title: Fungal endocarditis.
abstract: OBJECTIVE
  Fungal endocarditis remains a rare disease occurring mostly in patients with predisposing host conditions. Regarding its poor prognosis because of severe complications, there is an urgent need for properly established treatment guidelines and prophylaxis for patients at risk. In this review we provide up-to-date information on treatment recommendations, and discuss recent case reports on fungal endocarditis and challenges in prophylaxis and treatment.
  
  
  RESULTS
  Over the last year, an increase in cases caused by non-albicans species of Candida and other fungi like Fusarium solani, Lodderomyces elongisporus and Exophiala dermatitidis was reported. They were treated individually in case-by-case approaches, lacking randomized controlled trials and, mostly, treatment recommendations.
  
  
  CONCLUSIONS
  The scarcity of fungal endocarditis demands a high index of suspicion and knowledge of the group of at-risk patients. Diagnosis aggressively pursued by echocardiography and multiple blood cultures or surgical specimens has the potential to improve outcome. Candida endocarditis should be treated immediately, including surgical treatment in combination with liposomal amphotericin B or caspofungin with optional addition of flucytosine. Aspergillus endocarditis requires rapid surgery and voriconazole.
authors.affiliation: a1st Department of Internal Medicine, University Hospital of Cologne bZentrum für Klinische Studien (BMBF 01KN1106), cCologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany *Daniela Tacke and Philipp Koehler contributed equally to the writing of this article.
authors.forename: Daniela
authors.initials: D
authors.lastname: Tacke
authors.forename: Philipp
authors.initials: P
authors.lastname: Koehler
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D004696:Endocarditis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D017410:Practice Guidelines as Topic
chemical_list: D000935:Antifungal Agents