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Review
. 2023 Sep 21;36(3):e0001923.
doi: 10.1128/cmr.00019-23. Epub 2023 Jul 13.

Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management

George R Thompson 3rd  1   2 , Jeffrey D Jenks  3   4 , John W Baddley  5 , James S Lewis 2nd  6 , Matthias Egger  7 , Ilan S Schwartz  4 , Johannes Boyer  7 , Thomas F Patterson  8 , Sharon C-A Chen  9   10 , Peter G Pappas  11 , Martin Hoenigl  7   12
Affiliations
Review

Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management

George R Thompson 3rd et al. Clin Microbiol Rev. .

Abstract

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 18F-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.

Keywords: cardiac; diagnosis; endocarditis; endocardium; fungal; mycologic; mycology; treatment.

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Figures

FIG 1
FIG 1
Causative pathogens of fungal endocarditis.
FIG 2
FIG 2
Environmental and host risk factors for fungal endocarditis and rare fungal infections.
FIG 3
FIG 3
Pathogenesis of fungal endocarditis. Invasion of fungal pathogens through the gastrointestinal tract, through pulmonary alveoli, or via disruption of skin barrier. Following invasion, hematogenous dissemination occurs, allowing fungal endocarditis in the setting of a damaged endocardial surface.
FIG 4
FIG 4
Systemic and local complications of fungal endocarditis. Yellow rim indicates greater risk compared to bacterial endocarditis.
FIG 5
FIG 5
Tricuspid valve endocarditis caused by A. fumigatus. (A) Off-axis, 4-chamber view of large tricuspid valve (TV) vegetation on transesophageal echocardiogram (right atrium, RA; right ventricle, RV). (B) Left pulmonary artery embolus (blue arrow). (C) Peripheral consolidative opacity from emboli.
See this image and copyright information in PMC

References

    1. Hoenigl M, Seidel D, Sprute R, Cunha C, Oliverio M, Goldman GH, Ibrahim AS, Carvalho A. 2022. COVID-19-associated fungal infections. Nat Microbiol 7:1127–1140. doi:10.1038/s41564-022-01172-2. - DOI - PMC - PubMed
    1. Bongomin F, Gago S, Oladele RO, Denning DW. 2017. Global and multi-national prevalence of fungal diseases-estimate precision. J Fungi (Basel) 3:57. doi:10.3390/jof3040057. - DOI - PMC - PubMed
    1. Ellis ME, Al-Abdely H, Sandridge A, Greer W, Ventura W. 2001. Fungal endocarditis: evidence in the world literature, 1965–1995. Clin Infect Dis 32:50–62. doi:10.1086/317550. - DOI - PubMed
    1. Hoenigl M, Salmanton-García J, Walsh TJ, Nucci M, Neoh CF, Jenks JD, Lackner M, Sprute R, Al-Hatmi AMS, Bassetti M, Carlesse F, Freiberger T, Koehler P, Lehrnbecher T, Kumar A, Prattes J, Richardson M, Revankar S, Slavin MA, Stemler J, Spiess B, Taj-Aldeen SJ, Warris A, Woo PCY, Young JH, Albus K, Arenz D, Arsic-Arsenijevic V, Bouchara JP, Chinniah TR, Chowdhary A, de Hoog GS, Dimopoulos G, Duarte RF, Hamal P, Meis JF, Mfinanga S, Queiroz-Telles F, Patterson TF, Rahav G, Rogers TR, Rotstein C, Wahyuningsih R, Seidel D, Cornely OA. 2021. Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology. Lancet Infect Dis 21:e246–e257. doi:10.1016/S1473-3099(20)30784-2. - DOI - PubMed
    1. Chen SC, Perfect J, Colombo AL, Cornely OA, Groll AH, Seidel D, Albus K, de Almedia JN Jr., Garcia-Effron G, Gilroy N, Lass-Flörl C, Ostrosky-Zeichner L, Pagano L, Papp T, Rautemaa-Richardson R, Salmanton-García J, Spec A, Steinmann J, Arikan-Akdagli S, Arenz DE, Sprute R, Duran-Graeff L, Freiberger T, Girmenia C, Harris M, Kanj SS, Roudbary M, Lortholary O, Meletiadis J, Segal E, Tuon FF, Wiederhold N, Bicanic T, Chander J, Chen YC, Hsueh PR, Ip M, Munoz P, Spriet I, Temfack E, Thompson L, Tortorano AM, Velegraki A, Govender NP. 2021. Global guideline for the diagnosis and management of rare yeast infections: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect Dis 21:e375–e386. doi:10.1016/S1473-3099(21)00203-6. - DOI - PubMed

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