Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1979 Sep;55(647):632–641. doi: 10.1136/pgmj.55.647.632

Fungal endocarditis: patients at risk and their treatment

M S Seelig, P Goldberg, P J Kozinn, A R Berger
PMCID: PMC2425646  PMID: 392478

Abstract

Fungal endocarditis is not rare. It usually develops in patients with abnormal or surgically traumatized hearts, to whose blood fungi have gained access, perhaps during temporary (often iatrogenic) impairment of host defences. Although the blood is cleared rapidly, the fungus can establish itself in the endocardium, where it grows slowly. Thus, clinical and laboratory procedures (including blood and urine cultures) that have permitted early diagnosis and treatment of bacterial endocarditis, are not reliable in early fungal endocarditis. Greater reliance must be placed on serological monitoring of patients who have had transient fungaemia and are at risk of endocarditis. The clinician must consider factors that enhance fungal proliferation and invasion and be cognizant of its dangers - even in the absence of clear signs of infection. Prophylactic measures should be employed to protect the patient at risk, including topical, oral and systemic use of appropriate antifungal agents. Early therapy, the extent and duration of which can be determined by (1) obtaining the MIC of transitory blood or urine isolates - which should not be ignored - and (2) monitoring serology, might eliminate early invaders of the endocardium. Sixty-four reported cures of fungal endocarditis caused by Candida, the most common fungal pathogen, are tabulated, 29 were of classic fungal endocarditis requiring surgery, 3 of whom were seen later by others as fatal recurrences. Those treated early (shortly after candidaemia was diagnosed - mostly in patients on treatment for bacterial endocarditis or after cardiac surgery) survived without need for surgical removal of vegetations or valve replacement. Despite strong suggestive evidence that the first 35 patients tabulated had fungal endocarditis, histological proof exists for only a few who had surgery.

Cures of endocarditis caused by other fungi are noted. Improved surgical and medical therapy has improved the prognosis even of patients with the far-advanced disease. However, development of classic fungal endocarditis has been reported one or more years after cardiac surgery and late recurrences after intensive therapy of fungal endocarditis, that had led to clinical recovery of 2 years or more, have been reported. Serological monitoring of vulnerable patients might alert the physician to recurrence early enough for efficacy of drug therapy, averting fatal outcome or the need for further surgery.

