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Fungal endocarditis in paediatrics: a review of 192 cases (1971–2016)

Published online by Cambridge University Press:  27 March 2017

Vithiya Ganesan ,
Shunmuga Sundaram Ponnusamy  and
Raja Sundaramurthy
Vithiya Ganesan*
Affiliation:
Velammal Medical College Hospital and Research Institute, Microbiology and Interventional Cardiology, Velammal Village, Tuticorin Ring Road, Anuppanadi, Madurai, TN, India
Shunmuga Sundaram Ponnusamy
Affiliation:
Velammal Medical College Hospital and Research Institute, Microbiology and Interventional Cardiology, Velammal Village, Tuticorin Ring Road, Anuppanadi, Madurai, TN, India
Raja Sundaramurthy
Affiliation:
Velammal Medical College Hospital and Research Institute, Microbiology and Interventional Cardiology, Velammal Village, Tuticorin Ring Road, Anuppanadi, Madurai, TN, India
*
Correspondence to: V. Ganesan, Velammal Medical College Hospital and Research Institute, Microbiology, Velammal Village, Tuticorin Ring Road, Anuppanadi, Madurai, TN, 625009, India. Tel: 948632483; E-mail: vidhya.md@gmail.com
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Abstract

Background

The aims of this article were to review the published literature on fungal endocarditis in children and to discuss the aetiology and diagnosis, with emphasis on non-invasive methods and various treatment regimes.

Methods

We systematically reviewed published cases and case series of fungal endocarditis in children. We searched the literature, including PubMed and individual references for publications of original articles, single cases, or case series of paediatric fungal endocarditis, with the following keywords: “fungal endocarditis”, “neonates”, “infants”, “child”, and “cardiac vegetation”.

Results

There have been 192 documented cases of fungal endocarditis in paediatrics. The highest number of cases was reported in infants (93/192, 48%) including 60 in neonates. Of the neonatal cases, 57 were premature with a median gestational age of 27 weeks and median birth weight of 860 g. Overall, 120 yeast – fungus that grows as a single cell – infections and 43 mould – fungus that grows in multicellular filaments, hyphae – infections were reported. With increasing age, there was an increased infection rate with moulds. All the yeast infections were detected by blood culture. In cases with mould infection, diagnosis was mainly established by culture or histology of emboli or infected valves after invasive surgical procedures. There have been a few recent cases of successful early diagnosis by non-invasive methods such as blood polymerase chain reaction (PCR) for moulds. The overall mortality for paediatric fungal endocarditis was 56.25%. The most important cause of death was cardiac complications due to heart failure. Among the various treatment regimens used, none of them was significantly associated with better outcome.

Conclusions

Non-invasive methods such as PCR tests can be used to improve the chances of detecting and identifying the aetiological agent in a timely manner. Delays in the diagnosis of these infections may result in high mortality and morbidity. No significant difference was noted between combined surgical and medical therapy over exclusively combined medical therapy.

Keywords

Fungalendocarditisneonatesvegetationpaediatrics
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 8 , October 2017 , pp. 1481 - 1487
Copyright
© Cambridge University Press 2017 

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