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Fungal endocarditis in critically ill children
F Aspesberro1, M Beghetti, I Oberhänsli
1Unité de Cardiologie Pédiatrique, Hôpital des Enfants, Geneva, Switzerland.
Unlabelled:
All cases of infective endocarditis occurring from January 1990 to December 1996 at our institution were reviewed, with a special focus on fungal endocarditis. Five critically ill children with fungal endocarditis and eleven children with bacterial endocarditis were recorded. The proportion of fungal endocarditis in our series was 5/16 (31%) and Candida albicans (4/5) was the most common fungal pathogen. Only one patient required heart surgery because of a loose patch but all the others were treated only by medical management for cure. The hospital survival rate was 80% (4/5) and the overall long-term survival rate was 60% (3/5) with only one death directly related to fungal infection.
Conclusion:
Despite the small number of cases, a sole medical approach including amphotericin B and long-term fluconazole prophylaxis for the treatment of fungal endocarditis in critically ill children seems to offer an alternative to surgical treatment which may be kept for failure of medical treatment.
Insights
Fungal endocarditis in critically ill children is often caused by Candida albicans. Medical management, including antifungal medications, can be effective, reserving surgery for treatment failures.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Mycology
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Fungal IE is rare but carries high morbidity and mortality, particularly in critically ill children.
- This study reviews IE cases from 1990-1996, focusing on fungal etiologies in pediatric patients.
Observation:
- Five critically ill children with fungal endocarditis were identified, representing 31% of all IE cases during the study period.
- Candida albicans was the predominant fungal pathogen (4 out of 5 cases).
- Most patients (4 out of 5) were successfully treated with medical management alone, with only one requiring cardiac surgery.
Findings:
- The hospital survival rate for fungal endocarditis was 80% (4/5).
- The overall long-term survival rate was 60% (3/5), with one death attributed to the fungal infection.
- Medical treatment, including amphotericin B and fluconazole prophylaxis, demonstrated efficacy.
Implications:
- A medical-first approach for fungal endocarditis in critically ill children appears viable.
- Surgical intervention should be reserved for cases refractory to medical therapy.
- This suggests a potential shift in treatment paradigms for pediatric fungal endocarditis.