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Fungal Endocarditis Observed Over an 8-Year Period and a Review of the Literature

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Abstract

Background

Fungal endocarditis (FE) is a “modern” disease that is considered an emerging cause of infective endocarditis (IE). The most frequently identified fungal pathogens are Candida spp., which are responsible for up to two-thirds of all cases; the remaining cases are due to Aspergillus spp., Histoplasma capsulatum or, more rarely, other yeasts and moulds.

Objectives

To describe the prevalence, clinical characteristics and outcome of FE diagnosed in a single tertiary centre and review the literature concerning FE.

Design and setting

An 8-year retrospective review of the case records of patients attending a single Italian University Centre and diagnosed as having definite or probable IE as defined by the modified Duke criteria.

Results

Six patients were identified from 229 episodes of IE: five cases involved a prosthetic valve, and one a native valve of an intravenous drug user. Five cases were caused by Candida spp. (two by C. albicans, one each by C. lusitaniae, C. dubliniensis and C. glabrata) and one by Aspergillus flavus. Three patients were treated by means of surgery plus antifungal therapy; two received antifungal therapy alone. Three patients survived, but only the patient with Aspergillus endocarditis was followed up for a long time.

Conclusions

FE is difficult to diagnose but generally associated with healthcare infections. The optimal treatment is poorly characterised, and international collaborative studies are urgently needed to evaluate newer antifungal agents.

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Acknowledgments

The authors wish to thank Mrs. Enza Pallone for carefully selecting for the patients’ records from the in-hospital database, Dr. Alessandro Cialfi for his valuable contribution regarding echocardiography, Prof. Carlo Antona for his cardiosurgery contribution and Dr Giuliano Rizzardini for his helpful advice.

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Authors and Affiliations

  1. 3rd Division of Infectious Diseases, Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Via GB Grassi 74, 20157, Milan, Italy

    Spinello Antinori, Laurenzia Ferraris, Davide Ricaboni, Mario Corbellino, Salvatore Sollima, Massimo Galli & Laura Milazzo

  2. 1st Division of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy

    Giovanna Orlando

  3. Microbiology Service, Luigi Sacco Hospital, Milan, Italy

    Loredana Tocalli

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  1. Spinello Antinori
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  2. Laurenzia Ferraris
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Correspondence to Spinello Antinori.

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Antinori, S., Ferraris, L., Orlando, G. et al. Fungal Endocarditis Observed Over an 8-Year Period and a Review of the Literature. Mycopathologia 178, 37–51 (2014). https://doi.org/10.1007/s11046-014-9754-4

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  • DOI: https://doi.org/10.1007/s11046-014-9754-4

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