Candida Infective Endocarditis

Abstract

Candida species are an uncommon cause of infective endocarditis (IE). Given the rarity of this infection, the epidemiology, prognosis, and optimal therapy of Candida IE are poorly defined. We conducted a prospective, observational study at 18 medical centers in Italy, including all consecutive patients with a definite diagnosis of IE admitted from January 2004 through December 2007.A Candida species was the causative organism in 8 cases of prosthetic valve endocarditis (PVE), 5 cases of native valve endocarditis (NVE), 1 case of pacemaker endocarditis, and 1 case of left ventricular patch infection. Candida species accounted for 1.8% of total cases, and for 3.4% of PVE cases. Most patients (86.6%) had a health care-associated infection. PVE associated with a health care contact occurred after a median of 225 days from valve implantation. Ten patients (66.6%) were treated with caspofungin alone or in combination with other antifungal drugs. The overall mortality rate was 46.6%. Mortality was higher in patients with PVE (5 of 8 cases, 62.5%) than in patients with NVE (2 of 5 patients, 40%). A better outcome was observed in patients treated with a combined medical and surgical therapy.Candida IE should be classified as an emerging infectious disease, usually involving patients with intravascular prosthetic devices, and associated with substantial related morbidity and mortality. Candida PVE usually is a late-onset disease, which becomes clinically evident even several months after an initial episode of transient candidemia.

Prevention and control of biofilm-based medical-device-related infections

“…According to data provided by the European Sepsis Group, 28% of CVC infections in ICU patients are associated with sepsis, 24% with severe sepsis and 30% with septic shock, the remaining 18% being unclassified (Alberti et al , 2002; Donelli, 2006). Not surprisingly, catheter‐related infections are the most common cause of nosocomial endocarditis (Corey & Lalani, 2008; Falcone et al , 2009), the duration of catheterization and the anatomical location of CVC being among the major risk factors.…”

Candida tropicalis endocarditis: Treatment in a resource-poor setting

“…[14] The Candida species accounted for 1.8% of total cases and for 3.4% of prosthetic valve endocarditis cases; the overall mortality rate was 46.6%. [14] Luciani et al .…”

“…[14] The Candida species accounted for 1.8% of total cases and for 3.4% of prosthetic valve endocarditis cases; the overall mortality rate was 46.6%. [14] Luciani et al . have also described a case of a premature infant with mutliple Candida tricuspid valve mycetomas wherein eradication of infection was achieved by combined liposomal amphotericin therapy and complex tricuspid valve repair.…”

Fungal Dilated Cardiomyopathy in a Patient with Acute Leukemia, How to Treat?

“…On the other hand, fungal myocarditis or dilated cardiomyopathy is an exceedingly rare pathology and is frequently associated with overwhelming septicaemia. The most frequently responsible pathogens are the Candida species (1,2). However, the diagnosis is often difficult due to negative blood cultures, ineffective tests and scanty clinical findings of myocardial involvement.…”