Fungal endocarditis

Abstract

Fungal endocarditis (FE) is an increasingly prevalent and devastating disease in today's highly advancing medical practice. With more patients receiving broad-spectrum antibiotics or invasive interventions including long-term central venous catheters or prosthetic heart valve placements, FE is increasingly reported. Recognizing FE early can be difficult, because it often lacks some classic signs and symptoms found in bacterial endocarditis. Diagnosis can be further complicated by the difficulty of making FE meet the Duke Criteria, because blood cultures are often negative, despite vegetations demonstrated on echocardiography. Newer diagnostic modalities show some potential for future use; however, these methods are not yet ready to use for reliable diagnosis. Overall, the burden of diagnosis still lies with clinicians: they need a high index of suspicion for the entity by understanding the organisms and the patients who are likely to be infected. FE can only be effectively treated and its potential deadly outcomes avoided when it is recognized early. New antifungal agents such as second-generation triazoles and echinocandins demonstrate a dramatically improved toxicity profile compared to amphotericin B and increase optimism regarding FE management.

Fungal prosthetic valve endocarditis: Mayo Clinic experience with a clinicopathological analysis

“…Unlike patients with native valve fungal endocarditis, 3,4,6,12 most patients were immunocompetent. Observed risk factors for the development of fungal prosthetic valve endocarditis included recent cardiac surgery (within the last 6 months), other systemic infections, previous bacterial endocarditis and central venous catheters, which are similar to risk factors seen in previous studies 4,6,9,13 . However, 29% of patients had no apparent risk factors besides the presence of the prosthetic valve.…”

“…Infection of native cardiac valves by fungal organisms is rare (<5% of all endocarditis cases) 1,2 . The most common causative fungal agents of native valve endocarditis are Candida , Aspergillus and Histoplasma species, and affected patients often have underlying suppression of cell‐mediated immunity 3–6 . Although a much smaller segment of the population has prosthetic heart valves, the likelihood of fungal infection affecting a prosthetic valve is higher than for native valves 4,7,8 .…”

“…1,2 The most common causative fungal agents of native valve endocarditis are Candida, Aspergillus and Histoplasma species, and affected patients often have underlying suppression of cell-mediated immunity. [3][4][5][6] Although a much smaller segment of the population has prosthetic heart valves, the likelihood of fungal infection affecting a prosthetic valve is higher than for native valves. 4,7,8 There is a clinical suspicion that the number of cases of prosthetic valve endocarditis may be increasing.…”

“…[3][4][5][6] Although a much smaller segment of the population has prosthetic heart valves, the likelihood of fungal infection affecting a prosthetic valve is higher than for native valves. 4,7,8 There is a clinical suspicion that the number of cases of prosthetic valve endocarditis may be increasing. 2 The spectrum of causative fungal organisms is similar to that of native valve infection with Candida species being the most frequent, but patients with prosthetic valve endocarditis are most often immunocompetent.…”

Endocarditis of amplatzer® occluder devices after percutaneous closure of a mitral paravalvular leak

“…Fungal endocarditis accounts for less than 10% of all cases of infective endocarditis; risk factors include extensive reconstructive cardiac surgery, prosthetic valve replacement, and previous history of endocarditis . It is a devastating entity, associated with an estimated 50–100% mortality rate .…”