Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management.
George R Thompson IiiJeffrey D JenksJohn W BaddleyJames S LewisMatthias EggerIlan S SchwartzJohannes BoyerThomas F PattersonSharon C-A ChenPeter G PappasMartin HoeniglPublished in: Clinical microbiology reviews (2023)
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18 F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.
Keyphrases
- positron emission tomography
- computed tomography
- cell wall
- candida albicans
- minimally invasive
- pet ct
- magnetic resonance imaging
- coronary artery bypass
- heart failure
- healthcare
- high resolution
- pet imaging
- staphylococcus aureus
- stem cells
- contrast enhanced
- palliative care
- escherichia coli
- pain management
- risk factors
- pulmonary hypertension
- pseudomonas aeruginosa
- cystic fibrosis
- mesenchymal stem cells
- photodynamic therapy
- health insurance
- dual energy
- percutaneous coronary intervention
- aortic valve replacement
- replacement therapy