Endocarditis is a severe infectious disease with a high mortality rate. Cases arising from Candida are an uncommon presentation that represents only 1 to 2% of all episodes of infective endocarditis, with C. albicans being the most reported. Fungal endocarditis is also associated with C. parapsilosis, an infectious agent associated with vascular devices due to ability to form biofilm in medical devices. Here, we report an uncommon case of a 64-year-old woman diagnosed with large fungal vegetation formed byC. parapsilosis in her aortic prosthesis. A patient with a bioprosthetic aortic valve implanted 9 and a half years prior, with a previous history of cervical cancer and who was discharged 2 years ago after concluding the last cycle of radio therapy, sought a hospital service with complaints of progressive dyspnea, orthopnea, and paroxysmal nocturnal dyspnea with necessary hospitalization. An echocardiogram was initially performed showing aortic prosthesis dysfunction due to signs of leaflet rupture and mitral regurgitation. The patient presented with fever spikes, following which antimicrobial therapy with meropenem (1000 mg every 8 h for 7 days) associated with fluconazole (400 mg/day for 7 days) was started. On hospitalization day 15, a transesophageal echocardiogram was performed revealing biological prosthesis dysfunction with signs of leaflet rupture, transprosthetic regurgitation and a suggestive presence of vegetation. Thereafter, antifungal therapy was immediately changed to amphotericin B (20 mg day) and a valve replacement was required. However, no clinical improvements occurred following 14 days and another transesophageal echocardiogram was performed, showing a large mobile mass (2.11 cm by 1.61 cm in size) localized on the aortic valve, characteristic of fungal vegetation (Fig. 1A, B). After this discovery, the patient underwent aortic valve replacement being maintained on amphotericin B treatment. During the surgical procedure, an abscess between the commissural posts and large fungal vegetation attached to the aortic prosthesis were seen. To investigate the fungal agent involved in the formation of the fungal vegetation, a prosthetic valve sample (Fig. 1C) was submitted to laboratory tests, which included direct microscopic examination in KOH (20%) and Sabouraud Dextrose Agar culture. Direct microscopic examination of the tissue showed numerous hyaline yeast cells (Fig. 1D). After 7 days of incubation at 37 C, white and creamy yeast colonies grew. The isolates were identified as C. parapsilosis by LSU, 26 rDNA D1/D2 domain sequencing and the newly generated sequence was deposited in GenBank under the accession number MH744739, with a sample being deposited in the Cultures Collection Micoteca URM (URM8012). After surgery, the clinical condition of the patient deteriorated rapidly, and due to the

中文翻译：

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近平滑念珠菌引起的大型主动脉假体真菌性植被：一种不常见的表现

心内膜炎是一种严重的传染病，死亡率很高。念珠菌引起的病例是一种不常见的表现，仅占所有感染性心内膜炎发作的 1% 至 2%，其中白色念珠菌是报道最多的病例。真菌性心内膜炎也与近平滑念珠菌有关，近平滑念珠菌是一种与血管装置相关的传染性病原体，因为它能够在医疗器械中形成生物膜。在这里，我们报告了一个罕见的病例，一名 64 岁的女性被诊断患有由 C. 她的主动脉假体近平滑肌。一名在 9 年半前植入生物主动脉瓣的患者，既往有宫颈癌病史，2 年前完成最后一个放射治疗周期后出院，因进行性呼吸困难、端坐呼吸、和阵发性夜间呼吸困难，需要住院治疗。由于瓣叶破裂和二尖瓣关闭不全的迹象，最初进行的超声心动图显示主动脉假体功能障碍。患者出现发热高峰，随后开始使用美罗培南（每 8 小时 1000 毫克，持续 7 天）与氟康唑（400 毫克/天，持续 7 天）相关的抗菌治疗。在住院第 15 天，经食管超声心动图显示生物假体功能障碍，有瓣叶破裂、经假体反流和提示性赘生物的迹象。此后，立即将抗真菌治疗改为两性霉素 B（每天 20 毫克），并需要更换瓣膜。然而，14 天后没有出现临床改善，并进行了另一次经食道超声心动图检查，显示位于主动脉瓣上的大型活动团块（大小为 2.11 厘米 x 1.61 厘米），是真菌植物的特征（图 1A、B）。在这一发现之后，患者接受了主动脉瓣置换术，并继续接受两性霉素 B 治疗。在手术过程中，可以看到连合柱之间的脓肿和附着在主动脉假体上的大块真菌植被。为了研究参与真菌植被形成的真菌剂，将人工瓣膜样品（图 1C）提交给实验室测试，其中包括在 KOH (20%) 和 Sabouraud 葡萄糖琼脂培养基中的直接显微镜检查。组织的直接显微镜检查显示大量透明酵母细胞（图 1D）。在 37°C 下培养 7 天后，白色和奶油状酵母菌落生长。分离株被鉴定为 C. 通过 LSU，26 rDNA D1/D2 结构域测序和新生成的序列以登录号 MH744739 存放在 GenBank 中，样本存放在 Cultures Collection Micoteca URM (URM8012) 中。手术后，患者的临床状况迅速恶化，由于