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Candida endocarditis and suppurative thrombophlebitis

Carol A Kauffman, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD


Candida endocarditis is one of the most serious manifestations of candidiasis, and Candida is the most common cause of fungal endocarditis, causing over half of all cases. In a 2001 review of 270 cases of fungal endocarditis in the world literature, the following distribution of organisms was noted [1]:

Candida albicans – 24 percent

Non-albicans species of Candida – 28 percent

Aspergillus species – 24 percent

Histoplasma capsulatum – 6 percent


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Literature review current through: Sep 2016. | This topic last updated: Oct 4, 2016.
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  1. Ellis ME, Al-Abdely H, Sandridge A, et al. Fungal endocarditis: evidence in the world literature, 1965-1995. Clin Infect Dis 2001; 32:50.
  2. Pierrotti LC, Baddour LM. Fungal endocarditis, 1995-2000. Chest 2002; 122:302.
  3. Mayayo E, Moralejo J, Camps J, Guarro J. Fungal endocarditis in premature infants: case report and review. Clin Infect Dis 1996; 22:366.
  4. Muehrcke DD, Lytle BW, Cosgrove DM 3rd. Surgical and long-term antifungal therapy for fungal prosthetic valve endocarditis. Ann Thorac Surg 1995; 60:538.
  5. Melgar GR, Nasser RM, Gordon SM, et al. Fungal prosthetic valve endocarditis in 16 patients. An 11-year experience in a tertiary care hospital. Medicine (Baltimore) 1997; 76:94.
  6. Nguyen MH, Nguyen ML, Yu VL, et al. Candida prosthetic valve endocarditis: prospective study of six cases and review of the literature. Clin Infect Dis 1996; 22:262.
  7. Miró JM, Puig de la Bellacasa J, Odds FC, et al. Systemic candidiasis in Spanish heroin addicts: a possible source of infection. J Infect Dis 1987; 156:857.
  8. Noyola DE, Fernandez M, Moylett EH, Baker CJ. Ophthalmologic, visceral, and cardiac involvement in neonates with candidemia. Clin Infect Dis 2001; 32:1018.
  9. Bisbe J, Miro JM, Latorre X, et al. Disseminated candidiasis in addicts who use brown heroin: report of 83 cases and review. Clin Infect Dis 1992; 15:910.
  10. Levy I, Shalit I, Birk E, et al. Candida endocarditis in neonates: report of five cases and review of the literature. Mycoses 2006; 49:43.
  11. Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.
  12. Arnold CJ, Johnson M, Bayer AS, et al. Candida infective endocarditis: an observational cohort study with a focus on therapy. Antimicrob Agents Chemother 2015; 59:2365.
  13. Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435.
  14. Kuehnert MJ, Clark E, Lockhart SR, et al. Candida albicans endocarditis associated with a contaminated aortic valve allograft: implications for regulation of allograft processing. Clin Infect Dis 1998; 27:688.
  15. Nasser RM, Melgar GR, Longworth DL, Gordon SM. Incidence and risk of developing fungal prosthetic valve endocarditis after nosocomial candidemia. Am J Med 1997; 103:25.
  16. Rubinstein E, Noriega ER, Simberkoff MS, et al. Fungal endocarditis: analysis of 24 cases and review of the literature. Medicine (Baltimore) 1975; 54:331.
  17. Ellis M. Fungal endocarditis. J Infect 1997; 35:99.
  18. Melamed R, Leibovitz E, Abramson O, et al. Successful non-surgical treatment of Candida tropicalis endocarditis with liposomal amphotericin-B (AmBisome). Scand J Infect Dis 2000; 32:86.
  19. Czwerwiec FS, Bilsker MS, Kamerman ML, Bisno AL. Long-term survival after fluconazole therapy of candidal prosthetic valve endocarditis. Am J Med 1993; 94:545.
  20. Lejko-Zupanc T, Kozelj M. A case of recurrent Candida parapsilosis prosthetic valve endocarditis: cure by medical treatment alone. J Infect 1997; 35:81.
  21. Aaron L, Therby A, Viard JP, et al. Successful medical treatment of Candida albicans in mechanical prosthetic valve endocarditis. Scand J Infect Dis 2003; 35:351.
  22. Zahid MA, Klotz SA, Hinthorn DR. Medical treatment of recurrent candidemia in a patient with probable Candida parapsilosis prosthetic valve endocarditis. Chest 1994; 105:1597.
  23. Castiglia M, Smego RA Jr, Sames EL. Candida endocarditis and amphotericin B intolerance: potential role for fluconazole. Infect Dis Clin Pract 1994; 3:248.
