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Fungal endocarditis: evidence in the world literature, 1965-1995

M E Ellis1, H Al-Abdely, A Sandridge

  • 1Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. michael.ellis@uaeu.ac.ae

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|December 19, 2000
PubMed

Insights

Fungal endocarditis (FE) diagnosis improved with echocardiography, but mortality remains high at 72%. Early diagnosis and combined surgical-antifungal treatment improve survival rates for this serious infection.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Mycology

Background:

  • Fungal endocarditis (FE) is a rare but severe infection affecting heart valves.
  • Risk factors for FE include vascular lines, surgery, immunocompromise, and injection drug use.
  • Delayed diagnosis and extracardiac manifestations are common challenges in FE management.

Purpose of the Study:

  • To analyze trends, risk factors, diagnosis, treatment, and outcomes of fungal endocarditis over 30 years.
  • To identify factors associated with improved survival in fungal endocarditis patients.

Main Methods:

  • Retrospective analysis of 270 fungal endocarditis cases over three decades.
  • Comparison of diagnostic rates and outcomes before and after 1988.
  • Identification of common fungal pathogens and assessment of treatment strategies.

Main Results:

  • Increasing prevalence of risk factors like vascular lines and injection drug use.
  • Significant improvement in preoperative diagnosis rates from 43% to 72% since 1988.
  • Common fungi include Candida (albicans and non-albicans), Aspergillus, and Histoplasma; mortality rate is 72%.

Conclusions:

  • Combined surgical-antifungal treatment, Candida infection, and univalvular involvement are linked to better survival.
  • Survival rates have improved from <20% to 41% due to echocardiography and better diagnostics.
  • Early diagnosis, prompt treatment with lipid-based amphotericin B and surgery, and long-term follow-up are crucial for managing FE.

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