Skip to main content
Log in

Fungal endocarditis

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Recent advances in medicine have caused fungal endocarditis (FE) to be a more common disease entity. Many fungi are potential pathogens in FE, although Candida species and Aspergillus species are the most common. Valvular heart disease is the necessary underlying condition for FE, with intravenous devices and antibiotic use being the predisposing factors for yeast endocarditis, whereas immunosuppression in patients with valvulopathy predisposes for mold endocarditis. Better prognosis of FE depends on fast and accurate diagnosis and subsequent treatment. Echocardiography was the most valuable recent technique in the past two decades that allowed early diagnosis of FE and is probably responsible for the improved prognosis of patients with FE. In the future, development of nonculture-based diagnostic tests may further improve the sensitivity, specificity, and rapidity of microbiologic diagnosis of FE. Novel approaches in treatment, such as new antifungal drugs, also may assist in achieving cure and further improving the prognosis of this disease entity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Bayer AS, Scheld WM: Endocarditis and intravascular infections. In Principles and Practice of Infectious Diseases. Edited by Mandell GL, Bennet JE, Dolin R. Philadelphia: Churchill Livingstone; 2000:857–902.

    Google Scholar 

  2. Mylonakis E, Calderwood SB: Infective endocarditis in adults. N Engl J Med 2001, 345:1318–1330. Important study.

    Article  PubMed  CAS  Google Scholar 

  3. Ellis ME, Al-Abdely H, Sandridge A, et al.: Fungal endocarditis: evidence in the world literature, 1965–1995. Clin Infect Dis 2001, 32:50–62. This is a review of 270 cases of FE. Delayed diagnosis and extracardiac findings were characteristic. C. albicans (24%), non-albicans Candida (24%), and Aspergillus species (24%) were the common pathogens, as were recently described fungi (25%). Mortality was still high (72%), with a combined surgical-medical approach yielding the best cure rates.

    Article  PubMed  CAS  Google Scholar 

  4. Pierrotti LC, Baddour LM: Fungal endocarditis, 1995–2000. Chest 2002, 122:302–310. This recent review of 152 patients demonstrated that intravenous drug abuse decreased in importance as a risk factor for FE. However, prosthetic valves and immunoincompetence were more commonly identified. The mortality rate remained unacceptably high.

    Article  PubMed  Google Scholar 

  5. Rubinstein E, Lang R: Fungal endocarditis. Eur Heart J 1995, 16(Suppl B):84–89. This is an earlier review stressing the nonutility of blood cultures, particularly in Aspergillus endocarditis.

    PubMed  Google Scholar 

  6. Diekema DJ, Messer SA, Hollis RJ, et al.: An outbreak of Candida parapsilosis prosthetic valve endocarditis. Diagn Microbiol Infect Dis 1997, 29:147–153.

    Article  PubMed  CAS  Google Scholar 

  7. Kuehnert MJ, Clark E, Lockhart SR, et al.: Candida albicans endocarditis associated with a contaminated aortic valve allograft: implications for regulation of allograft processing. Clin Infect Dis 1998, 27:688–691.

    PubMed  CAS  Google Scholar 

  8. Joly V, Belmatoug N, Leperre A, et al.: Pacemaker endocarditis due to Candida albicans: case report and review. Clin Infect Dis 1997, 25:1359–1362.

    PubMed  CAS  Google Scholar 

  9. Ciobotaro P, Strahilewitz Y, Siegma-Igra Y: An outbreak of Phialemonium curvatum infections in patients with erectile dysfunction. Paper presented at the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, IL, September 14–17, 2003.

  10. Nurozler F, Argenziano M, Oz MC, Naka Y: Fungal left ventricular assist device endocarditis. Ann Thorac Surg 2001, 71:614–618. Important study.

    Article  PubMed  CAS  Google Scholar 

  11. Chim CS, Ho PL, Yuen ST, Yuen KY: Fungal endocarditis in bone marrow transplantation: case report and review of literature. J Infect 1998, 37:287–291.

    Article  PubMed  CAS  Google Scholar 

  12. Paterson DL, Dominguez EA, Chang FY, et al.: Infective endocarditis in solid organ transplant recipients. Clin Infect Dis 1998, 26:689–694.

    PubMed  CAS  Google Scholar 

  13. Casson DH, Riordan FA, Ladusens EJ: Aspergillus endocarditis in chronic granulomatous disease. Acta Paediatr 1996, 85:758–759.

    PubMed  CAS  Google Scholar 

  14. Miro JM, del Rio A, Mestres CA: Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. Infect Dis Clin North Am 2002, 16:273–295.

    Article  PubMed  Google Scholar 

  15. Johnston BL, Schlech WF 3rd, Marrie TJ: An outbreak of Candida parapsilosis prosthetic valve endocarditis following cardiac surgery. J Hosp Infect 1994, 28:103–112.

