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Pediatric Fungal Endocarditis Workup

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

Laboratory Studies

In fungal endocarditis (FE), blood cultures may be persistently positive despite therapy, especially with Candida infection. However, culture is often negative; less than one half of candidal endocarditis cases yield positive blood cultures, and other causative organisms are even less frequently identified in blood.

Culture of urine, sputum, cerebrospinal fluid, synovial fluid, lymph node, and/or bone marrow may offer the only evidence of systemic fungal infection.

The CBC count may reveal leukocytosis with or without a left shift. Thrombocytopenia may be seen with fungal infections in general in the neonate.

Erythrocyte sedimentation rates and/or C-reactive protein levels may be elevated, although this is unusual in neonates.

Urinalysis may demonstrate hematuria, proteinuria, and/or casts.

Urine for Histoplasma antigen may be positive.

Polymerase chain reaction (PCR) on blood and/or valve tissue has been described.[8]

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Imaging Studies

Chest radiography

Chest radiography may reveal cardiomegaly.

Chest radiography may indicate embolic pulmonary infiltrates or pleural effusions.

Echocardiography

Transthoracic echocardiography is less sensitive than transesophageal echocardiography but is also less invasive.

Vegetations and intracardiac thrombi are the most common types but are still rare.

Echocardiography may demonstrate pericardial effusion.

Normal valves are rarely involved.

Echocardiography may suggest myocardial abscesses.

Echocardiography may demonstrate associated myocarditis or pericarditis.

Magnetic resonance imaging

Magnetic resonance imaging is particularly useful in identifying ring abscesses.

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Other Tests

Fungal smears and cultures of operative specimens

Electrocardiography is usually nonspecific, although it may demonstrate supraventricular arrhythmias, QRS changes, and/or marked T-wave changes, particularly with myocarditis.

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Procedures

Cardiac catheterization

Catheterization may reveal vegetations, thrombi, or underlying cardiac abnormalities.

It should be performed with care in the context of active infection.

Postcatheterization precautions include hemorrhage, vascular disruption after balloon dilation, pain, nausea and vomiting, and arterial or venous obstruction from thrombosis or spasm.

Complications may include rupture of blood vessel, tachyarrhythmias, bradyarrhythmias, and vascular occlusion.

Contrast-enhanced central venous catheter

Contrast-enhanced central venous catheter (CVC) injection studies may reveal a catheter-associated thrombus.

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Histologic Findings

Biopsy or operative specimens should be cultured and special stains should be used to reveal acute and chronic inflammation and/or fungal elements.

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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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