Fungal Endocarditis: An Update

Abstract

While it used to affect mostly intravenous drug users and patients who underwent cardiac surgery, during the years 1965-1995’s, fungal endocarditis is currently mostly observed in severely immunocompromised patients, with chronic central venous access and/or broad-spectrum antibiotic use, or total parenteral nutrition. The requirement of specific blood culture bottles for fungus has virtually disappeared, thanks to the optimization of automated blood culture systems. Meanwhile, the advent of several blood tests for invasive mycosis – galactomannan for invasive aspergillosis, mannan/anti-mannan antibodies for candidemia and β-1,3-D glucans for any invasive mycosis – shall improve sensitivity, and reduce diagnosis delay, although limited data are available on their yield for the diagnosis of fungal endocarditis. New antifungal agents available since the early 2000s probably represent dramatic improvement for fungal endocarditis: 1) a new class, echinocandins, has the potential to improve the management of Candida sp. endocarditis, due to its fungicidal effect on yeasts, and the tolerability of increased doses; 2) voriconazole improved survival in patients with invasive aspergillosis, as compared to amphotericin B, and this achievement may apply to Aspergillus sp. endocarditis as well, although the prognosis of these latter remains dismal and largely dependent on cardiac surgery.