Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Medical Center, Sacramento, California, USA.
Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA.
Clin Microbiol Rev. 2023 Sep 21;36(3):e0001923. doi: 10.1128/cmr.00019-23. Epub 2023 Jul 13.
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by and spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for spp. or galactomannan testing and PCR for spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for endocarditis or voriconazole therapy for endocarditis.
真菌性心内膜炎占所有感染性心内膜炎病例的 1%至 3%，与高发病率和死亡率 (>70%)相关，并且在临床护理中存在诸多挑战。 spp. 是真菌性心内膜炎的最常见原因，在超过 50%的病例中涉及，其次是 和 spp. 真菌性心内膜炎的重要危险因素包括人工瓣膜、先前的心脏手术和注射药物使用。真菌性心内膜炎的体征和症状是非特异性的，需要高度的临床怀疑，并明智地使用诊断测试来进行诊断。除了微生物学诊断（例如，血液培养以检测 spp. 或半乳甘露聚糖检测和 spp. 的 PCR）外，超声心动图仍然是评估潜在感染性心内膜炎的关键，尽管放射性核素成像方式，如 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描，越来越多地被使用。需要采用多模式治疗方法：通常需要手术，并且应伴随长期全身抗真菌治疗，例如棘白菌素治疗 心内膜炎或伏立康唑治疗 心内膜炎。
