I will wrap this one up so we can focus on JCH's and MLazar's postings.
This is mixed fungal and bacterial endocarditis. Though Candida is a concern and has a fairly high mortality, Aspergillus is the second most common cause of fungal endocarditis and has a very poor prognosis: mortality for treated Aspergillus endocarditis is usually ~80%. The cytology smears were typical of Aspergillus... We started therapy with Vanco (as suggested by JCH I think), gent and Rif (since he had a new prosthetic valve) as well as ampho B and Cancidas. I did not find good data on "double-coverage" for Aspergillu but it has such a dismall prognosis there are many case studies and small series review using Ampho and Voriconazole or Cancidas.
Despite aggressive support his hemodynamics continued to deteriorate for the first week. His family made him a DNR and he died one night of sudden VFib...
Wednesday, August 10, 2005
Subscribe to:
Post Comments (Atom)
2 comments - CLICK HERE to read & add your own!:
Scary disease for your patient. Is there any data for both gent and rifampin with vanco?
For MRSA/MRSE or other resistant GPC's with prosthetic valve endocarditis that is the suggested regimen. His smears showed Strep (not Staph) but Cxs were negative...
Post a Commenttest post a comment