Fungal endocarditis

Fungal endocarditis (FE) is an uncommon infection that is associated with substantial morbidity and mortality. The incidence of FE is expected to rise in the future owing to an increase in the populations at risk, as well as increasing use of prosthetic heart materials and implantable electronic devices. The most common causative organisms are Candida and Aspergillus spp.; however, multiple fungal spp. have been implicated. A high degree of clinical suspicion is crucial for the diagnosis of FE, given that blood cultures have low sensitivity for diagnosis. For this reason, it is imperative that histopathological examinations are performed and cultures of intraoperative valve and tissue specimens are obtained. Current practice guidelines recommend valve replacement for FE, if feasible, combined with prolonged antifungal therapy for the treatment of both native and prosthetic valve FE. A liposomal formulation of amphotericin B with or without flucytosine is recommended as the treatment of choice for patients with Candida endocarditis. For Aspergillus endocarditis, the treatment of choice is voriconazole. This review will focus on the current epidemiology, treatment, and outcomes of FE complicating valves and electronic implantable or circulatory support devices.