Fungal endocarditis: Evidence in the world literature, 1965-1995

We analyzed 270 cases of fungal endocarditis (FE) that occurred over 30 yea rs. Vascular lines, non-cardiac surgery, immunocompromise and injection dru g abuse are increasing risk factors. Delayed or mistaken diagnosis (82% of patients), long duration of symptoms before hospitalization (mean +/- stand ard deviation, 32 +/- 39 days) and extracardiac manifestations were charact eristic. From 1988 onwards, 72% of patients were diagnosed preoperatively, compared with 43% before 1988 (P=.0001). The fungi most commonly isolated w ere Candida albicans (24% of patients), non-albicans species of Candida (24 %), Apergillus species (24%), and Histoplasma species (6%); recently-emerge d fungi accounted for 25% of cases. The mortality rate was 72%. Survival ra tes were better among patients who received combined surgical-antifungal tr eatment, were infected with Candida, and had univalvular involvement. Impro vement in the survival rate (from <20% before 1974 to 41% currently) coinci ded with the introduction of echocardiography and with improved diagnostic acumen. Fungal endocarditis recurs in 30% of survivors. It is recommended t hat fungal endocarditis be diagnosed early through heightened diagnostic ac umen; that patients be treated with combined lipid-based amphotericin B and early surgery; and that patients be followed up for <greater than or equal to>4 years while on prophylactic antifungal therapy.