Pediatric Fungal Endocarditis Treatment & Management

  • Author: Robert W Tolan Jr, MD; Chief Editor: Steven R Neish, MD, SM   more...
 
Updated: Jan 9, 2012
 

Medical Care

  • In fungal endocarditis (FE), aggressive antifungal therapy is always necessary but may not prove sufficient to completely alleviate the problem. Removal of the infected nidus is often central to management.
  • Provide inotropic support as required.
  • Remove the central venous catheter (CVC) when appropriate.
  • Decrease immune suppression as much as possible.
  • Provide supportive measures.
Next

Surgical Care

  • Although a small number of patients have survived with medical therapy alone, most survivors have required both medical and surgical treatment. Operative intervention is almost always required.
  • Specific indications include ongoing infection (not fully responsive to medical therapy), embolic phenomena, and cardiac decompensation.
  • Delaying operation when specific indications are present is not advantageous.
  • Thrombus removal, valve replacement, and abscess resection are the most frequent procedures.
  • The occasional neonate with a line-associated candidal infection may not require operative intervention.
Previous
Next

Consultations

  • Consultation with infectious diseases specialists, cardiologists, and cardiothoracic surgeons is often required.
  • Neonatology or critical care consultation should accompany admission to the ICU.
Previous
Next

Diet

  • As tolerated by the patient's condition and as needed for operative intervention
Previous
Next

Activity

  • As tolerated by the patient's condition and as needed for operative intervention
Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Specialty Editor Board

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, FAAP, FACC, FAHA 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, Cardiac Electrophysiology Society, New York Academy of Sciences, Society for Pediatric Research, Texas Medical Association, and Texas Pediatric Society

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM  Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine

Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association

Disclosure: Nothing to disclose.

References
  1. Marom D, Levy I, Gutwein O, Birk E, Ashkenazi S. Healthcare-associated Versus Community-associated Infective Endocarditis in Children. Pediatr Infect Dis J. Jul 2011;30(7):585-8. [Medline].

  2. Benjamin DK, Miro JM, Hoen B, et al. Candida endocarditis: contemporary cases from the International Collaboration of Infectious Endocarditis Merged Database (ICE-mD). Scand J Infect Dis. 2004;36(6-7):453-5. [Medline].

  3. Blum MD, Wiedermann BL. Aspergillus infections. In: Fletcher J, ed. Textbook of Pediatric Infectious Diseases. WB Saunders; 1998:2288-96.

  4. Nikolousis E, Velangi M. Two cases of aspergillus endocarditis in non neutropenic children on chemotherapy for acute lymphoblastic leukaemia. Hematol Rep. Jan 13 2011;3(1):e7. [Medline]. [Full Text].

  5. Alhaji M, Sadikot RT. Cryptococcal endocarditis. South Med J. May 2011;104(5):363-4. [Medline].

  6. Ahmad S, Zia S, Sarwari AR. Scedosporium prolificans endocarditis: case report and review of literature. W V Med J. Sep-Oct 2010;106(6):24-6. [Medline].

  7. Kühn C, Disqué C, Mühl H, Orszag P, Stiesch M, Haverich A. Evaluation of commercial universal rRNA gene PCR plus sequencing tests for identification of bacteria and fungi associated with infectious endocarditis. J Clin Microbiol. Aug 2011;49(8):2919-23. [Medline]. [Full Text].

  8. Smego RA Jr, Ahmad H. The role of fluconazole in the treatment of Candida endocarditis: a meta-analysis. Medicine (Baltimore). Jul 2011;90(4):237-49. [Medline].

  9. Kaufman D, Boyle R, Hazen KC, et al. Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N Engl J Med. Dec 6 2001;345(23):1660-6. [Medline].

  10. Ankola PA, Perveen S, Fish B. Fungal endocarditis. J Perinatol. Aug 2006;26(8):509-10. [Medline].

  11. Baddley JW, Benjamin DK Jr, Patel M, et al. Candida infective endocarditis. Eur J Clin Microbiol Infect Dis. Jul 2008;27(7):519-29. [Medline].

  12. Baghaei R, Moghaddam MY, Shahidi M. An unusual right atrial mass in a two-month old infant. Cardiol Young. Dec 2007;17(6):673-4. [Medline].

  13. Baltimore RS. Infective endocarditis. In: Pediatric Infectious Diseases: Principles and Practice. 2002:845-56.

  14. Benjamin DK Jr, Stoll BJ, Gantz MG, Walsh MC, Sánchez PJ, Das A, et al. Neonatal Candidiasis: Epidemiology, Risk Factors, and Clinical Judgment. Pediatrics. Sep 27 2010;[Medline].

  15. Biel MA. Photodynamic therapy of bacterial and fungal biofilm infections. Methods Mol Biol. 2010;635:175-94. [Medline].

