Fungal endocarditis (Candidiasis)

The photo is from an immunocomprised patient with a fungus ball attached to the posterior leaflet of the mitral valve and to the chordae.  Such a lesion predisposes to embolism.

Fungal endocarditis (FE) is relatively rare. It is most likely to occur in neonates, the immunosuppressed, the postoperative cardiac surgery patient, the patient undergoing central hyperalimentation, or the IV drug user. Pre-existing valvular lesions or prosthetic valves increase the risk. The vegetations tend to embolize and at times the diagnosis is not made until pathological examination of an embolus. In neonates it can be associated with a disseminated fungus infection – neonatal candidiasis. Candida accounts for the majority of cases of FE. Other organisms associated with FE include aspergillus, histoplasma, cryptococcus, and mucor. The prognosis is poor because of poor response to therapy and, in some cases, the extensive comorbid conditions.