Abstract：
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%.
METHODS: 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.
METHODS: 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.
摘要：
背景：真菌性心内膜炎是一种低频疾病，具有挑战性的诊断，因为它可能被误认为是细菌性心内膜炎。真菌性心内膜炎导致免疫功能低下患者的死亡率更高。在临床实践中,真菌引起的心内膜炎占所有感染性心内膜炎病例的10%，死亡率接近50%。
方法：这里我们介绍一个53岁的女性，她正在接受糖皮质激素治疗，有风湿性心脏病史，主动脉瓣置换术,和类风湿性关节炎，表现为白色念珠菌引起的真菌性心内膜炎。即使患者接受了3年的氟康唑抗真菌预防，做了瓣膜置换手术,接受了重症监护,病人最终病情恶化并死亡。
结论：合并症和皮质类固醇治疗使患者易患真菌性心内膜炎。该案例强调了实施真菌分离和鉴定程序的重要性，以及进行抗真菌药敏试验，以及建立监测计划，以确定医院中引起感染的物种和耐药模式。此外，设计和升级感染性心内膜炎的算法是未来诊断改进的关键。
方法：这里我们介绍一个53岁的女性，她正在接受糖皮质激素治疗，有风湿性心脏病史，主动脉瓣置换术,和类风湿性关节炎，表现为白色念珠菌引起的真菌性心内膜炎。即使患者接受了3年的氟康唑抗真菌预防，做了瓣膜置换手术,接受了重症监护,病人最终病情恶化并死亡。
结论：合并症和皮质类固醇治疗使患者易患真菌性心内膜炎。该案例强调了实施真菌分离和鉴定程序的重要性，以及进行抗真菌药敏试验，以及建立监测计划，以确定医院中引起感染的物种和耐药模式。此外，设计和升级感染性心内膜炎的算法是未来诊断改进的关键。
