1887

JMM Case Reports

Volume 5, Issue 9

Native valve dual pathogen endocarditis caused by Burkholderia cepacia and Aspergillus flavus – a case report Open Access

Abstract

Introduction. Infective endocarditis (IE) is an important clinical condition with significant morbidity and mortality among the affected population. A single etiological agent is identifiable in more than 90 % of the cases, however, polymicrobial endocarditis (PE) is a rare find, with a poor clinical outcome. Here we report a case of native valve dual pathogen endocarditis caused by Burkholderia cepacia and Aspergillus flavus in an immunocompetent individual. It is among unique occurrences of simultaneous bacterial and fungal etiology in IE.

Case presentation. A 30-year-old male was admitted to a cardiology institute with complaints of low grade intermittent fever and progressive shortness of breath for last two months. He was a known case of rheumatic heart disease and had suffered an episode of IE three years ago. On the basis of clinical presentation and the results of radiological investigations, a diagnosis of infective endocarditis was made. Paired blood samples for culture and sensitivity, sampled before the commencement of antimicrobial therapy, yielded growth of Burkholderia cepacia which was highly drug resistant. Sensitivity results-directed therapy consisting of tablet Trimethoprim–Sulfamethoxazole, two double-strength tablets 12 hourly, and Meropenem, 1 g IV every 8 h, was commenced. Despite mild relief of fever intensity, overall clinical condition did not improve and double valve replacement therapy was carried out. Excised valves were sent for microbiological analysis. Burkholderia cepacia was grown on tissue culture with a similar antibiogram to that previously reported from the blood culture of this patient. Direct microscopy of section of valvular tissue with 10 % KOH revealed abundant fungal hyphae. Patient serum galactomannan antigen assay was also positive. Histopathological examination of vegetations also revealed hyphae typical of species of the genus Aspergillus. The patient was successfully treated with meropenem, trimethoprim–sulfamethoxazole and voriconazole.

Conclusion. The hallmark of successful treatment in this case was exact identification of pathogens, antibiogram-directed therapy and good liaison between laboratory experts and treating clinicians.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): Aspergillus flavus , Burkholderia cepacia , dual infection , MICs , native valve endocarditis and polymicrobial endocarditis
© 2018 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.005143
2018-03-08
2024-04-18
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/5/9/jmmcr005143.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.005143&mimeType=html&fmt=ahah

References

  1. Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG. et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 2009; 169:463–473 [View Article][PubMed]
     [Google Scholar]
  2. Peters BM, Jabra-Rizk MA, O'May GA, Costerton JW, Shirtliff ME. Polymicrobial interactions: impact on pathogenesis and human disease. Clin Microbiol Rev 2012; 25:193–213 [View Article][PubMed]
     [Google Scholar]
  3. Burkholderia WH. Sour skin, a bacterial rot of onion bulbs. Phytopathology 1950; 40:115–118
     [Google Scholar]
  4. Tablan OC, Chorba TL, Schidlow DV, White JW, Hardy KA et al. Pseudomonas cepacia colonization in patients with cystic fibrosis: risk factors and clinical outcome. J Pediatr 1985; 107:382–387 [View Article][PubMed]
     [Google Scholar]
  5. Aggarwal N, Garg S, Pannu HS, Kler TS. Fatal Burkholderia cepacia early prosthetic valve endocarditis: a very rare case and a review of the literature. J Heart Valve Dis 2005; 14:271–274[PubMed]
     [Google Scholar]
  6. Rana M, Fahad B, Abid Q. Embolic Aspergillus endophthalmitis in an immunocompetent patient from aortic root Aspergillus endocarditis. Mycoses 2008; 51:352–353 [View Article][PubMed]
     [Google Scholar]
  7. El-Hamamsy I, Dürrleman N, Stevens LM, Perrault LP, Carrier M et al. Aspergillus endocarditis after cardiac surgery. Ann Thorac Surg 2005; 80:359–364 [View Article][PubMed]
     [Google Scholar]
  8. García-Granja PE, López J, Vilacosta I, Ortiz-Bautista C, Sevilla T et al. Polymicrobial infective endocarditis: clinical features and prognosis. Medicine (Baltimore) 2015; 94:e2000 [View Article][PubMed]
     [Google Scholar]
  9. Cicalini S, Francavilla R, Massaroni K, de Rosa FG. Polymicrobial infective endocarditis in Italy. Recenti Prog Med 2002; 93:92–95[PubMed]
     [Google Scholar]
  10. Schønheyder HC, Jensen HE, Gams W, Nyvad O, van Nga P et al. Late bioprosthetic valve endocarditis caused by Phialemonium aff. curvatum and Streptococcus sanguis: a case report. J Med Vet Mycol 1996; 34:209–214 [View Article][PubMed]
     [Google Scholar]
  11. Degeorges M, Heintz C, Valty J. Endocarditis infectieuse and Listeria monocytogenes et a Cephalosporium. Presse Med 1971; 79:1377–1380
     [Google Scholar]
  12. Saaraswat V, Barzaniy SB, Mishra S, Adler M, Chandra P et al. Late prosthetic valve endocarditis caused by Burkholderia cepacia and Candida dubliniensis - first case report In the medical literature. The Internet Journal of Cardiology 2009; 9:
     [Google Scholar]
  13. Popescu GA, Prazuck T, Poisson D, Picu C. "True" polymicrobial endocarditis: Candida tropicalis and Staphylococcus aureus- to a drug user. Case presentation and literature review. Rom J Intem Med 2005; 43:157–161
     [Google Scholar]
  14. Julien D, Benoit F, Anne CN, Ines H, Stephane R et al. Late post-operative Aspergillus flavus endocarditis. Demonstration of six years incubation period using micro satellite typing. Medical Mycology Case Report 2012; 1:29–31
     [Google Scholar]
  15. Cheon S, Yang MK, Kim CJ, Kim TS, Song KH et al. Disseminated Aspergillosis in the immunocompetent host: a case report and literature review. Mycopathologia 2015; 180:217–222 [View Article][PubMed]
     [Google Scholar]
  16. Zeichner LO, Vitale RG, Nucci M. New serological markers in medical mycology: 1,3-β-D glucan and Aspergillus galactomannan. Infectio 2012; 3:59–63
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.005143
Loading
Native valve dual pathogen endocarditis caused by Burkholderia cepacia and Aspergillus flavus – a case report
JMM Case Rep 5, e005143 (2018); https://doi.org/10.1099/jmmcr.0.005143
/content/journal/jmmcr/10.1099/jmmcr.0.005143
/content/journal/jmmcr/10.1099/jmmcr.0.005143
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error