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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: [email protected]
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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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References

1. Andreas, HG, Emmanuel, R, Thomas, JW. Chapter 22, Section 3: Fungal infections in pediatric patients. In Clinical Mycology, 2009, Thu Nguyen/Sue Hodgson, 481-500, Elsevier Health Sciences, UK.Google Scholar
2. Millar, BC, Jugo, J, Moore, JE. Fungal endocarditis in neonates and children. Pediatr Cardiol, 2005; 26: 517–536.Google Scholar
3. Grizelj, R, Vuković, J, Sarić, D, et al. Giant mycotic right atrial thrombus due to Candida dubliniensis septicemia in a premature infant. Pediatr Infect Dis J 2010; 29: 785–786.Google Scholar
4. Patted, SV, Halkati, PC, Yavagal, ST, et al. Candida krusei infection presenting as a right ventricular mass in a two month old Infant. Ann Pediatr Cardiol 2009; 2: 170–172.Google Scholar
5. Ruiz-Esquide, EF, Diaz, JMC, Wu, HE, Silva, VV. Saccharomyces cerevisiae endocarditis in a preterm infant. Report of one case. Rev Med Child 2002; 130: 1165–1169.Google Scholar
6. Tissieres, P, Gervaix, A, Beghetti, M, Jaeggi, ET. Value and limitations of the von Reyn, Duke, and modified Duke criteria for the diagnosis of infective endocarditis in children. Pediatrics 2003; 112: E467–E471.Google Scholar
7. Sundaram, PS, Bijulal, S, Tharakan, JA, et al. Kodamaea ohmeri tricuspid valve endocarditis with right ventricular inflow obstruction in a neonate with structurally normal heart. Ann Pediatr Cardiol 2011; 4: 77–80.CrossRefGoogle Scholar
8. Seriki, O, Aderele, WI, Johnson, A, Smith, JA. Disseminated histoplasmosis due to histoplasma capsulatum in two Nigerian children. J Trop Med Hyg 1975; 78: 248–255.Google Scholar
9. Naveh, Y, Friedman, A, Merzbach, D, Hashman, N. Endocarditis caused by Rhodotorula successfully treated with 5-fluorocytosine. Br Heart J 1975; 37: 101–104.CrossRefGoogle ScholarPubMed
10. Muro, MD, Motta Fde, A, Burger, M, Melo, AS, Dalla-Costa, LM. Echinocandin resistance in two Candida haemulonii isolates from pediatric patients. J Clin Microbiol 2012; 50: 3783–3785.Google Scholar
11. 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 2010; 139: e71–e72.Google Scholar
12. Mishra, RC, Barik, R, Arif, MA, Malempati, AR. Right atrial fungal endocarditis with bilateral extensive pulmonary infiltration caused by Neoscytalidium dimidiatum in an immunocompetent child: first case report from India. Indian J Thorac Cardiovasc Surg 2016; 32: 23–26.Google Scholar
13. Sutton, A. Miconazole in systemic candidiasis. Arch Dis Child 1983; 58: 319.Google Scholar
14. Miranda, JO, de Sousa, AR, Monterroso, J. Aspergillus endocarditis in a paediatric patient after a cardiac surgery, associated with septic pulmonary embolism and pulmonary hypertension. Cardiol Young 2015; 25: 563–565.CrossRefGoogle Scholar
15. Badiee, P, Amirghofran, AA, Ghazi Nour, M, Shafa, M, Nemati, MH. Incidence and outcome of documented fungal endocarditis. Int Cardiovasc Res J 2014; 8: 152–155.Google Scholar
16. Casson, DH, Riordan, FAI, Ladusens, EJ. Aspergillus endocarditis in chronic granulomatous disease. Acta Paediatr 1996; 85: 758–759.CrossRefGoogle ScholarPubMed
17. Nikolousis, E, Velangi, M. Two cases of aspergillus endocarditis in non neutropenic children on chemotherapy for acute lymphoblastic leukaemia. Hematol Rep 2011; 3: e7.Google Scholar
