Fungal endocarditis in critically ill children

Abstract

Despite the small number of cases, a sole medical approach including amphotericin B and long-term fluconazole prophylaxis for the treatment of fungal endocarditis in critically ill children seems to offer an alternative to surgical treatment which may be kept for failure of medical treatment.

Increase of Fungal Endocarditis in Children

“…Nevertheless, the spectrum of organisms may have substantially changed in recent years because of the widespread use of intravascular catheters, critical care support, improved survival of congenital heart disease patients, better diagnostic methods (microbiology, echocardiography) as well as the use and abuse of antimicrobial drugs. Recent epidemiological studies outlined an increase in fungemia during recent decades [12][13][14]. We aimed to analyze possible recent changes in the pattern of pediatric IE and to identify risk factors.…”

Treatment of Candida albicans Endocarditis: Case Report and a Review

“…At the time of removal of the valve and surrounding vegetations, the area can be washed with an amphotericin B-containing solution. Following surgery, amphotericin B should be given for 5-10 weeks because of the high incidence of relapse [6]. Desoxycholate amphotericin B therapy acts by binding to the ergosterol of fungal membranes, thus creating channels through which vital molecules leak from the cells leading to cellular death.…”

“…The pathogenesis of infective endocarditis has been well summarized [6]. Alterations in the vascular endothelium, turbulent blood flow and mechanical stress promote the deposition of platelets and fibrin in the heart valves.…”

Successful medical treatment of Candida endocarditis with liposomal amphotericin B without surgical intervention

“…Therefore, antifungal therapy without surgery may now be considered as an option, especially in critically ill patients in whom surgery is not feasible [1].…”