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

PurposeFungal 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.MethodsThis 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.ResultsDespite 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.ConclusionThis 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.