Full text

PDF
640

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ABRAMS G. D., BISHOP J. E. NORMAL FLORA AND LEUKOCYTE MOBILIZATION. Arch Pathol. 1965 Feb;79:213–217. [PubMed] [Google Scholar]
  2. ALLISON F., Jr, LANCASTER M. G., CROSTHWAITE J. L. STUDIES ON THE PATHOGENESIS OF ACUTE INFLAMMATION. V. AN ASSESSMENT OF FACTORS THAT INFLUENCE IN VITRO THE PHAGOCYTIC AND ADHESIVE PROPERTIES OF LEUKOCYTES OBTAINED FROM RABBIT PERITONEAL EXUDATE. Am J Pathol. 1963 Nov;43:775–795. [PMC free article] [PubMed] [Google Scholar]
  3. Acar J., Cabrol C., Jallut H., Frottier J., Duron F., Bastin R. Endocardite à candida sur prothèse mitrale (à propos d'un cas guéri par réintervention. Arch Mal Coeur Vaiss. 1973 Sep;66(9):1211–1216. [PubMed] [Google Scholar]
  4. Alcock N. W., Shils M. E., Lieberman P. H., Erlandson R. A. Thymic changes in the magnesium-depleted rat. Cancer Res. 1973 Sep;33(9):2196–2204. [PubMed] [Google Scholar]
  5. Alcock N. W., Shils M. E. Serum immunoglobulin G in the magnesium-depleted rat. Proc Soc Exp Biol Med. 1974 Mar;145(3):855–858. doi: 10.3181/00379727-145-37910. [DOI] [PubMed] [Google Scholar]
  6. Alexander J. W., Good R. A. Effect of antibiotics on the bactericidal activity of human leukocytes. J Lab Clin Med. 1968 Jun;71(6):971–983. [PubMed] [Google Scholar]
  7. Alexander J. W., Hegg M., Altemeier W. A. Neutrophil function in selected surgical disorders. Ann Surg. 1968 Sep;168(3):447–458. doi: 10.1097/00000658-196809000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Anderson A. O., Yardley J. H. Demonstration of candida in blood smears. N Engl J Med. 1972 Jan 13;286(2):108–108. doi: 10.1056/NEJM197201132860222. [DOI] [PubMed] [Google Scholar]
  9. Arnon R. G., Ehrlich R. Systemic candidiasis following cardiac surgery: an improved outlook. South Med J. 1977 May;70(5):585–587. doi: 10.1097/00007611-197705000-00026. [DOI] [PubMed] [Google Scholar]
  10. BENACK R. T., PILEGGI P., BRAUN R. Subacute bacterial endocarditis due to Streptococcus viridans and Candida albicans. ST Vincents Hosp Med Bull. 1962 Jul;4:2–4. [PubMed] [Google Scholar]
  11. BYBEE J. D., ROGERS D. E. THE PHAGOCYTIC ACTIVITY OF POLYMORPHONUCLEAR LEUKOCYTES OBTAINED FROM PATIENTS WITH DIABETES MELLITUS. J Lab Clin Med. 1964 Jul;64:1–13. [PubMed] [Google Scholar]
  12. Bacon P. A., Davidson C., Smith B. Antibodies to candida and autoantibodies in sub-acute bacterial endocarditis. Q J Med. 1974 Oct;43(172):537–550. [PubMed] [Google Scholar]
  13. Bar R. S., Wilson H. E., Mazzaferri E. L. Hypomagnesemic hypocalcemia secondary to renal magnesium wasting. Ann Intern Med. 1975 May;82(5):646–649. doi: 10.7326/0003-4819-82-5-646. [DOI] [PubMed] [Google Scholar]
  14. Beemer A. M., Kuttin E. S., Pinto M. Treatment with antifungal vaccines. Contrib Microbiol Immunol. 1977;4:136–146. [PubMed] [Google Scholar]
  15. Bemmer A. M., Davidson W., Kuttin E. S., Zydon Y., Pinto M. Vaccine and Mycostatin in treatment of cryptococcosis of the respiratory tract. Sabouraudia. 1976 Jul;14(2):171–179. doi: 10.1080/00362177685190241. [DOI] [PubMed] [Google Scholar]
  16. Bodey G. P. Patient isolation units for cancer patients treated with chemical immunosuppressive agents. Transplant Proc. 1973 Sep;5(3):1279–1284. [PubMed] [Google Scholar]
  17. Brennan M. F., Goldman M. H., O'Connell R. C., Kundsin R. B., Moore F. D. Prolonged parenteral alimentation: Candida growth and the prevention of candidemia by amphotericin instillation. Ann Surg. 1972 Sep;176(3):265–272. doi: 10.1097/00000658-197209000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Buchbinder N. A., Roberts W. C. Active infective endocarditis confined to mural endocardium. A study of six necropsy patients. Arch Pathol. 1972 May;93(5):435–440. [PubMed] [Google Scholar]
