Fungal Endocarditis: Epidemiology, and Diagnosis

P. Badiee1, A.A. Amirghofran2, F. Farhoudi1, M. Ghazi Nour2, M. Shafa2, M. H. Neamati2

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Backgrounds: Endocarditis due to fungal etiology has been characterized by excessive mortality and morbidity, and is the most severe form of infective endocarditis. Blood cultures are typically negative and documented diagnosis is made with histopathologic examination of the cardiac valves, and embolic materials by surgery. Early diagnosis and therapies can improve patients’ outcomes. The aim of this study is to investigate the epidemiology of fungal endocarditis and evaluate the diagnosis of it by noninvasive methods for the best management of the respective patients. Material and Methods: The cardiac valve, vegetation and embolic materials by surgery from the patients suspected with infective endocarditis between the years December 2009 and November 2010 in two big university hospitals in south of Iran, were examined for fungal infections by direct smear and culture. Blood samples were cultured and galactomannan and mannan Ag ELISA tests were performed in sera from the patients. Results: From the 27 patients suspected with infective endocarditis, 11 (37%) were due to fungi. The male-to-female ratio was approximately 2:1, and the median age of the patients was 39.3 years. The most frequent predisposing risk factors were drug abuse and previous surgery. The organisms isolated were Aspergillus fumigatus in 2, Candida albicans in 1, Aspergillus flavus in 2, and Aspergillus niger in 5 patients. Galactomannan Ag test results were positive in 8 patients with positive culture for Aspergillus and one patient without positive culture. The sensitivity and specificity of the test in documented patients were 88.8% and 94.4%, respectively. Mannan Ag test results were negative in all the patients. Conclusion: Taking into account the high epidemiological rate of the infection and to develop more efficient management and high quality care of the patients suspected with fungal endocarditis, serological and noninvasive methods can serve as the reliable ones for early detection of these infections. Keywords: Endocarditis; Fungi, Galactomannan, Mannan Ag test

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Full conference title: 

Iranian Congress on Medical Mycology
    • ICMM 2011