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Fungal endocarditis in paediatrics: a review of 192 cases (1971-2016)
Vithiya Ganesan1, Shunmuga Sundaram Ponnusamy1, Raja Sundaramurthy1
1Velammal Medical College Hospital and Research Institute,Microbiology and Interventional Cardiology,Velammal Village,Tuticorin Ring Road,Anuppanadi,Madurai,TN,India.
Background:
The aims of this article were to review the published literature on fungal endocarditis in children and to discuss the aetiology and diagnosis, with emphasis on non-invasive methods and various treatment regimes.
Methods:
We systematically reviewed published cases and case series of fungal endocarditis in children. We searched the literature, including PubMed and individual references for publications of original articles, single cases, or case series of paediatric fungal endocarditis, with the following keywords: "fungal endocarditis", "neonates", "infants", "child", and "cardiac vegetation".
Results:
There have been 192 documented cases of fungal endocarditis in paediatrics. The highest number of cases was reported in infants (93/192, 48%) including 60 in neonates. Of the neonatal cases, 57 were premature with a median gestational age of 27 weeks and median birth weight of 860 g. Overall, 120 yeast - fungus that grows as a single cell - infections and 43 mould - fungus that grows in multicellular filaments, hyphae - infections were reported. With increasing age, there was an increased infection rate with moulds. All the yeast infections were detected by blood culture. In cases with mould infection, diagnosis was mainly established by culture or histology of emboli or infected valves after invasive surgical procedures. There have been a few recent cases of successful early diagnosis by non-invasive methods such as blood polymerase chain reaction (PCR) for moulds. The overall mortality for paediatric fungal endocarditis was 56.25%. The most important cause of death was cardiac complications due to heart failure. Among the various treatment regimens used, none of them was significantly associated with better outcome.
Conclusions:
Non-invasive methods such as PCR tests can be used to improve the chances of detecting and identifying the aetiological agent in a timely manner. Delays in the diagnosis of these infections may result in high mortality and morbidity. No significant difference was noted between combined surgical and medical therapy over exclusively combined medical therapy.
Insights
Fungal endocarditis in children, particularly in neonates, has a high mortality rate of over 56%. Early diagnosis using non-invasive methods like polymerase chain reaction (PCR) is crucial for improving outcomes in pediatric fungal endocarditis.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Mycology
Background:
- Fungal endocarditis is a rare but serious condition in children.
- The review focuses on aetiology, diagnosis, and treatment of pediatric fungal endocarditis.
Purpose of the Study:
- To review published literature on fungal endocarditis in children.
- To discuss diagnosis, emphasizing non-invasive methods.
- To evaluate various treatment regimens.
Main Methods:
- Systematic review of published cases and case series.
- Literature search using keywords: "fungal endocarditis", "neonates", "infants", "child", "cardiac vegetation".
- Inclusion of studies from PubMed and individual references.
Main Results:
- 192 pediatric cases documented; highest incidence in infants (48%), especially premature neonates.
- Yeast infections (120 cases) detected by blood culture; mould infections (43 cases) diagnosed via culture/histology of surgical specimens.
- Non-invasive methods like blood polymerase chain reaction (PCR) show promise for early mould detection.
- Overall mortality is 56.25%, primarily due to cardiac complications; no treatment regimen showed significantly better outcomes.
Conclusions:
- Non-invasive methods, such as PCR, can enhance early detection and identification of the causative fungal agent.
- Delayed diagnosis significantly increases mortality and morbidity.
- No significant difference in outcomes between combined surgical and medical therapy versus exclusively medical therapy was observed.
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