Summary about Disease
Fungal endocarditis is a rare but serious infection of the inner lining of the heart (endocardium) or heart valves caused by fungi. It's a form of infective endocarditis, typically occurring in individuals with compromised immune systems, prosthetic heart valves, or intravenous drug use. It can lead to significant heart damage and systemic complications.
Symptoms
Symptoms of fungal endocarditis can be similar to those of bacterial endocarditis, but they may develop more slowly. Common symptoms include:
Fever
Chills
Fatigue
Night sweats
Shortness of breath
New or worsening heart murmur
Skin changes (e.g., petechiae, Janeway lesions, Osler's nodes)
Unexplained weight loss
Causes
The most common causes of fungal endocarditis include:
Candida species (e.g., *Candida albicans*, *Candida parapsilosis*)
Aspergillus species
Other less common fungi Risk factors include:
Intravenous drug use
Prosthetic heart valves
Central venous catheters
Prolonged antibiotic use
Immunosuppression (e.g., due to HIV, cancer treatment, organ transplantation)
Prior heart surgery
Medicine Used
Antifungal medications are the primary treatment for fungal endocarditis. Common medications include:
Amphotericin B (often used initially, but can have significant side effects)
Azole antifungals (e.g., fluconazole, voriconazole, posaconazole)
Echinocandins (e.g., caspofungin, micafungin, anidulafungin) Combination therapy with multiple antifungals may be necessary. Surgical valve replacement is often required, especially with large vegetations or valve dysfunction.
Is Communicable
Fungal endocarditis is generally not communicable from person to person through casual contact. It typically arises from a person's own fungal flora entering the bloodstream or from contaminated medical equipment.
Precautions
Prevention of fungal endocarditis involves:
Avoiding intravenous drug use
Strict sterile technique during insertion and maintenance of central venous catheters
Prophylactic antifungal therapy in high-risk patients undergoing cardiac surgery (in some cases)
Prompt treatment of fungal infections elsewhere in the body
Good hygiene practices.
How long does an outbreak last?
Fungal endocarditis does not typically occur in "outbreaks" in the same way as some viral or bacterial infections. It's usually an individual case arising from specific risk factors. The duration of the infection depends on how quickly it is diagnosed and treated, the specific fungus involved, and the patient's overall health. Treatment often requires weeks or months of intravenous antifungal therapy.
How is it diagnosed?
Diagnosis of fungal endocarditis involves:
Blood cultures: To identify the causative fungus. Multiple sets of blood cultures are usually drawn.
Echocardiography: Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are used to visualize vegetations on the heart valves. TEE is more sensitive for detecting vegetations, especially in patients with prosthetic valves.
Clinical presentation: Assessing the patient's symptoms and risk factors.
Imaging studies: CT scans or MRI may be used to evaluate for complications such as embolic events.
Pathological examination: If a valve is surgically removed, it is sent for pathological examination and cultures.
Duke Criteria: Modified Duke Criteria are often used to help establish the diagnosis of infective endocarditis, including fungal endocarditis.
Timeline of Symptoms
The timeline of symptoms can vary. In some cases, the onset is acute, developing rapidly over days to weeks. In other cases, the symptoms are more insidious, developing slowly over weeks to months. There may be an initial flu-like illness, followed by the development of cardiac symptoms such as shortness of breath and a heart murmur. Embolic events (e.g., stroke, pulmonary embolism) can occur at any point in the disease course.
Important Considerations
Fungal endocarditis is a life-threatening infection requiring prompt diagnosis and aggressive treatment.
Early surgical intervention (valve replacement) is often necessary in addition to antifungal therapy.
The prognosis is often poor, especially in patients with significant comorbidities or delayed diagnosis.
Consultation with an infectious disease specialist and a cardiothoracic surgeon is essential.
Long-term monitoring is required to assess for recurrence of the infection.