Echocardiographic features of Candida species endocarditis: 12 cases and a review of published reports

Abstract

Objective-To describe the specific echocardiographic features of Candida species endocarditis. Design-Retrospective review of the case records of patients with confirmed candida endocarditis. Setting-Cases referred to three French university centres over an eight year period were studied. Design-12 patients with confirmed Candida species endocarditis infection were identified. The transthoracic (n = 12) and transoesophageal (n = 12) echocardiographic appearances were compared with the surgical findings (n = 10). Results-Large dense heterogeneous vegetations were found in 11/12 cases. A hyperechogenic heterogeneous myocardial texture, observed in seven of the 12 patients, was associated with extensive myocardial damage at surgery. While it was possible to diagnose candidal cardiac infection in all patients by transthoracic echocardiography, transoesophageal echocardiography was useful for optimal assessment of the valvar and paravalvar structures. Conclusions-In the setting of endocarditis, the detection of myocardial involvement, which is characterised by a heterogeneous myocardial texture, is an argument in favour of Candida species endocarditis and may warrant early surgical intervention.

Histological detection of intramyocardial abscesses in Candida sepsis mimicking left ventricular non‐compaction/hypertrabeculation on echocardiography

“…Among other organisms, reported to cause myocardial abscesses, are Streptococcus , Salmonella , gram‐negative rods, Aspergillus , coliform bacteria and Listeria monocytogenes 5,24–27 . Echocardiographic reports about myocardial abscesses in Candida sepsis are rare 3,6 . A thickened myocardium has been reported in some of them, possibly because of inflammatory infiltration and interstitial edema.…”

“…5,[24][25][26][27] Echocardiographic reports about myocardial abscesses in Candida sepsis are rare. 3,6 A thickened myocardium has been reported in some of them, possibly because of inflammatory infiltration and interstitial edema. Cardiac candidosis is found in 10% of cancer patients at autopsy, all of them with disseminated Candida infection.…”

“…1,2 Cardiac candidosis may manifest as endocarditis with large valvular vegetations or myocardial abscesses. 3,4 Myocardial abscesses in Candida sepsis are mainly diagnosed invasively at cardiac surgery or postmortem and only rarely by echocardiography. [1][2][3][4][5][6] We report a case in which myocardial abscesses echocardiographically mimicked left ventricular non-compaction/hypertrabeculation (LVHT), a cardiac abnormality frequently associated with neuromuscular disorders and characterized by more than three trabeculations protruding from the left ventricular wall, apically to the papillary muscles, visible in one echocardiographic image plane, and intertrabecular spaces perfused from the ventricular cavity.…”

German guidelines for the diagnosis and management of infective endocarditis

“…For isolated infection of the tricuspid valve, medical therapy is usually [72]. Echocardiography often shows large vegetations [73]. Histological and microbiological evaluation of embolic material can enhance the diagnosis.…”

Fungal prosthetic aortic valve endocarditis and endarteritis: An unusual cause of aortic root vegetations

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Other, less common, sites of infection have also been described, such as the right atrial septum, right ventricular cavity, and left atrial cavity. Surgical specimen cultures grew C albicans, which was sensitive to fluconazole.…”