RESUMO
BACKGROUND: Candida prosthetic endocarditis is associated with high mortality rates and valve replacement surgery, together with antifungal treatment, play a major role in eradicating the fungal infection. Valve reoperations in these scenarios may be relatively common due to the high infection relapse rates and, in some cases, heart transplantation may be an imposing therapy for infection resolution and for the heart failure related to the myocardial reoperation injury. Among the many postoperative complications related to heart transplantation, chylopericardium is a rare but challenging example. CASE PRESENTATION: We report the case of a 55-year-old man who was admitted to our hospital with a 1-month history of progressive dyspnea and fatigue. His past medical history included four open-heart surgeries for aortic and mitral valve replacement due to recurrent Candida parapsilosis infective endocarditis. Transthoracic echocardiogram showed a markedly reduced left ventricular systolic function and normofunctioning bioprosthetic valves. An inotropic dependency condition led to heart transplantation surgery. In the early postoperative period, a persistent chylous fluid started to drain from the pericardial tube, compatible with the diagnosis of chylopericardium. The lack of clinical response to total parenteral nutrition and intravenous infusion of octreotide imposed the need of interventional radiology with diagnostic lymphography through cisterna chyli puncture and thoracic duct catheterization, confirming the presence of a lymphatic fistula. A successful treatment outcome was achieved with percutaneous thoracic duct embolization using coils and n-butyl-cyanoacrilate glue, possibiliting hospital discharge. CONCLUSIONS: Fungal endocarditis requires combined treatment (surgical and antimicrobial) for eradication. Valve replacement, while necessary, may lead to severe ventricular deterioration and heart transplantation may be the only viable therapeutic solution. Among the several postoperative complications of heart transplantation, chylopericardium is an uncommon and defiant example. Advances in interventional radiology like the percutaneous embolization allow a less invasive and highly efficient approach for this complication.
Assuntos
Candida parapsilosis/patogenicidade , Candidíase/cirurgia , Endocardite/cirurgia , Fístula/etiologia , Transplante de Coração/efeitos adversos , Implante de Prótese de Valva Cardíaca , Doenças Linfáticas/etiologia , Derrame Pericárdico/etiologia , Antifúngicos/uso terapêutico , Candidíase/diagnóstico , Candidíase/microbiologia , Embolização Terapêutica , Endocardite/diagnóstico , Endocardite/microbiologia , Fístula/diagnóstico por imagem , Fístula/terapia , Humanos , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/terapia , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/terapia , Recidiva , Resultado do TratamentoRESUMO
The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae. To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae.
Assuntos
Candidíase/cirurgia , Enucleação Ocular , Infecções por Klebsiella/cirurgia , Klebsiella pneumoniae/isolamento & purificação , Panoftalmite/cirurgia , Antibacterianos/uso terapêutico , Candidíase/microbiologia , Coinfecção/cirurgia , Terapia Combinada , Perfuração da Córnea/etiologia , Progressão da Doença , Feminino , Humanos , Infecções por Klebsiella/microbiologia , Pessoa de Meia-Idade , Celulite Orbitária/tratamento farmacológico , Celulite Orbitária/cirurgia , Panoftalmite/tratamento farmacológicoRESUMO
BACKGROUND: Intracranial fungal masses are uncommon diseases, but their incidence is increasing, most often due to the prolonged survival of patients with different immunodeficiencies. The management of patients with intracranial fungal masses included stereotactic biopsy for diagnosis, partial or radical surgery excision and prolonged antifungal therapy. AIMS: We report the case of a 51-year-old diabetic man with a history of psoas abscess due to Candida albicans 1 year before the onset of neurological symptoms, including headache and generalized tonoclonic seizures. METHODS: Magnetic resonance imaging showed a single lesion located in the right parietal lobe with mass effect, surrounding edema and enhancement after injection of gadolinium. The material was purulent. RESULTS: Direct microscopic examination showed hyaline, branched and septate hyphae compatible with fungal elements. CONCLUSIONS: Fungal infections, especially due to Candida species, should be considered in diabetic patients with parenchymal brain abscesses. Radical excision followed by prolonged antifungal therapy based on fluconazole or amphotericin B is necessary to improve the prognosis of this type of patients.
Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Abscesso Encefálico/cirurgia , Candidíase/cirurgia , Craniotomia , Ácido Desoxicólico/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Fluconazol/uso terapêutico , Lobo Parietal/microbiologia , Anfotericina B/administração & dosagem , Abscesso Encefálico/complicações , Abscesso Encefálico/tratamento farmacológico , Candida albicans/isolamento & purificação , Candidíase/complicações , Candidíase/tratamento farmacológico , Terapia Combinada , Ácido Desoxicólico/administração & dosagem , Combinação de Medicamentos , Quimioterapia Combinada , Fluconazol/administração & dosagem , Humanos , Hifas/isolamento & purificação , Imageamento por Ressonância Magnética , Masculino , Manitol/uso terapêutico , Pessoa de Meia-Idade , Abscesso do Psoas/complicações , Abscesso do Psoas/microbiologiaRESUMO
Candida biliary tract infection is a rare disease. Most of the reported cases have been diagnosed in patients with surgery or invasive procedures of the biliary tract, critical illness, immunosuppression or antibiotic treatment. This report deals with an 85 years old female patient with Candida albicans cholecystitis without previous risk factors and with a literature review on the subject. Only four patients without risk factors have been so far reported.
Assuntos
Candidíase/microbiologia , Colecistite/microbiologia , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Doenças Biliares/microbiologia , Bronquite/complicações , Candidíase/complicações , Candidíase/tratamento farmacológico , Candidíase/cirurgia , Colecistectomia Laparoscópica , Colecistite/complicações , Colecistite/tratamento farmacológico , Colecistite/cirurgia , Colelitíase/complicações , Colelitíase/tratamento farmacológico , Colelitíase/cirurgia , Doença Crônica , Terapia Combinada , Feminino , Fluconazol/uso terapêutico , Humanos , Fatores de RiscoRESUMO
BACKGROUND AND OBJECTIVE: The infection of the corneal graft is one of the most serious complications following keratoplasty. In many instances, it can be treated successfully with intensive topical and subconjunctival antibiotics. However, when this therapy is ineffective, a surgical approach must be considered. The usefulness of partial conjunctival flaps that spare the visual axis for managing corneal graft infections is reported. PATIENTS AND METHODS: Retrospective review of four cases. All patients were males between 12 and 85 years old. The four abscesses developed in the penetrating corneal graft during the first year after keratoplasty. The organisms found were Propionibacterium acnes, Candida albicans, Staphylococcus aureus, and Streptococcus pneumoniae. After failure of medical therapy, they were operated on using the partial, thick conjunctival flap technique. RESULTS: Resolution of the infection and maintenance of a clear graft was achieved in all patients. The follow-up ranged from 5 to 8 years. CONCLUSION: The partial conjunctival flap is an effective surgical procedure for the treatment of abscesses in penetrating keratoplasties when medical treatment has failed.