Dual fungal endocarditis in a pediatric dialysis patient: First case of Aspergillus flavus and Candida parapsilosis co-infection

Author: mycolabadmin
9/20/2025
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Summary

A 13-year-old boy with kidney disease requiring dialysis developed a rare dual fungal heart infection caused by two different fungi simultaneously. Doctors diagnosed the infection using heart imaging, blood tests, and tissue examination, then treated him with antifungal medications and two heart surgeries to remove infected tissue and replace a damaged heart valve. Despite the extreme rarity and severity of this condition, the patient survived, which had never been reported in children before.

Background

Fungal infective endocarditis is a rare but highly lethal infection accounting for fewer than 2% of all endocarditis cases with mortality rates exceeding 50%. Pediatric patients with end-stage renal disease on hemodialysis are particularly vulnerable due to chronic catheter use and uremia-related immune dysregulation. Dual fungal endocarditis is exceptionally rare and clinically challenging.

Objective

To report the first documented pediatric case of dual fungal infective endocarditis caused by Aspergillus flavus and Candida parapsilosis co-infection in a dialysis-dependent child. The case illustrates diagnostic challenges, therapeutic complexity, and management strategies for severe polymicrobial fungal infections in immunocompetent but medically vulnerable pediatric patients.

Results

The patient presented with right ventricular thrombus, tricuspid regurgitation, and septic pulmonary emboli. Blood cultures grew Candida parapsilosis on day 4, and histopathology confirmed Aspergillus flavus with dichotomous branching. Despite initial tricuspid valve repair on day 11, persistent vegetation required tricuspid valve replacement on day 97 with a tissue valve. The patient survived beyond six months post-infection with combination antifungal therapy and surgical intervention.

Conclusion

This first reported pediatric case of dual Aspergillus flavus and Candida parapsilosis endocarditis with long-term survival demonstrates that early recognition, multidisciplinary care, combination antifungal therapy, and aggressive surgical intervention can improve outcomes in severe fungal endocarditis. The case emphasizes the critical role of early diagnosis, serial galactomannan monitoring, and improved access to fungal diagnostics in high-risk settings.

Published in:Medical Mycology Case Reports,
Study Type:Case Report,
Source: PMID: 41050732