Diagnostic, cardiac imaging, and management considerations in fungal infective endocarditis: a contemporary narrative review.

Authors

Jan K Kalinski, Bo Xu

Published in

Cardiovascular diagnosis and therapy. Volume 16. Issue 3. Pages 51. Jun 18, 2026. Epub Jun 12, 2026.

Abstract

Fungal infective endocarditis (FIE) is a rare but clinically important cause of endocarditis that poses unique challenges to diagnosis and treatment. As clinicians are faced with an aging population, increasing utilization of prosthetic valves and implantable cardiac devices, as well as increasing use of immunosuppressive therapies, which are known risk factors, familiarity with FIE is increasingly relevant. This narrative review presents the current state of knowledge concerning laboratory diagnosis, imaging tools, and treatment of FIE.
A comprehensive literature search was conducted using PubMed between January 2000 and September 2025. Original research, reviews, meta-analyses, guideline documents, and consensus statements were considered. Individual case reports and non-English publications were excluded.
FIE is caused by a wide range of pathogens, with the most common etiological organisms being Candida spp. followed by Aspergillus spp. and Histoplasma spp. Laboratory diagnostic methods are wide-ranging and specific to different genera of fungi. Blood cultures yield negative results in the case of various fungal infections, and for this reason, molecular diagnostic methods such as circulating cell-free DNA (cfDNA) and real-time polymerase chain reaction (PCR) are increasingly being used. Cardiac imaging, particularly echocardiography, remains a cornerstone of diagnosis, though increasingly cardiac computed tomography (CT) and 18-fluorine fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) are being recommended to improve sensitivity of the current diagnostic criteria of infective endocarditis (IE). Treatment often requires definitive cardiac surgery and systemic antifungal therapy.
The prognosis of FIE continues to be poor, likely owing to difficulties that exist in both diagnosis and treatment. Broader awareness of the risk factors, nuanced diagnostic options and management considerations may serve to improve patient outcomes.

PMID:
42428660
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.

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