Catastrophic Candida prosthetic valve endocarditis and COVID-19 comorbidity: A rare case

Document Type : Case report

Authors

1 Antimicrobial Resistance Research Center, Communicable Diseases Institute, and Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran

2 Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

3 Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran

4 Department of Cardiology, Mazandaran University of Medical Sciences, Sari, Iran

5 Invasive Fungi Research Center(IFRC),Communicable Diseases Institute, and Department of Medical Mycology, Mazandaran University of Medical Sciences, Sari, Iran.

6 Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

10.18502/cmm.7.2.7157

Abstract

Background and Purpose: Coronavirus disease 2019 (COVID-19) and Candida prostatic valve endocarditis present various clinical manifestations which may overlap;hence, discrimination between them is extremely difficult.
Case report: The case was a 66-year-old man with a past medical history of mitral and aortic valves replacement one year before COVID-19 co-infection. He was admitted with fever (for 7 days), shortness of breath, cough, seizure, lethargy,headache, and 85% oxygen saturation. Transesophageal echocardiography revealed multiple large-sized, highly mobile masses on both sides of the mechanical mitral valve highly suggestive of vegetation. Chest computed tomography scanning showed simulating scattered COVID-19 peripheral ground-glass opacities confirmed by reverse-transcription polymerase chain reaction. The set of blood cultures yielded
yeast colonies that were identified as Candida tropicalis. The patient died of septic shock shortly after receiving antifungal therapy.
Conclusion: This case emphasized the importance of early diagnosis and
implementation of antifungal treatment, particularly in patients with prosthetic cardiac
valves, to reduce their unfavorable outcomes in COVID-19 patients
 

Keywords

References

1. Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al.
The continuing 2019-nCoV epidemic threat of novel
coronaviruses to global health-The latest 2019 novel coronavirus
outbreak in Wuhan, China. Int J Infect Dis. 2020; 91:264-6.
2. Hui DS, Zumla A. Severe acute respiratory syndrome: historical,
epidemiologic, and clinical features. Infect Dis Clin. 2019;
33(4):869-89.
3. Wang HY, Li XL, Yan ZR, Sun XP, Han J, Zhang BW.
Potential neurological symptoms of COVID-19. Ther Adv
Neurol Disord. 2020; 13:1756286420917830.
4. Nobel YR, Phipps M, Zucker J, Lebwohl B, Wang TC,
Sobieszczyk ME, et al. Gastrointestinal symptoms and
coronavirus disease 2019: a case-control study from the United
States. Gastroenterology. 2020; 159(1):373-5.
5. Teixeira R, Santos M, Gil V. COVID-19 and cardiovascular
comorbidities: an update. Rev Port Cardiol. 2020; 39(8):417-9.
6. Wu Z, Chen Y, Xiao T, Niu T, Shi Q, Xiao Y. Epidemiology
and risk factors of infective endocarditis in a tertiary hospital in
China from 2007 to 2016. BMC Infect Dis. 2020; 20(1):428.
7. Kermani F, Shokohi T, Abastabar M, Davoodi L, Tabari SZ,
Jalalian R, et al. Prosthetic valve endocarditis caused by
multidrug-resistant Candida albicans in a patient with
myelodysplasia syndrome: a case report and literature review.
Curr Med Mycol. 2018; 4(3):23-7.
8. Antinori S, Bonazzetti C, Gubertini G, Capetti A, Pagani C,
Morena V, et al. Tocilizumab for cytokine storm syndrome in
COVID-19 pneumonia: an increased risk for candidemia?
Autoimmun Rev. 2020; 19(7):102564.
9. Taj-Aldeen S, Kolecka A, Boesten R, Alolaqi A, Almaslamani
M, Chandra P, et al. Epidemiology of candidemia in Qatar, the
Middle East: performance of MALDI-TOF MS for the
identification of Candida species, species distribution, outcome,
and susceptibility pattern. Infection. 2014; 42(2):393-404.
10. Kothari A, Sagar V. Epidemiology of Candida bloodstream
infections in a tertiary care institute in India. Indian J Med
Microbiol. 2009; 27(2):171-2.
11. Vaezi A, Fakhim H, Khodavaisy S, Alizadeh A, Nazeri M,
Soleimani A, et al. Epidemiological and mycological
characteristics of candidemia in Iran: a systematic review and
meta-analysis. J Mycol Med. 2017; 27(2):146-52.
12. Hallen-Adams HE, Suhr MJ. Fungi in the healthy human
gastrointestinal tract. Virulence. 2017; 8(3):352-8.
13. Lamoth F, Lockhart SR, Berkow EL, Calandra T. Changes in the
epidemiological landscape of invasive candidiasis. J Antimicrob
Chemother. 2018; 73(Suppl 1):i4-13.
14. Megri Y, Arastehfar A, Boekhout T, Daneshnia F, Hörtnagl C,
Sartori B, et al. Candida tropicalis is the most prevalent yeast
species causing candidemia in Algeria: the urgent need for
antifungal stewardship and infection control measures.
Antimicrob Resist Infect Control. 2020; 9(1):50.
15. Negri M, Martins M, Henriques M, Svidzinski TI, Azeredo J,
Oliveira R. Examination of potential virulence factors of
Candida tropicalis clinical isolates from hospitalized patients.
Mycopathologia. 2010; 169(3):175-82.
16. Sasani E, Khodavaisy S, Rezaie S, Salehi M, Yadegari MH. The
relationship between biofilm formation and mortality in patients
with Candida tropicalis candidemia. Microb Pathog. 2021;
155:104889.
17. White PL, Dhillon R, Cordey A, Hughes H, Faggian F, Soni S,
et al. A national strategy to diagnose coronavirus disease 2019–
associated invasive fungal disease in the intensive care unit. Clin
Infect Dis. 2020; In Press.
18. Arastehfar A, Carvalho A, Nguyen MH, Hedayati MT, Netea
MG, Perlin DS, et al. COVID-19-associated candidiasis
(CAC): an underestimated complication in the absence of
immunological predispositions? J Fungi. 2020; 6(4):211.
19. Giacobbe DR, Mikulska M, Tumbarello M, Furfaro E, Spadaro
M, Losito AR, et al. Combined use of serum (1, 3)-β-D-glucan
and procalcitonin for the early differential diagnosis between  candidaemia and bacteraemia in intensive care units. Crit Care.
2017; 21(1):176.
20. Nucci M, Barreiros G, Guimarães LF, Deriquehem VA,
Castiñeiras AC, Nouér SA. Increased incidence of candidemia in
a tertiary care hospital with the COVID‐19 pandemic. Mycoses.
2021; 64(2):152-6. 
Current Medical Mycology
Volume 7, Issue 2
June 2021
Pages 43-47

Files

History

  • Receive Date: 30 June 2021
  • Revise Date: 07 September 2021
  • Accept Date: 12 September 2021
  • Publish Date: 01 June 2021

Share

How to cite

Statistics