[Candida endocarditis: retrospective study in 12 patients]

Candida endocarditis are rare, with a poor prognosis. Actually, the principal problem concerns the growing incidence of nosocomial fungal infections. The objective of the present investigation is to assess a disease which risks becoming more pronounced in the future.

We have collected observations of Candida sp. endocarditis between 1985 to 1997 from three French university hospitals.

Twelve of the observations fit the Duke criteria of acute endocarditis. Patients were eight men and four women, with a mean age of 46 years. An immunodepression was found in seven cases, and four patients were active drug addicts. Six had an underlying heart disease at risk to acute endocarditis. Candidemia risk factors were found in nine cases, with an average of 2.7 risk factors per patient. The fungal agents detected were Candida albicans (eight cases), C. tropicalis (one case), C. parapsilosis (two cases), and C. glabrata (one case). These vegetations were on aortic (seven cases), mitral (three cases), tricuspid valves (two cases) or in other areas (three cases), with multiple localizations (two cases). In three observations, vegetations were associated with myocardium abscesses. Eight patients had embolic complications, two had a cardiac insufficiency leading to death. The treatment was medical in all of the cases and combined with a surgical treatment in ten cases. The surgery was performed, on an average, 17 days after diagnosis, allowing seven surviving patients. Among them, five received a secondary prophylaxis and no recurrence was recorded.

Prognosis remains severe because of the voluminous, friable and necrotic vegetations, which favor embolic migrations and which are not easily accessible to antifungals, which penetrate poorly into these vegetations. Therapy is based on a medical treatment combined with a valve replacement which needs to be done early on, and is followed by a relapse prevention which can occur several years after the initial episode.