The Frequency of Infective Endocarditis in Candida Bloodstream Infections: a Retrospective Study in a Child Hospital

Abstract

IntroductionFungal endocarditis is reported less frequently than bacterial endocarditis, with an incidence of 0-12% of the total pediatric infective endocarditis.ObjectiveIn this study, the incidence of infective endocarditis in Candida bloodstream infections in a tertiary hospital during the periods of 2007 and 2016 was reviewed.MethodsPatients with positive blood or catheter cultures in terms of Candida spp. during the study period of January 2007 and January 2016 were analyzed in terms of Candida infective endocarditis. Infective endocarditis was defined according to the modified Duke criteria. The outcome, possible associated predisposing factors for Candida endocarditis were determined.Results221 patients and 256 attacks with positive blood or catheter cultures in terms of Candida were included in the study. The most common Candida species was Candida parapsilosis, isolated in 157 (61.3%) attacks, followed by Candida albicans in 70 (27.3%). Neurological diseases (23%), hemato-oncological diseases (12.1%), previously known heart diseases (8.2%), inborn errors of metabolism (9%) were common comorbidities. Twelve (5.4%) patients had a previous history of cardiac surgery. Among the 221 patients, Candida endocarditis was present in only two (0.9%) of them.ConclusionAlthough Candida infective endocarditis is an uncommon but frequently fatal infection in pediatrics, echocardiography should be performed routinely for patients with positive blood or catheter cultures in terms of Candida. Prompt and effective antimicrobial therapy might prevent cardiac surgery in selected cases, however this could not be a general rule for all patients.

Native valve endocarditis due to Candida albicans in two children: Two new case reports

“…The most commonly isolated fungus in many fungal endocarditis is Candida albicans ; followed by Aspergillus spp . From infective endocarditis, the rate of fungal endocarditis in varies between 0% and 12% . In our hospital, between January 2008 and December 2017, 211 episodes of 172 non‐neutropenic patients with candidemia were evaluated, with only two cases (0.9%) of endocarditis due to Candida albicans being detected.…”

“…Kara A et al evaluated the blood and catheter cultures of 221 patients who had suffered 256 attacks from Candida . Only two (0.9%) were revealed as having CE.…”

“…Lipid formulation of amphotericin B or a high‐dose echinocandin has been recommended as the first‐line therapy, and flucytosine can be added to a lipid formulation of amphotericin B due to synergistic activity. Chronic suppressive treatment can be continued with oral fluconazole after amphotericin B . In our patients, liposomal amphotericin B was administered as monotherapy and followed by fluconazole.…”

“…The clinical findings of infective endocarditis vary from asymptomatic to acute and rapidly developing symptoms such as fever, changing or new heart murmurs, and signs and symptoms of heart failure. 9 An echocardiography has been generally recommended for all patients with persistent candidemia due to the fact that murmur may be absent; particularly in initial period. 16 Our patients were diagnosed with fungal endocarditis via echocardiography, their physical examinations had been normal.…”

Candida Glabrata Infection in a Burn Patient

“…[2,3] Study data from Turkey indicate that Candida parapsilosis is the most fre-quently seen, with a rate of 61.3%, followed by Candida albicans (27.3%), Candida tropicalis (6.3%), Candida lusitaniae (2%), Candida glabrata (1.2%) and Candida dubliniensis (0.4%). [4] It has been established that the rate of infection with non-albicans species has increased in recent years. [3] According to United States data, Candida glabrata is the cause of 20% to 30% of candidemia cases.…”