  19. Calderone R. A., Rotondo M. F., Sande M. A. Candida albicans endocarditis: ultrastructural studies of vegetation formation. Infect Immun. 1978 Apr;20(1):279–289. doi: 10.1128/iai.20.1.279-289.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Carrizosa J., Kohn C., Levison M. E. Experimental aspergillus endocarditis in rabbits. J Lab Clin Med. 1975 Nov;86(5):746–753. [PubMed] [Google Scholar]
  21. Carrizosa J., Levison M. E., Lawrence T., Kaye D. Cure of Aspergillus ustus endocarditis on a prosthetic valve. Arch Intern Med. 1974 Mar;133(3):486–490. [PubMed] [Google Scholar]
  22. Cherubin C. E., Neu H. C. Infective endocarditis at the Presbyterian Hospital in New York City from 1938-1967. Am J Med. 1971 Jul;51(1):83–96. doi: 10.1016/0002-9343(71)90326-3. [DOI] [PubMed] [Google Scholar]
  23. Cocchi P., Marianelli L. Phagocytosis and intracellular killing of Pseudomonas aeruginosa in premature infants. Helv Paediatr Acta. 1967 Apr;22(1):110–118. [PubMed] [Google Scholar]
  24. Coen R., Grush O., Kauder E. Studies of bactericidal activity and metabolism of the leukocyte in full-term neonates. J Pediatr. 1969 Sep;75(3):400–406. doi: 10.1016/s0022-3476(69)80265-9. [DOI] [PubMed] [Google Scholar]
  25. Conway N., Kothari M. L., Lockey E., Yacoub M. H. Candida endocarditis after heart surgery. Thorax. 1968 Jul;23(4):353–355. doi: 10.1136/thx.23.4.353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Curtis J., Richman B. L., Feinstein M. A. Infective endocarditis in drug addicts. South Med J. 1974 Jan;67(1):4–9. doi: 10.1097/00007611-197401000-00003. [DOI] [PubMed] [Google Scholar]
  27. Darrell J. H., Garrod L. P. Secondary septicaemia from intravenous cannulae. Br Med J. 1969 May 24;2(5655):481–482. doi: 10.1136/bmj.2.5655.481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Downey R. J., Pisano J. C. Effect of bacitracin on in vitro phagocytosis. Nature. 1966 May 7;210(5036):654–656. doi: 10.1038/210654a0. [DOI] [PubMed] [Google Scholar]
  29. Drutz D. J., Spickard A., Rogers D. E., Koenig M. G. Treatment of disseminated mycotic infectioons. A new approach to amphotericin B therapy. Am J Med. 1968 Sep;45(3):405–418. doi: 10.1016/0002-9343(68)90075-2. [DOI] [PubMed] [Google Scholar]
  30. Dupont B., Drouhet E. In vitro synergy and antagonism of antifungal agents against yeast-like fungi. Postgrad Med J. 1979 Sep;55(647):683–686. doi: 10.1136/pgmj.55.647.683. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Elin R. J. The effect of magnesium deficiency in mice on serum immunoglobulin concentrations and antibody plaque-forming cells. Proc Soc Exp Biol Med. 1975 Mar;148(3):620–624. doi: 10.3181/00379727-148-38596. [DOI] [PubMed] [Google Scholar]
  32. Ellis C. A., Spivack M. L. The significance of candidemia. Ann Intern Med. 1967 Sep;67(3):511–522. doi: 10.7326/0003-4819-67-3-511. [DOI] [PubMed] [Google Scholar]
  33. Erdos M. S., Butt K., Weinstein L. Mucormycotic endocarditis of the pulmonary valve. JAMA. 1972 Nov 20;222(8):951–953. [PubMed] [Google Scholar]
  34. Everett E. D., LaForce F. M., Eickhoff T. C. Serologic studies in suspected visceral candidiasis. Arch Intern Med. 1975 Aug;135(8):1075–1078. [PubMed] [Google Scholar]
  35. Freedman L. R., Johnson M. L. Experimental endocarditis. IV. Tricuspid and aortic valve infection with Candida albicans in rabbits. Yale J Biol Med. 1972 Apr;45(2):163–175. [PMC free article] [PubMed] [Google Scholar]
  36. GLOOR F., LOEFFLER A., SCHOLER H. J. [Mucormycoses]. Pathol Microbiol (Basel) 1961;24:1043–1064. [PubMed] [Google Scholar]
  37. GLUCK L., SILVERMAN W. A. Phagocytosis in premature infants. Pediatrics. 1957 Dec;20(6):951–957. [PubMed] [Google Scholar]
