Endocarditis caused by Candida orthopsilosis is a rare clinical condition and an important infection associated with the hospital environment. A 60-year-old woman with diabetes mellitus and chronic kidney disease, receiving renal replacement therapy through a long-term semi-implantable venous catheter, developed fungemia due to C. orthopsilosis with low minimum inhibitory concentrations within the susceptibility range for the antifungal agents tested for C. parapsilosis and other Candida spp. with breakpoints defined by the Brazilian Committee on Antimicrobial Susceptibility Testing (BrCAST) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) for amphotericin B, fluconazole, and anidulafungin. The vascular catheter was removed. Transesophageal echocardiography revealed thickening of the tricuspid valve with mild regurgitation and a mobile image suggestive of thrombus and/or vegetation measuring 1.19 × 0.77 cm. The patient developed septic pulmonary embolism. Blood cultures became negative for fungi 24 hours after valve replacement. C. orthopsilosis was additionally isolated from valve tissue. After three weeks of anidulafungin, with blood cultures remaining persistently negative for 15 days, the patient was discharged on fluconazole for 28 days and remained clinically stable. Endocarditis due to C. orthopsilosis is a rare but potentially devastating infection, considered an important healthcare-associated infection, and its management involves challenges with debatable therapeutic decisions that may contribute to relapse. This case confirms the importance of species in the Candida parapsilosis complex as etiologic agents of fungal endocarditis arising from catheter-related bloodstream infections with long-term, semi-implantable central venous catheters. The susceptibility of strains to treatment depends, among other factors, on Candida spp. virulence and correlates with their potential for biofilm production. This phenomenon is highly relevant in the treatment of endocarditis caused by C. orthopsilosis. Echinocandins and azole derivatives are therapeutic alternatives considered for these cases due to low toxicity risk and mortality similar to other therapies. Our study also highlights the importance of early diagnosis and rapid removal of infectious foci in fungal endocarditis.
Pierre et al. (Sun,) studied this question.