  24. Wells CJ, Leech GJ, Lever AM, Wansbrough-Jones MH. Treatment of native valve Candida endocarditis with fluconazole. J Infect 1995; 31:233.
  25. Venditti M, De Bernardis F, Micozzi A, et al. Fluconazole treatment of catheter-related right-sided endocarditis caused by Candida albicans and associated with endophthalmitis and folliculitis. Clin Infect Dis 1992; 14:422.
  26. Mayrer AR, Brown A, Weintraub RA, et al. Successful medical therapy for endocarditis due to Candida parapsilosis. A clinical and epidemiologic study. Chest 1978; 73:546.
  27. Westling K, Thalme A, Julander I. Candida albicans tricuspid valve endocarditis in an intravenous drug addict: successful treatment with fluconazole. Scand J Infect Dis 2005; 37:310.
  28. Jiménez-Expósito MJ, Torres G, Baraldés A, et al. Native valve endocarditis due to Candida glabrata treated without valvular replacement: a potential role for caspofungin in the induction and maintenance treatment. Clin Infect Dis 2004; 39:e70.
  29. Rajendram R, Alp NJ, Mitchell AR, et al. Candida prosthetic valve endocarditis cured by caspofungin therapy without valve replacement. Clin Infect Dis 2005; 40:e72.
  30. Smego RA Jr, Ahmad H. The role of fluconazole in the treatment of Candida endocarditis: a meta-analysis. Medicine (Baltimore) 2011; 90:237.
  31. Steinbach WJ, Perfect JR, Cabell CH, et al. A meta-analysis of medical versus surgical therapy for Candida endocarditis. J Infect 2005; 51:230.
  32. Talarmin JP, Boutoille D, Tattevin P, et al. Candida endocarditis: role of new antifungal agents. Mycoses 2009; 52:60.
  33. Cornely OA, Lasso M, Betts R, et al. Caspofungin for the treatment of less common forms of invasive candidiasis. J Antimicrob Chemother 2007; 60:363.
  34. De Rosa FG, D'Avolio A, Corcione S, et al. Anidulafungin for Candida glabrata infective endocarditis. Antimicrob Agents Chemother 2012; 56:4552.
  35. Mrówczyński W, Wojtalik M. Caspofungin for Candida endocarditis. Pediatr Infect Dis J 2004; 23:376.
  36. Bacak V, Biocina B, Starcevic B, et al. Candida albicans endocarditis treatment with caspofungin in an HIV-infected patient--case report and review of literature. J Infect 2006; 53:e11.
  37. Lye DC, Hughes A, O'Brien D, Athan E. Candida glabrata prosthetic valve endocarditis treated successfully with fluconazole plus caspofungin without surgery: a case report and literature review. Eur J Clin Microbiol Infect Dis 2005; 24:753.
  38. López-Ciudad V, Castro-Orjales MJ, León C, et al. Successful treatment of Candida parapsilosis mural endocarditis with combined caspofungin and voriconazole. BMC Infect Dis 2006; 6:73.
  39. Falcone M, Barzaghi N, Carosi G, et al. Candida infective endocarditis: report of 15 cases from a prospective multicenter study. Medicine (Baltimore) 2009; 88:160.
  40. Lefort A, Chartier L, Sendid B, et al. Diagnosis, management and outcome of Candida endocarditis. Clin Microbiol Infect 2012; 18:E99.
  41. Moudgal V, Little T, Boikov D, Vazquez JA. Multiechinocandin- and multiazole-resistant Candida parapsilosis isolates serially obtained during therapy for prosthetic valve endocarditis. Antimicrob Agents Chemother 2005; 49:767.
  42. Gilbert HM, Peters ED, Lang SJ, Hartman BJ. Successful treatment of fungal prosthetic valve endocarditis: case report and review. Clin Infect Dis 1996; 22:348.
  43. Penk A, Pittrow L. Role of fluconazole in the long-term suppressive therapy of fungal infections in patients with artificial implants. Mycoses 1999; 42 Suppl 2:91.
  44. Baley JE, Meyers C, Kliegman RM, et al. Pharmacokinetics, outcome of treatment, and toxic effects of amphotericin B and 5-fluorocytosine in neonates. J Pediatr 1990; 116:791.
  45. Friedland IR. Peripheral thrombophlebitis caused by Candida. Pediatr Infect Dis J 1996; 15:375.
  46. Benoit D, Decruyenaere J, Vandewoude K, et al. Management of candidal thrombophlebitis of the central veins: case report and review. Clin Infect Dis 1998; 26:393.
  47. Block AA, Thursky KA, Worth LJ, Slavin MA. Thrombolytic therapy for management of complicated catheter-related Candida albicans thrombophlebitis. Intern Med J 2009; 39:61.
  48. Pan SC, Hsieh SM, Chang SC, et al. Septic Candida krusei thrombophlebitis of inferior vena cava with persistent fungemia successfully treated by new antifungal agents. Med Mycol 2005; 43:731.