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Case report
Potential benefit of combination antifungal therapy in Aspergillus endocarditis
  1. Kate Lennard1,
  2. Aiveen Bannan2,
  3. Peter Grant3 and
  4. Jeffrey Post4,1
  1. 1Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
  2. 2Infectious Diseases, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
  3. 3Cardiothoracic Surgery, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
  4. 4Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Jeffrey Post;{at}


Aspergillus endocarditis (AE) is a rare condition with a mortality rate greater than 60%. While it is generally accepted that both antifungal therapy and surgery are necessary for survival, the optimal antifungal regimen is unclear. A 62-year-old man was diagnosed with AE of a prosthetic aortic valve, complicated by cerebral emboli. He underwent debridement of the aortic valve abscess and valve replacement, and was managed with a combination of liposomal amphotericin B and voriconazole for 7 weeks followed by long-term suppressive azole therapy. He remained well at follow-up 18 months later. Data from a review of case reports published between 1950 and 2010 revealed greater survival rates in patients managed with two or more antifungals as opposed to single agent therapy. We provide an updated literature review with similar findings, suggesting that dual agent antifungal therapy should be considered in patients with AE.

  • infections
  • infectious diseases

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  • Contributors KL was the main author for this article and collected and interpreted all data. JP was a major contributor to editing of the manuscript. AB and PG also contributed to editing. All authors read and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.