  16. Chopra T, Bhargava A, Kumar S, et al. Candida kefyr endocarditis in a patient with hypertrophic obstructive cardiomyopathy. Am J Med Sci. Feb 2010;339(2):188-9. [Medline].

  17. Davutoglu V, Ercan S, Tekbas E. Cardiac aspergillosis: endocardial or endomyocardial?. Int J Infect Dis. Sep 2011;15(9):e653. [Medline].

  18. Day MD, Gauvreau K, Shulman S, Newburger JW. Characteristics of children hospitalized with infective endocarditis. Circulation. Feb 17 2009;119(6):865-70. [Medline].

  19. Divekar A, Rebekya IM, Soni R. Late Onset Candida parapsilosis Endocarditis After Surviving Nosocomial Candidemia in an Infant With Structural Heart Disease. Pediatr Infect Dis J. May 2004;23(5):472-475. [Medline].

  20. Ellis ME, Al-Abdely H, Sandridge A, et al. Fungal endocarditis: evidence in the world literature, 1965-1995. Clin Infect Dis. Jan 2001;32(1):50-62. [Medline].

  21. Falcone M, Barzaghi N, Carosi G, Grossi P, Minoli L, Ravasio V, et al. Candida infective endocarditis: report of 15 cases from a prospective multicenter study. Medicine (Baltimore). May 2009;88(3):160-8. [Medline].

  22. Garcia-Teresa MA, Casado-Flores J, Delgado Dominguez MA, et al. Infectious complications of percutaneous central venous catheterization in pediatric patients: a Spanish multicenter study. Intensive Care Med. Mar 2007;33(3):466-76. [Medline].

  23. Grizelj R, Vukovic J, Saric D, Luetic T. Giant mycotic right atrial thrombus due to Candida dubliniensis septicemia in a premature infant. Pediatr Infect Dis J. Aug 2010;29(8):785-6. [Medline].

  24. Guzman-Cottrill JA, Zheng X, Chadwick EG. Fusarium solani endocarditis successfully treated with liposomal amphotericin B and voriconazole. Pediatr Infect Dis J. Nov 2004;23(11):1059-61. [Medline].

  25. Hallum JL, Williams TW Jr. Candida endocarditis. In: Bodey GP, ed. Candidiasis: Pathogenesis, Diagnosis, and Treatment. 2nd ed. Lippincott-Raven; 1993:357-69.

  26. Hughes WT, Flynn PM. Candidiasis. In: Fletcher J, ed. Textbook of Pediatric Infectious Diseases. 4th ed. WB Saunders; 1998:2303-13.

  27. Karatza AA, Dimitriou G, Marangos M, Christofidou M, Pavlou V, Giannakopoulos I, et al. Successful resolution of cardiac mycetomas by combined liposomal Amphotericin B with Fluconazole treatment in premature neonates. Eur J Pediatr. Sep 2008;167(9):1021-3. [Medline].

  28. Kothari A, Pillai BS, Bhan A. Pacing lead endocarditis due to Aspergillus fumigatus. Indian J Med Microbiol. Jan-Mar 2010;28(1):72-3. [Medline].

  29. La Via WV, Koulouri S, Ross LA, et al. Right atrial mass in a child with disseminated coccidioidomycosis. Pediatr Infect Dis J. May 2005;24(5):470-2. [Medline].

  30. Levy I, Shalit I, Askenazi S, et al. Duration and outcome of persistent candidaemia in newborn infants. Mycoses. May 2006;49(3):197-201. [Medline].

  31. Levy I, Shalit I, Birk E, et al. Candida endocarditis in neonates: report of five cases and review of the literature. Mycoses. Jan 2006;49(1):43-8. [Medline].

  32. Luciani GB, Casali G, Viscardi F, et al. Tricuspid valve repair in an infant with multiple obstructive Candida mycetomas. Ann Thorac Surg. Dec 2005;80(6):2378-81. [Medline].

  33. Marodi L, Johnston RB Jr. Invasive Candida species disease in infants and children: occurrence, risk factors, management, and innate host defense mechanisms. Curr Opin Pediatr. Dec 2007;19(6):693-7. [Medline].

  34. Mayayo E, Moralejo J, Camps J, Guarro J. Fungal endocarditis in premature infants: case report and review. Clin Infect Dis. Feb 1996;22(2):366-8. [Medline].

  35. Millar BC, Jugo J, Moore JE. Fungal Endocarditis in Neonates and Children. Pediatr Cardiol. 11 18 2004;[Medline].

  36. Mitchell ME, McManus M, Dietz J, Camitta BM, Szabo S, Havens P. Absidia corymbifera endocarditis: survival after treatment of disseminated mucormycosis with radical resection of tricuspid valve and right ventricular free wall. J Thorac Cardiovasc Surg. Apr 2010;139(4):e71-2. [Medline].

  37. Moreno-Martinez FL, Lopez FH, Bermudez R, et al. A case report of fungal mitral-valve endocarditis. MedGenMed. Jan 28 2003;5(1):9. [Medline].