    Article  PubMed  CAS  Google Scholar 

  16. Aspesberro F, Beghetti M, Oberhansli I, Friedli B: Fungal endocarditis in critically ill children. Eur J Pediatr 1999, 158:275–280.

    Article  PubMed  CAS  Google Scholar 

  17. Mayayo E, Moralejo J, Camps J, Guarro J: Fungal endocarditis in premature infants: case report and review. Clin Infect Dis 1996, 22:366–368.

    PubMed  CAS  Google Scholar 

  18. Lewis RE, Lo HJ, Raad II, Kontoyiannis DP: Lack of catheter infection by the efg1/efg1 cph1/cph1 double-null mutant, a Candida albicans strain that is defective in filamentous growth. Antimicrob Agents Chemother 2002, 46:1153–1155.

    Article  PubMed  CAS  Google Scholar 

  19. Spellberg B, Edwards JE: The pathophysiology and treatment of Candida sepsis. Curr Infect Dis Rep 2002, 4:387–399.

    PubMed  Google Scholar 

  20. Cannom RR, French SW, Johnston D, et al.: Candida albicans stimulates local expression of leukocyte adhesion molecules and cytokines in vivo. J Infect Dis 2002, 186:389–396.

    Article  PubMed  CAS  Google Scholar 

  21. Wilson WR, Giuliani ER, Danielson GK, Geraci JE: Management of complications of infective endocarditis. Mayo Clin Proc 1982, 57:162–170.

    PubMed  CAS  Google Scholar 

  22. Deprele C, Berthelot P, Lemetayer F, et al.: Risk factors for systemic emboli in infective endocarditis. Clin Microbiol Infect 2004, 10:46–53.

    Article  PubMed  CAS  Google Scholar 

  23. Cheitlin MD, Armstrong WF, Aurigemma GP, et al.: ACC/AHA/ ASE 2003 Guideline Update for the Clinical Application of Echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Soc Echocardiogr 2003, 16:1091–1110.

    PubMed  Google Scholar 

  24. Heidenreich PA, Masoudi FA, Maini B, et al.: Echocardiography in patients with suspected endocarditis: a cost-effectiveness analysis. Am J Med 1999, 107:198–208.

    Article  PubMed  CAS  Google Scholar 

  25. Nasser RM, Melgar GR, Longworth DL, Gordon SM: Incidence and risk of developing fungal prosthetic valve endocarditis after nosocomial candidemia. Am J Med 1997, 103:25–32.

    Article  PubMed  CAS  Google Scholar 

  26. Maertens J, Van Eldere J, Verhaegen J, et al.: Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis 2002, 186:1297–1306.

    Article  PubMed  CAS  Google Scholar 

  27. Jones BL, McLintock LA: Impact of diagnostic markers on early antifungal therapy. Curr Opin Infect Dis 2003, 16:521–526. Important study.

    Article  PubMed  CAS  Google Scholar 

  28. Digby J, Kalbfleisch J, Glenn A, et al.: Serum glucan levels are not specific for presence of fungal infections in intensive care unit patients. Clin Diagn Lab Immunol 2003, 10:882–885.

    Article  PubMed  CAS  Google Scholar 

  29. Hebart H, Loffler J, Reitze H, et al.: Prospective screening by a panfungal polymerase chain reaction assay in patients at risk for fungal infections: implications for the management of febrile neutropenia. Br J Haematol 2000, 111:635–640.

    Article  PubMed  CAS  Google Scholar 

  30. Bosshard PP, Kronenberg A, Zbinden R, et al.: Etiologic diagnosis of infective endocarditis by broad-range polymerase chain reaction: a 3-year experience. Clin Infect Dis 2003, 37:167–172.

    Article  PubMed  Google Scholar 

  31. Grijalva M, Horvath R, Dendis M, et al.: Molecular diagnosis of culture negative infective endocarditis: clinical validation in a group of surgically treated patients. Heart 2003, 89:263–268.

    Article  PubMed  CAS  Google Scholar 

  32. Gauduchon V, Chalabreysse L, Etienne J, et al.: Molecular diagnosis of infective endocarditis by PCR amplification and direct sequencing of DNA from valve tissue. J Clin Microbiol 2003, 41:763–766.

    Article  PubMed  CAS  Google Scholar 

  33. Millar B, Moore J, Mallon P, et al.: Molecular diagnosis of infective endocarditis--a new Duke’s criterion. Scand J Infect Dis 2001, 33:673–680. Important study.

