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      Fungal endocarditis: evidence in the world literature, 1965-1995.

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          Abstract

          We analyzed 270 cases of fungal endocarditis (FE) that occurred over 30 years. Vascular lines, non-cardiac surgery, immunocompromise and injection drug abuse are increasing risk factors. Delayed or mistaken diagnosis (82% of patients), long duration of symptoms before hospitalization (mean +/- standard deviation, 32+/-39 days) and extracardiac manifestations were characteristic. From 1988 onwards, 72% of patients were diagnosed preoperatively, compared with 43% before 1988 (P=.0001). The fungi most commonly isolated were Candida albicans (24% of patients), non-albicans species of Candida (24%), Apergillus species (24%), and Histoplasma species (6%); recently-emerged fungi accounted for 25% of cases. The mortality rate was 72%. Survival rates were better among patients who received combined surgical-antifungal treatment, were infected with Candida, and had univalvular involvement. Improvement in the survival rate (from <20% before 1974 to 41% currently) coincided with the introduction of echocardiography and with improved diagnostic acumen. Fungal endocarditis recurs in 30% of survivors. It is recommended that fungal endocarditis be diagnosed early through heightened diagnostic acumen; that patients be treated with combined lipid-based amphotericin B and early surgery; and that patients be followed up for > or =4 years while on prophylactic antifungal therapy.

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          Author and article information

          Journal
          Clin Infect Dis
          Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
          University of Chicago Press
          1058-4838
          1058-4838
          Jan 2001
          : 32
          : 1
          Affiliations
          [1 ] Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. michael.ellis@uaeu.ac.ae
          Article
          CID994352
          10.1086/317550
          11118386
          2d35f9c2-e00b-43a0-a1b1-a130f2bc2fd3
          History

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