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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.
European Journal of Pediatrics
|April 17, 1999
Summary
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.