Fungal endocarditis.

Fungal endocarditis (FE) is an increasingly prevalent and devastating disease in today's highly advancing medical practice. With more patients receiving broad-spectrum antibiotics or invasive interventions including long-term central venous catheters or prosthetic heart valve placements, FE is increasingly reported. Recognizing FE early can be difficult, because it often lacks some classic signs and symptoms found in bacterial endocarditis. Diagnosis can be further complicated by the difficulty of making FE meet the Duke Criteria, because blood cultures are often negative, despite vegetations demonstrated on echocardiography. Newer diagnostic modalities show some potential for future use; however, these methods are not yet ready to use for reliable diagnosis. Overall, the burden of diagnosis still lies with clinicians: they need a high index of suspicion for the entity by understanding the organisms and the patients who are likely to be infected. FE can only be effectively treated and its potential deadly outcomes avoided when it is recognized early. New antifungal agents such as second-generation triazoles and echinocandins demonstrate a dramatically improved toxicity profile compared to amphotericin B and increase optimism regarding FE management.