Fungal endocarditis is quite uncommon but has significant mortality, typically affecting patients who have had cardiovascular surgery, received a prolonged course of broad-spectrum antibiotics, have long-term catheter placement, are immunocompromised, or are IVDUs.10,39 Survival rates have remained poor, at approximately 15%, but improvements (approximately 30%) have been reported owing to advances in diagnosis and treatment. 9 The poor prognosis has been attributed to large vegetations, propensity for organism invasion into the myocardium, extensive septic emboli, poor antifungal penetration into the vegetation, and low toxic-to-therapeutic ratio and lack of cidal activity of certain antifungals.39,40 The two most commonly associated organisms are Candida spp. and Aspergillus spp. Lack of clinical studies makes treatment decisions difficult. Typically, combination and/or high-dose therapy in conjunction with surgery is required.

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