Medical Care

Patients with fungal endocarditis (FE) require monitoring in an ICU setting.

Note the following:

In fungal endocarditis, 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.
Disappointingly, of the many treatment regimens examined, no single regimen used appears to produce a better outcome than other regimens tried. ^[12]

Consultations

Consultation with infectious diseases specialists, cardiologists, and cardiothoracic surgeons is often required.

Neonatology or critical care consultation should accompany admission to the ICU.

Transfer

Arrange for transfer if the appropriate resources are not locally available.

Diet and activity

Diet and activity are as tolerated by the patient's condition and as needed for operative intervention.

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.^{[15, 16]}Note the following:

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.

Medication

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Media Gallery

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).