a severe and hard-to-treat infection. Immunosuppressed subjects and carriers of prosthetic valves or intracardiac devices are at risk. This article presents the case of an immunocompetent 74-year-old man affected by endocarditis of the prosthetic aortic valve. After Bentall surgery, cultures of the removed valve demonstrated Trichosporon ashaii as the etiological agent. The patient was treated with amphotericin B at first and subsequently with fluconazole. Given the fragility of the patient and the aggressiveness of the pathogen, life-long prophylactic therapy with fluconazole was prescribed. After 5 years follow-up, no drug-related toxicities were reported and the patient never showed any signs of recurrence. The review of the literature illustrates that Trichosporon spp. endocarditis may present even many years after heart surgery, and it is often associated with massive valve vegetations, severe embolic complications, and unfavorable outcome. Due to the absence of international guidelines, there is no unanimous therapeutic approach, but amphotericin B and azoles are usually prescribed. Additionally, a prompt surgical intervention seems to be of paramount importance. When dealing with a life-threatening disease, such as mycotic endocarditis of prosthetic valves, it is essential to consider and treat even rare etiological agents such as Trichosporon spp.
摘要：
Trichosporonspp.心内膜炎是一种严重且难以治疗的感染。免疫抑制的受试者和人工瓣膜或心内装置的携带者处于危险之中。本文介绍了一名具有免疫能力的74岁男子受人工主动脉瓣心内膜炎影响的病例。Bentall手术后,切除瓣膜的培养物证明了沙沙曲孢菌是病原体。患者首先用两性霉素B治疗，随后用氟康唑治疗。鉴于患者的脆弱性和病原体的侵袭性，使用氟康唑进行终身预防性治疗.经过5年的随访,未报告药物相关毒性,患者从未出现任何复发迹象.文献综述说明了毛滴虫属。心内膜炎甚至可能在心脏手术后很多年出现，它通常与大量的瓣膜植被有关，严重的栓塞并发症,不利的结果。由于缺乏国际准则，没有一致的治疗方法，但两性霉素B和唑类药物通常是处方。此外,及时的手术干预似乎是最重要的。当面对威胁生命的疾病时,比如人工瓣膜的霉菌性心内膜炎,必须考虑和治疗甚至罕见的病原体，例如Trichosporonspp。