18. Babayigit, A, Cebeci, B, Buyukkale, G, et al. Treatment of neonatal fungal infective endocarditis with recombinant tissue plasminogen: activator in a low birth weight infant case report and review of the literature. Mycoses 2015; 58: 578–581.Google Scholar
19. Marks, KA, Zucker, N, Kapelushnik, J, Karplus, M, Levitas, A. Infective endocarditis successfully treated in extremely low birth weight infants with recombinant tissue plasminogen activator. Pediatrics 2002; 109: 153–158.Google Scholar
20. Aydemir, C, Erdeve, O, Oguz, SS, Altug, N, Dilmen, U. Successful treatment of Candida albicans endocarditis vegetations with recombinant tissue plasminogen activator in an extremely low birth weight preterm infant. Mycoses 2011; 54: e590–e592.Google Scholar
21. Murray, PR, Masur, H. Current approaches to the diagnosis of bacterial and fungal bloodstream infections in the intensive care unit. Crit Care Med 2012; 40: 3277–3282.Google Scholar
22. Guzman-Cottrill, JA, Zheng, X, Chadwick, EG. Fusariumsolani endocarditis successfully treated with liposomal amphotericin B and voriconazole. Pediatr Infect Dis J 2004; 23: 1059–1061.Google Scholar
23. Guinvarc’h, A, Guilbert, L, Marmorat-Khuong, A, et al. Disseminated Fusariumsolani infection with endocarditis in a lung transplant recipient. Mycoses 1998; 41: 59–61.Google Scholar
24. Guzman-Cottrill, JA, Xiaotian Zheng, DO, Chadwick, EG. Fusariumsolaniendocarditis successfully treated with liposomal amphotericin B and voriconazole. Pediatr Infect Dis J 2004; 23: 1059–1061.Google Scholar
25. Sobottka, I, Deneke, J, Pothmann, W, Heinemann, A, Mack, D. Fatal native valve endocarditis due to Scedosporium apiospermum (Pseudallescheria boydii) following trauma. Eur J Clin Microbiol Infect Dis 1999; 18: 387–389.Google Scholar
26. Gavin, PJ, Sutton, DA, Katz, BZ. Fatal endocarditis in a neonate caused by the dematiaceous fungus Phialemonium obovatum: case report and review of the literature. J Clin Microbiol 2002; 40: 2207–2212.Google Scholar
27. Badiee, P, Amirghofran, AA, Ghazi Nour, M. Evaluation of noninvasive methods for the diagnosis of fungal endocarditis. Med Mycol 2014; 52: 530–536.CrossRefGoogle ScholarPubMed
28. Walsh, TJ, Hutchins, GM. Aspergillus mural endocarditis. Am J Clin Pathol 1979; 71: 640–644.Google Scholar
29. van de Glind, GJ, Gidding, CE, Verlaat, CM, et al. Acute cardiac failure due to intra-atrial mass caused by zygomycetes in an immunocompromised paediatric patient. Case Rep Med 2010; 2010: 241791, 5 pp.Google Scholar
30. Barst, RJ, Prince, AS, Neu, HC. Aspergillus endocarditis in children: case report and review of the literature. Pediatrics 1981; 68: 73–78.Google Scholar
31. Emel, A, Hulya, B, Ahmet, S, Eren, O. Successful treatment of Candida parapsilosis fungemia in two preterms with voriconazole. Case Rep Pediatr 2015; 2015: 402137, 3 pp.Google Scholar
32. Sharma, J, Nagraj, A, Allapathi, D, Rajegowda, B, Leggiadro, R. Fungal endocarditis in a premature infant complicated by a right atrial mycetoma and inferior vena cava thrombosis. Images Paediatr Cardiol 2009; 11: 6–11.Google Scholar
33. Karatza, AA, Dimitiou, G, Marangos, M, et al. Successful resolution of cardiac mycetomas by combined liposomal Amphotericin B with Fluconazole treatment in premature neonates. Eur J Pediatr 2008; 167: 1021–1023.Google Scholar
34. Goksu Cetinkaya, AP, Yavuz, T, Karatekin, G. Eustachian valve fungal endocarditis in neonate. J Case Rep 2015; 5: 532–534.Google Scholar
35. Levitas, A, Krymko, H, Richardson, J, Zalzstein, E, Ioffe, V. Recombinant tissue plasminogen activator as a novel treatment option for infective endocarditis: a retrospective clinical study in 32 children. Cardiol Young 2016; 26: 110–115.Google Scholar