Journal Article

Fungal endocarditis. A retrospective analysis from a high-volume surgical centre and review of the literature

Scheggi, Valentina, Fidanzati, Antonio, Stefàno, Pier Luigi, Papi, Matilde

2025

Overview

Purpose Fungal endocarditis (FE), a rare but severe subset of infective endocarditis (IE), accounts for 2–4% of cases, with significant morbidity and mortality despite combined clinical and surgical interventions. The incidence of FE has been rising due to an increase in patients with predisposing risk factors, such as prosthetic heart valves, indwelling central venous catheters, prolonged fungemia, and intravenous drug use, alongside advancements in diagnostic techniques. Diagnosing FE is challenging due to nonspecific symptoms and often negative or delayed blood culture results, necessitating repeated cultures and sometimes surgical specimen collection for confirmation. FE is associated with a higher incidence of extracardiac complications, such as systemic and central nervous system embolization, compared to bacterial endocarditis. Methods This study retrospectively analyzed 687 patients with non-device-related IE admitted to a high-volume surgical center from January 2013 to December 2023, identifying 8 cases of FE (1.2%). The diagnostic work-up followed European Society of Cardiology guidelines, including blood cultures and echocardiography. Management involved a multidisciplinary team approach, combining antifungal therapy and early surgical intervention. Results Despite advancements, the prognosis of FE remains poor, with a mortality rate exceeding 50%. Early diagnosis and timely intervention, including early surgery, are crucial for improving outcomes. Conclusion This study and the review of the literature aim to enhance understanding of FE by reviewing clinical presentations, diagnostic challenges, and management strategies, emphasizing the importance of a high index of suspicion and comprehensive diagnostic evaluation in high-risk patients.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abdomen / Abscesses / Adult / Aged / Antibiotics / Antifungal Agents - therapeutic use / Blood / Blood culture / Cardiac surgery / Cardiology / Care and treatment / Caspofungin / Catheters / Central nervous system / Diagnosis / Diagnostic workup / Drug addiction / Drug use / Echocardiography / Embolisms / Embolization / Endocarditis / Endocarditis - diagnosis / Endocarditis - epidemiology / Endocarditis - microbiology / Endocarditis - mortality / Endocarditis - therapy / Female / Fever / Fungal endocarditis / Fungemia / Fungi / Fungicides / Health aspects / Heart / Heart valves / Homeopathy / Hospitals / Humans / Implants, Artificial / Infectious Diseases / Infective endocarditis / Informed consent / Internal Medicine / Ischemia / Literature reviews / Male / Materia medica and therapeutics / Medical examination / Medical imaging / Medical Microbiology / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Morbidity / Mortality / Mycoses - diagnosis / Mycoses - epidemiology / Mycoses - microbiology / Mycoses - mortality / Mycoses - therapy / Parasitology / Patients / Physiological aspects / Plastic surgery / Prognosis / Prostheses / Prosthesis / Prosthetic valves / Retrospective Studies / Risk Factors / Risk groups / Surgery / Surgical clinics / Therapeutics / Tropical Medicine / Vegetation