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Fungal endocarditis — a report on seven cases and a brief review

Pilzendokarditis — Bericht über sieben Fälle und kurze Literaturübersicht

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Summary

Candida endocarditis is an unusual but severe complication of systemic infection caused byCandida albicans and occasionally by other fungal species. We describe seven cases that occurred during a period of 20 years in western Sweden. In four cases infections were located on prosthetic valves and in three cases native valves were involved. Three patients died of the disease in the acute phase. A definite diagnosis was established in one of four survivors. This patient had an aortic valve endocarditis and a saddle embolisation and was treated with immediate surgery, followed by intensive treatment with liposomal amphotericin B + flucytosine. Fungal endocarditis is still a serious disease with a high mortality and whenever the diagnosis is suspected, antifungal therapy must be started and transesophageal sonography should be performed to visualize vegetations. Immediate surgery should be considered.

Zusammenfassung

DieCandida-Endokarditis ist eine seltene, aber schwere Komplikation einer systemischen Infektion durchCandida albicans und gelegentlich auch durch andere Pilzspezies. Wir berichten über sieben Fälle, die in einem Zeitraum von 20 Jahren in Westschweden beobachtet wurden. In vier Fällen waren Klappenprothesen und in drei Fällen natürliche Klappen betroffen. Drei Patienten starben in der akuten Phase an der Krankheit. Bei einem der vier überlebenden Patienten konnte die Diagnose eindeutig gesichert werden. Dieser Patient hatte eine Aortenklappenendokarditis und einen reitenden Embolus. Er wurde sofort operiert und hochdosiert mit liposomalem Amphotericin B und mit Flucytosin behandelt. Die Pilzendokarditis ist nach wie vor eine ernste, mit hoher Letalität belastete Krankheit. Die antimykotische Therapie muß bereits beim ersten Verdacht begonnen werden. Um Vegetationen nachzuweisen, sollte die transösophageale Sonographie durchgeführt werden. Ein sofortiges chirurgisches Eingreifen ist zu erwägen.

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  1. Dept. of Infectious Diseases, Göteborg University, S-416 85, Göteborg, Sweden

    Harriet Hogevik M. D. & K. Alestig M. D., Ph. D.

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  1. Harriet Hogevik M. D.
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  2. K. Alestig M. D., Ph. D.
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Hogevik, H., Alestig, K. Fungal endocarditis — a report on seven cases and a brief review. Infection 24, 17–21 (1996). https://doi.org/10.1007/BF01780644

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