  38. Mrowczynski W, Wojtalik M. Caspofungin for Candida endocarditis. Pediatr Infect Dis J. Apr 2004;23(4):376. [Medline].

  39. Nadir E, Rubinstein E. Fungal Endocarditis. Curr Infect Dis Rep. Aug 2004;6(4):276-282. [Medline].

  40. Noyola DE, Fernandez M, Moylett EH, Baker CJ. Ophthalmologic, visceral, and cardiac involvement in neonates with candidemia. Clin Infect Dis. Apr 1 2001;32(7):1018-23. [Medline].

  41. Odio CM, Araya R, Pinto LE, et al. Caspofungin therapy of neonates with invasive candidiasis. Pediatr Infect Dis J. Dec 2004;23(12):1093-7. [Medline].

  42. Overturf GD. Focal bacterial infections. In: Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. WB Saunders; 2006:347-84.

  43. Ozkiraz S, Tarcan A, Gokmen Z, et al. Invasive Candida albicans infection mimicking leukemia in a neonate. J Matern Fetal Neonatal Med. Jul 2007;20(7):555-7. [Medline].

  44. Pai MP, Samples ML, Mercier RC, Spilde MN. Activities and ultrastructural effects of antifungal combinations against simulated Candida endocardial vegetations. Antimicrob Agents Chemother. Jul 2008;52(7):2367-76. [Medline].

  45. Palomares JC, Bernal S, Marín M, Holgado VP, Castro C, Morales WP, et al. Molecular diagnosis of Aspergillus fumigatus endocarditis. Diagn Microbiol Infect Dis. Aug 2011;70(4):534-7. [Medline].

  46. Philippe B, Grenet D, Honderlick P, et al. Severe Aspergillus endocarditis in a lung transplant recipient with a five-year survival. Transpl Infect Dis. Jun 2010;12(3):273-6. [Medline].

  47. Robertson J, Shilkofski N. Drug doses. In: The Harriet Lane Handbook: A Manual for Pediatric House Officers. Philadelphia, PA: Mosby; 2005:679-1009.

  48. Rodriguez D, Almirante B, Park BJ, et al. Candidemia in neonatal intensive care units: Barcelona, Spain. Pediatr Infect Dis J. Mar 2006;25(3):224-9. [Medline].

  49. Sanchez PJ, Siegel JD, Fishbein J. Candida endocarditis: successful medical management in three preterm infants and review of the literature. Pediatr Infect Dis J. Mar 1991;10(3):239-43. [Medline].

  50. Starke JR. Infective endocarditis. In: Fletcher J, ed. Textbook of Pediatric Infectious Diseases. 4th ed. WB Saunders; 1998:315-38.

  51. Steinbach WJ, Benjamin DK. New antifungal agents under development in children and neonates. Curr Opin Infect Dis. Dec 2005;18(6):484-9. [Medline].

  52. Steinbach WJ, Perfect JR, Cabell CH, et al. A meta-analysis of medical versus surgical therapy for Candida endocarditis. J Infect. Oct 2005;51(3):230-47. [Medline].

  53. Talarmin JP, Boutoille D, Tattevin P, Abgueguen P, Ansart S, Roblot F, et al. Candida endocarditis: role of new antifungal agents. Mycoses. Jan 2009;52(1):60-6. [Medline].

  54. Tissières P, Jaeggi ET, Beghetti M, Gervaix A. Increase of fungal endocarditis in children. Infection. Aug 2005;33(4):267-72. [Medline].

  55. Tolan RW, Kleiman MB, Frank M, et al. Operative intervention in active endocarditis in children: report of a series of cases and review. Clin Infect Dis. Apr 1992;14(4):852-62. [Medline].

  56. Varghese GM, Sobel JD. Fungal endocarditis. Curr Infect Dis Rep. Jul 2008;10(4):275-9. [Medline].

  57. Weinstein L, Brusch JL. Microbiology of infective endocarditis and clinical correlates: gram-negative and other organisms. In: Infective Endocarditis. Oxford University Press; 1996:73-122.

  58. Weinstein L, Brusch JL. Pediatric endocarditis. In: Infective Endocarditis. Oxford University Press;1996:229-35.

  59. Wertz KK, Pretzlaff RK. Caspofungin in a pediatric patient with persistent candidemia. Pediatr Crit Care Med. Mar 2004;5(2):181-3. [Medline].

  60. Wong CW, Porter G, Tisch J, Young C. Outcome and prognostic factors on 57 cases of infective endocarditis in a single centre. N Z Med J. Oct 9 2009;122(1304):54-62. [Medline].

  61. Yellapu RK, Mittal V, Grewal P. Education and Imaging. Hepatobiliary and pancreatic: Candida liver abscesses associated with endocarditis. J Gastroenterol Hepatol. May 2010;25(5):1017. [Medline].

Previous
Next
 
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).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.