Fungal prosthetic valve endocarditis: Mayo Clinic experience with a clinicopathological analysis

Fungal prosthetic valve endocarditis is a rare but devastating disease. To better characterise this syndrome, we retrospectively reviewed 21 cases of fungal prosthetic valve endocarditis seen at Mayo Clinic over the past 40 years. The average patient age was 65 years with a 2 : 1 male predominance. Twelve of 21 cases (57%) occurred within 1 year of prosthetic valve placement. The aortic valve was most commonly affected, and the most common aetiological agent was Candida species, followed by Histoplasma capsulatum. Although 20 of 21 patients (95%) were immunocompetent, they had other risk factors for fungal infection. Patients typically presented with systemic signs and symptoms of infection, and cardiac imaging was abnormal in 68% of cases. Pathological evaluation of valve material was of high yield, with organisms identified in 92% of cases who underwent valve replacement surgery or had an autopsy performed. Prosthetic valve fungal endocarditis was associated with a high morbidity and mortality, with 67% of patients experiencing complications and 57% of patients dying of infection-related disease. Hopefully, with the prompt institution of early medical therapy, surgical intervention and lifelong oral antifungal suppressive therapy, cure rates will continue to improve.