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Pediatric Fungal Endocarditis Clinical Presentation

  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: P Syamasundar Rao, MD  more...
 
Updated: Mar 09, 2015
 

History

Patients with fungal endocarditis (FE) may have a history of cardiac surgery complicated by symptoms of infection, such as fever, deteriorating cardiac status, embolic phenomena, and dehiscence.

a history of intrathoracic or systemic fungal infection with spread to the heart is rare.

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Physical

On rare occasions, fungal endocarditis presents as typical bacterial endocarditis, with fever, weight loss, splenomegaly, splinter hemorrhages, Roth spots (pale retinal lesions with surrounding hemorrhage), Osler nodes (painful nodular lesions on the finger and/or toe pads), petechiae, Janeway lesions (painless hemorrhagic plaques on the palms and/or soles), arthritis, and a new or changing heart murmur.

Often, an indwelling central venous catheter (CVC) is present. The use of CVC for central hyperalimentation (CHA) is an additional risk factor.

Occasionally, positive blood culture results or positive culture results of other tissues and fluids (despite negative blood culture results) are the only evidence.

Cardiac involvement, without other symptoms or signs of infection, may be the only clinically apparent feature.

An inflow obstruction (superior vena cava syndrome with cough, hoarseness, dysphagia, and/or a full sensation in the ears) due to an infected thrombus may be the sole manifestation of disease.

In neonates, symptoms are often nonspecific and include apnea and bradycardia, hypothermia, poor perfusion, feeding intolerance, increased ventilatory support, and evidence of septic emboli. Rarely, a new or changing heart murmur is present.

In neonates, Janeway lesions, petechiae, splinter hemorrhages, and evidence of multiple septic emboli have been reported, although Osler nodes and Roth spots have not been reported.

In the postoperative period, patients may have symptoms such as fever, cardiac decompensation, a new or changing heart murmur, evidence of embolic phenomena, and dehiscence.

Superior vena cava syndrome may manifest as hoarseness, swelling of the face, wheezing or stridor, and/or venous engorgement.

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Causes

No particular inheritance patterns are associated with fungal endocarditis.

Causal organisms include the following:

  • Candida species (two thirds of all reported cases) [2]
  • Aspergillus species (particularly in postoperative patients, with spread from systemic and pulmonary infections, and in immunocompromised hosts) [3, 4]
  • Histoplasma capsulatum (causes pericarditis more frequently)
  • Blastomyces dermatitidis, Cryptococcus neoformans, [5] Coccidioides immitis (mostly pericarditis; rarely endocarditis)
  • Mucor species, Torulopsis glabrata, Trichosporon beigelii, Fusarium species (rare)
  • Pseudallescheria boydii (prosthetic valve endocarditis)
  • Scedosporium species [6]

Risk factors include the following:

  • Neonatal period
  • History of cardiac surgery (eg,palliative shunt procedures, complex intracardiac repairs, vascular patches, vascular grafts, prosthetic valves) [7]
  • CVC in place
  • CHA
  • Broad-spectrum antibacterial therapy
  • Intravenous drug use
  • Preexisting valvular lesion or injury, such as congenital heart disease (eg, ventricular septal defect, atrial septal defect, patent ductus arteriosus, tetralogy of Fallot), [7] bacterial endocarditis, rheumatic heart disease
  • Transient fungemia after bowel surgery
  • Any condition associated with immune compromise (eg, transplantation, leukemia)

Fungal endocarditis rarely affects native valves.

Fungal endocarditis may spread from intrathoracic (particularly pleural-based) infections.

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Contributor Information and Disclosures
Author

Sandy N Shah, DO, MBA, FACC, FACP, FACOI Cardiologist

Sandy N Shah, DO, MBA, FACC, FACP, FACOI is a member of the following medical societies: American College of Cardiology, American College of Osteopathic Internists, American College of Physicians, American Osteopathic Association, Society for Cardiovascular Angiography and Interventions, American Society of Nuclear Cardiology, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Autonomic Society, American Physiological Society

Disclosure: Received grant/research funds from Lundbeck Pharmaceuticals for none.

Chief Editor

P Syamasundar Rao, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital

P Syamasundar Rao, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey Allen Towbin, MD, MSc FAAP, FACC, FAHA, Professor, Departments of Pediatrics (Cardiology), Cardiovascular Sciences, and Molecular and Human Genetics, Baylor College of Medicine; Chief of Pediatric Cardiology, Foundation Chair in Pediatric Cardiac Research, Texas Children's Hospital

Jeffrey Allen Towbin, MD, MSc is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Association, American Society of Human Genetics, New York Academy of Sciences, Society for Pediatric Research, Texas Medical Association, Texas Pediatric Society, Cardiac Electrophysiology Society

Disclosure: Nothing to disclose.

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Candida albicans vegetation (blue arrow) in the left atrium and attached to the intra-atrial septum in a 24-week estimated gestational age newborn (courtesy of Albert Santos and Dr. Sumekala Nadaraj, New Brunswick, NJ).
Candida albicans vegetation (blue arrow) in the left atrium and attached to the intra-atrial septum in a 24-week estimated gestational age newborn (courtesy of Albert Santos and Dr. Sumekala Nadaraj, New Brunswick, NJ).
 
 
 
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