title: Fungal endocarditis observed over an 8-year period and a review of the literature.
abstract: BACKGROUND
  Fungal endocarditis (FE) is a "modern" disease that is considered an emerging cause of infective endocarditis (IE). The most frequently identified fungal pathogens are Candida spp., which are responsible for up to two-thirds of all cases; the remaining cases are due to Aspergillus spp., Histoplasma capsulatum or, more rarely, other yeasts and moulds.
  
  
  OBJECTIVE
  To describe the prevalence, clinical characteristics and outcome of FE diagnosed in a single tertiary centre and review the literature concerning FE.
  
  
  METHODS
  An 8-year retrospective review of the case records of patients attending a single Italian University Centre and diagnosed as having definite or probable IE as defined by the modified Duke criteria.
  
  
  RESULTS
  Six patients were identified from 229 episodes of IE: five cases involved a prosthetic valve, and one a native valve of an intravenous drug user. Five cases were caused by Candida spp. (two by C. albicans, one each by C. lusitaniae, C. dubliniensis and C. glabrata) and one by Aspergillus flavus. Three patients were treated by means of surgery plus antifungal therapy; two received antifungal therapy alone. Three patients survived, but only the patient with Aspergillus endocarditis was followed up for a long time.
  
  
  CONCLUSIONS
  FE is difficult to diagnose but generally associated with healthcare infections. The optimal treatment is poorly characterised, and international collaborative studies are urgently needed to evaluate newer antifungal agents.
authors: 3rd Division of Infectious Diseases, Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Via GB Grassi 74, 20157, Milan, Italy, spinello.antinori@unimi.it.
authors: Spinello
authors: S
authors: Antinori
authors: Laurenzia
authors: L
authors: Ferraris
authors: Giovanna
authors: G
authors: Orlando
authors: Loredana
authors: L
authors: Tocalli
authors: Davide
authors: D
authors: Ricaboni
authors: Mario
authors: M
authors: Corbellino
authors: Salvatore
authors: S
authors: Sollima
authors: Massimo
authors: M
authors: Galli
authors: Laura
authors: L
authors: Milazzo
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D004696:Endocarditis / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D005658:Fungi / Q000145:classification* / Q000302:isolation & purification*; D006801:Humans; D007558:Italy; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D015995:Prevalence; D013514:Surgical Procedures, Operative; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents