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Fungal endocarditis: current challenges

Pierre Tattevin1, Matthieu Revest2, Agnès Lefort3

  • 1Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France; INSERM U835, Faculté de Médecine, Université Rennes 1, IFR140, Rennes, France; Association pour l'Etude et la Prévention de l'Endocardite Infectieuse (AEPEI), Bichat-Claude Bernard Hôpital, Paris, France.

International Journal of Antimicrobial Agents
|September 3, 2014
PubMed

Insights

Fungal endocarditis now affects immunocompromised patients, differing from its past association with drug use. Advances in diagnostics and new antifungal drugs offer improved treatment options, potentially reducing the need for surgery in select cases.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Mycology

Background:

  • Fungal endocarditis (FE) incidence has shifted from intravenous drug users and post-cardiac surgery patients to those with severe immunodeficiency, chronic central venous access, and broad-spectrum antibiotic use.
  • Improved infection control and harm-reduction policies have likely decreased FE rates in developed nations.
  • Traditional diagnostic methods for FE have evolved with advancements in culture media and automated systems.

Purpose of the Study:

  • To review the changing epidemiology, diagnostic advancements, and therapeutic strategies for fungal endocarditis.
  • To highlight the impact of new diagnostic techniques and antifungal agents on FE management.

Main Methods:

  • Literature review of epidemiological trends, diagnostic modalities, and treatment outcomes for fungal endocarditis.
  • Analysis of the role of emerging diagnostic tools such as fungal antigen detection and PCR.
  • Evaluation of the efficacy of newer antifungal agents, including echinocandins and voriconazole.

Main Results:

  • Fungal endocarditis is increasingly seen in immunocompromised individuals, particularly in onco-hematology patients.
  • Rapid diagnostic techniques like galactomannan, mannan/anti-mannan antibodies, β-1,3-d-glucans, and PCR show promise for improved sensitivity and reduced diagnostic delays.
  • Newer antifungal agents, notably echinocandins for Candida and voriconazole for Aspergillus, offer improved treatment options, potentially enabling medical management alone in select high-risk surgical candidates.

Conclusions:

  • Fungal endocarditis epidemiology has shifted towards immunocompromised populations.
  • Advancements in diagnostics and the availability of novel antifungal agents represent significant progress in managing fungal endocarditis.
  • Prolonged medical therapy with newer antifungals may be a viable alternative to surgery for selected patients with fungal endocarditis.
Keywords:
Aspergillus sp.Candida sp.EchinocandinsEndocarditisβ-1,3-d-Glucans

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