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Year : 2018  |  Volume : 20  |  Issue : 2  |  Page : 96-101

Fungal infective endocarditis: A case series

1 Department of Microbiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
2 Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Correspondence Address:
Dr. Kavita Raja
Department of Microbiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram - 695 011, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jacm.jacm_21_18

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This case series proposes to describe the clinical features and laboratory findings associated with fungal infective endocarditis (FIE) encountered in this tertiary care referral centre for cardiology. All cases of FIE, proved by culture of blood or tissue samples for a period of 10 years from June 2007 to June 2017 were included. Retrospective data on patients, whose blood culture grew fungi, mould or yeast, were collected from the medical records section and analysed. A total of 276 cases of IE occurred, in this period and 14 cases (5.07%) of culture-positive FIE occurred. Prosthetic valves (11 cases) were more common than native valves (3). There were eight Candida parapsilosis and all except two were from prosthetic valve which included both metallic (5) and bio-prosthetic valve (1). Other candida spp. included one Candida albicans isolated from bio-prosthetic valve, one Candida haemolunii isolated from bio-prosthetic valve and one Candida pelliculosa isolated from a native aortic valve, detected during surgery for ventricular septal defect closure. There were two mould fungi, namely Wangiella dermatitidis and Aspergillus niger. Out of 14 cases, 10 vegetations were more than 10 mm in size. In 9/14 patients, C-reactive protein (CRP) was greater than100 units when done at admission. One C.parapsilosis was resistant to fluconazole and voriconazole, while another was resistant to fluconazole and amphotericin B. Embolisation to brain and peripheral areas was the most common complication. Surgical excision was successful in three cases, while medical treatment was successful only in one case. Though culture negativity was achieved with drugs, embolisation was the most common cause of death even after culture became negative. In conclusion, FIE is a rare cause of endocarditis. It occurs more commonly in prosthetic valves. Most common aetiological agent in this series was C.parapsilosis. Among prognostic factors, CRP showed a very consistent increase. Surgical excision was curative and embolisation to the brain was the most common cause of death. A multicentre study will be needed to study prognostic factors and risk factors for mortality and to find the best combination of antifungals for treatment.

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