title: Tricuspid valve mycetoma in an infant successfully treated by excision and complex tricuspid valve repair followed by fluconazole therapy.
abstract: BACKGROUND
  Fungal valve endocarditis in children is an uncommon and lethal disease. The risk increases with use of central venous catheters (CVC), total parenteral nutrition (TPN), and use of broad-spectrum antibiotics during the neonatal period. Due to high mortality, a combination of surgery and antifungal therapy is usually recommended for treatment.
  
  
  METHODS
  Case report and review of the literature.
  
  
  RESULTS
  We present a case of an asymptomatic infant with multiple Candida tricuspid valve mycetomas. Complete cure was achieved by combined tricuspid valve repair and fluconazole therapy. We also review 26 cases of tricuspid valve Candida endocarditis in children published in the literature.
  
  
  CONCLUSIONS
  From being uniformly fatal five decades ago to a current survival rate of 64% to 100%, the prognosis of Candida endocarditis has changed dramatically with the use of antifungal therapy alone or in combination with surgery. Our case re-emphasizes the role of valve-sparing debridement with repair of the native valve using autologous pericardium in combination with long-term antifungal therapy as a feasible option in managing tricuspid valve Candida endocarditis.
authors.affiliation: 1 Department of Microbiology, Amrita Institute of Medical Sciences , Kerala, India .
authors.forename: V
authors.initials: V
authors.lastname: Anil Kumar
authors.forename: Edwin
authors.initials: E
authors.lastname: Francis
authors.forename: Sreekala
authors.initials: S
authors.lastname: Sreehari
authors.forename: Benedict
authors.initials: B
authors.lastname: Raj
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D004696:Endocarditis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D008271:Mycetoma / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D014261:Tricuspid Valve / Q000382:microbiology* / Q000601:surgery*
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole