Fungal endocarditis

Abstract and Introduction

Abstract

Purpose of review Fungal endocarditis remains a rare disease occurring mostly in patients with predisposing host conditions. Regarding its poor prognosis because of severe complications, there is an urgent need for properly established treatment guidelines and prophylaxis for patients at risk. In this review we provide up-to-date information on treatment recommendations, and discuss recent case reports on fungal endocarditis and challenges in prophylaxis and treatment.
Recent findings Over the last year, an increase in cases caused by non-albicans species of Candida and other fungi like Fusarium solani, Lodderomyces elongisporus and Exophiala dermatitidis was reported. They were treated individually in case-by-case approaches, lacking randomized controlled trials and, mostly, treatment recommendations.

Summary The scarcity of fungal endocarditis demands a high index of suspicion and knowledge of the group of at-risk patients. Diagnosis aggressively pursued by echocardiography and multiple blood cultures or surgical specimens has the potential to improve outcome. Candida endocarditis should be treated immediately, including surgical treatment in combination with liposomal amphotericin B or caspofungin with optional addition of flucytosine. Aspergillus endocarditis requires rapid surgery and voriconazole.

Introduction

Fungal endocarditis is a very rare disease accounting for only 2–4% of all cases of endocarditis^[1] and comprises three major entities: native valve endocarditis, prosthetic valve endocarditis and cardiac device-related infective endocarditis.^[2] Its incidence has increased throughout the last decades because of a growing number of at-risk patients.^[3] The aim of our review is to provide up-to-date recommendations for the treatment of fungal endocarditis based on the literature published in 2012 and 2013. Lacking randomized controlled trials, our current treatment recommendations are mostly based on expert opinions, preexisting guidelines and evidence from latest case reports (Table 1 ^{[3,4,5,6,7,8–10,11,12,13,14,15–17]}).