    Article  PubMed  CAS  Google Scholar 

  34. Durack DT, Lukes AS, Bright DK: New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med 1994, 96:200–209.

    Article  PubMed  CAS  Google Scholar 

  35. Li JS, Sexton DJ, Mick N, et al.: Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000, 30:633–638.

    Article  PubMed  CAS  Google Scholar 

  36. Kay JH, Bernstein S, Feinstein D, Biddle M: Surgical cure of Candida albicans endocarditis with open-heart surgery. N Engl J Med 1961, 264:907–910. Important study.

    Article  PubMed  CAS  Google Scholar 

  37. Pappas PG, Rex JH, Sobel JD, et al.: Infectious Diseases Society of America Guidelines for treatment of candidiasis. Clin Infect Dis 2004, 38:161–189.

    Article  PubMed  Google Scholar 

  38. Stevens DA, Kan VL, Judson MA, et al.: Practice guidelines for diseases caused by Aspergillus. Infectious Diseases Society of America. Clin Infect Dis 2000, 30:696–709.

    Article  PubMed  CAS  Google Scholar 

  39. Mayrer AR, Brown A, Weintraub RA, et al.: Successful medical therapy for endocarditis due to Candida parapsilosis. A clinical and epidemiologic study. Chest 1978, 73:546–549.

    PubMed  CAS  Google Scholar 

  40. Maderazo EG, Hickingbotham N, Cooper B, Murcia A: Aspergillus endocarditis: cure without surgical valve replacement. South Med J 1990, 83:351–352.

    Article  PubMed  CAS  Google Scholar 

  41. Rao K, Saha V: Medical management of Aspergillus flavus endocarditis. Pediatr Hematol Oncol 2000, 17:425–427.

    Article  PubMed  CAS  Google Scholar 

  42. Melamed R, Leibovitz E, Abramson O, et al.: Successful nonsurgical treatment of Candida tropicalis endocarditis with liposomal amphotericin-B (AmBisome). Scand J Infect Dis 2000, 32:86–89.

    Article  PubMed  CAS  Google Scholar 

  43. Roel JE, Gamba A, Curone M, et al.: Successful medical treatment of Candida tropicalis in prosthetic valve endocarditis. Medicina (B Aires) 1998, 58:301–302.

    CAS  Google Scholar 

  44. Rubinstein E, Noriega ER, Simberkoff MS, Rahal JJ: Tissue penetration of amphotericin B in fungal endocarditis. Chest 1974, 66:376–377.

    PubMed  CAS  Google Scholar 

  45. Louie A, Liu W, Miller DA, et al.: Efficacies of high-dose fluconazole plus amphotericin B and high-dose fluconazole plus 5-fluorocytosine versus amphotericin B, fluconazole, and 5-fluorocytosine monotherapies in treatment of experimental endocarditis, endophthalmitis, and pyelonephritis due to Candida albicans. Antimicrob Agents Chemother 1999, 43:2831–2840.

    PubMed  CAS  Google Scholar 

  46. Louie A, Kaw P, Banerjee P, et al.: Impact of the order of initiation of fluconazole and amphotericin B in sequential or combination therapy on killing of Candida albicans in vitro and in a rabbit model of endocarditis and pyelonephritis. Antimicrob Agents Chemother 2001, 45:485–494.

    Article  PubMed  CAS  Google Scholar 

  47. Penk A, Pittrow L: Role of fluconazole in the long-term suppressive therapy of fungal infections in patients with artificial implants. Mycoses 1999, 42(Suppl 2):91–96.

    PubMed  CAS  Google Scholar 

  48. Marchetti O, Entenza JM, Sanglard D, et al.: Fluconazole plus cyclosporine: a fungicidal combination effective against experimental endocarditis due to Candida albicans. Antimicrob Agents Chemother 2000, 44:2932–2938.

    Article  PubMed  CAS  Google Scholar 

  49. Martin MV, Yates J, Hitchcock CA: Comparison of voriconazole (UK-109,496) and itraconazole in prevention and treatment of Aspergillus fumigatus endocarditis in guinea pigs. Antimicrob Agents Chemother 1997, 41:13–16.

    PubMed  CAS  Google Scholar 

  50. Abgueguen P, Gouello JP, Pichard E, et al.: Candida endocarditis: retrospective study in 12 patients. Rev Med Interne 2002, 23:30–40.

    Article  PubMed  CAS  Google Scholar 

  51. Melgar GR, Nasser RM, Gordon SM, et al.: Fungal prosthetic valve endocarditis in 16 patients. An 11-year experience in a tertiary care hospital. Medicine (Baltimore) 1997, 76:94–103.

    Article  CAS  Google Scholar 

  52. Muehrcke DD: Fungal prosthetic valve endocarditis. Semin Thorac Cardiovasc Surg 1995, 7:20–24.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nadir, E., Rubinstein, E. Fungal endocarditis. Curr Infect Dis Rep 6, 276–282 (2004). https://doi.org/10.1007/s11908-004-0048-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-004-0048-8

Keywords

Navigation