Journal Article

Fungal Endocarditis: Evidence in the World Literature, 1965–1995

M. E. Ellis, H. Al-Abdely, A. Sandridge, W. Greer and W. Ventura

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 32, issue 1, pages 50-62
Published in print January 2001 | ISSN: 1058-4838
Published online January 2001 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/317550
Fungal Endocarditis: Evidence in the World Literature, 1965–1995

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We analyzed 270 cases of fungal endocarditis (FE) that occurred over 30 years. Vascular lines, non-cardiac surgery, immunocompromise and injection drug abuse are increasing risk factors. Delayed or mistaken diagnosis (82% of patients), long duration of symptoms before hospitalization (mean ± standard deviation, 32 ± 39 days) and extracardiac manifestations were characteristic. From 1988 onwards, 72% of patients were diagnosed preoperatively, compared with 43% before 1988 (P = .0001). The fungi most commonly isolated were Candida albicans (24% of patients), non-albicans species of Candida (24%), Apergillus species (24%), and Histoplasma species (6%); recently-emerged fungi accounted for 25% of cases. The mortality rate was 72%. Survival rates were better among patients who received combined surgical-antifungal treatment, were infected with Candida, and had univalvular involvement. Improvement in the survival rate (from <20% before 1974 to 41% currently) coincided with the introduction of echocardiography and with improved diagnostic acumen. Fungal endocarditis recurs in 30% of survivors. It is recommended that fungal endocarditis be diagnosed early through heightened diagnostic acumen; that patients be treated with combined lipid-based amphotericin B and early surgery; and that patients be followed up for ⩾4 years while on prophylactic antifungal therapy.

Journal Article.  7554 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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