Fungal Endocarditis: Diagnostic Strategies from Blood Culture to PET/CT Imaging
This review covers the diagnosis and management of fungal endocarditis, which accounts for 1-3% of infective endocarditis cases but carries mortality exceeding 70%. Candida species cause over half of cases, followed by Aspergillus and Histoplasma. The diagnostic workup requires pathogen-specific approaches: blood culture for Candida, galactomannan and PCR for Aspergillus, supplemented by echocardiography and increasingly by 18F-FDG PET/CT when echocardiographic findings are inconclusive. Treatment demands a multimodal strategy combining surgery with prolonged antifungal therapy.
The original study
Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management.
- Authors
- Thompson GR, Jenks JD, Baddley JW, Lewis JS, Egger M, Schwartz IS, et al.
- Journal
- Clinical microbiology reviews
- Type
- Journal Article, Review, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't
- PMID
- 37439685
Original abstract
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.