Fungal Endocarditis: Diagnostic and Therapeutic Challenges in a Tertiary-Center Case Series

Fungal infective endocarditis is rare but highly lethal, with limited evidence to guide management. Diagnosis is often delayed, source control may be difficult, and effective antifungal options may be limited.

We describe 8 patients with fungal infective endocarditis, ranging from a 40-day-old infant to a 56-year-old adult. Organisms included Candida parapsilosis in 3 patients, multidrug-resistant Candida auris, Candida glabrata, Candida albicans, Fusarium species, and Apiosporium mycotoxinivorans. Infection involved native valves, prosthetic valves, aortic root grafts, and intracardiac device leads. Five patients underwent definitive source control. In 1 patient, fungal prosthetic valve endocarditis initially mimicked prosthetic valve thrombosis, leading to thrombolysis before infection was recognized. In-hospital mortality was 50%.

Outcomes appeared to depend on early recognition, antifungal susceptibility, and feasibility of source control. These cases emphasize the need for microbiological suspicion, multimodality imaging, and multidisciplinary decision-making in fungal infective endocarditis.