  38. Gaines J. D., Remington J. S. Diagnosis of deep infection with Candida. A study of Candida precipitins. Arch Intern Med. 1973 Nov;132(5):699–702. [PubMed] [Google Scholar]
  39. Galgiani J. N., Stevens D. A. Fungal endocarditis: need for guidelines in evaluating therapy. Experience with two patients previously reported. J Thorac Cardiovasc Surg. 1977 Feb;73(2):293–296. [PubMed] [Google Scholar]
  40. Gazzaniga A. B., Mir-Sepasi M. H., Jefferies M. R., Yeo M. T. Candida endocarditis complicating glucose total intravenous nutrition. Ann Surg. 1974 Jun;179(6):902–905. doi: 10.1097/00000658-197406000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Gladstone J. L., Friedman S. A., Cerruti M. M., Jomain S. L. Treatment of Candida endocarditis and arteritis. J Thorac Cardiovasc Surg. 1976 Jun;71(6):835–838. [PubMed] [Google Scholar]
  42. Goenen M., Reynaert M., Jaumin P., Chalant C. H., Tremouroux J. A case of candida albicans endocarditis 3 years after an aortic valve replacement. Successful combined medical and surgical therapy. J Cardiovasc Surg (Torino) 1977 Jul-Aug;18(4):391–396. [PubMed] [Google Scholar]
  43. Goldmann D. A., Maki D. G. Infection control in total parenteral nutrition. JAMA. 1973 Mar 19;223(12):1360–1364. [PubMed] [Google Scholar]
  44. Graybill J. R., Silva J., Jr, Alford R. H., Thor D. E. Immunologic and clinical improvement of progressive coccidioidomycosis following administration of transfer factor. Cell Immunol. 1973 Jul;8(1):120–135. doi: 10.1016/0008-8749(73)90099-3. [DOI] [PubMed] [Google Scholar]
  45. Grehl T. M., Cohn L. H., Angell W. W. Management of Candida endocarditis. J Thorac Cardiovasc Surg. 1972 Jan;63(1):118–120. [PubMed] [Google Scholar]
  46. Hairston P., Lee W. H., Jr Management of infected prosthetic heart valves. Ann Thorac Surg. 1970 Mar;9(3):229–237. doi: 10.1016/s0003-4975(10)65495-1. [DOI] [PubMed] [Google Scholar]
  47. Hairston P., Manos J. P., Graber C. D., Lee W. H., Jr Depression of immunologic surveillance by pump-oxygenation perfusion. J Surg Res. 1969 Oct;9(10):587–593. doi: 10.1016/0022-4804(69)90015-8. [DOI] [PubMed] [Google Scholar]
  48. Haldane E. V., MacDonald J. L., Gittens W. O., Yuce K., van Rooyen C. E. Prosthetic valvular endocarditis due to the fungus Paecilomyces. Can Med Assoc J. 1974 Nov 2;111(9):963-5, 968. [PMC free article] [PubMed] [Google Scholar]
  49. Harding S. A., Sandford G. R., Merz W. G. Three serologic tests for candidiasis. Diagnostic value in distinguishing deep or disseminated infection from superficial infection or colonization. Am J Clin Pathol. 1976 Jun;65(6):1001–1009. doi: 10.1093/ajcp/65.6.1001. [DOI] [PubMed] [Google Scholar]
  50. Harford C. G. Postoperative fungal endocarditis. Fungemia, embolism, and therapy. Arch Intern Med. 1974 Jul;134(1):116–120. [PubMed] [Google Scholar]
  51. Harris P. D., Yeoh C. B., Breault J., Meltzer J., Katz S. Fungal endocarditis secondary to drug addiction. Recent concepts in diagnosis and therapy. J Thorac Cardiovasc Surg. 1972 Jun;63(6):980–985. [PubMed] [Google Scholar]
  52. Hart P. D., Russell E., Jr, Remington J. S. The compromised host and infection. II. Deep fungal infection. J Infect Dis. 1969 Aug;120(2):169–191. doi: 10.1093/infdis/120.2.169. [DOI] [PubMed] [Google Scholar]
  53. Hartley R. A., Remsberg J. R., Sinaly N. P. Histoplasma endocarditis. Case report and review of the literature. Arch Intern Med. 1967 May;119(5):527–531. doi: 10.1001/archinte.119.5.527. [DOI] [PubMed] [Google Scholar]
  54. Hermans P. E., Ulrich J. A., Markowitz H. Chronic mucocutaneous candidiasis as a surface expression of deep-seated abnormalities. Report of a syndrome of superficial candidiasis, absence of delayed hypersensitivity and aminoaciduria. Am J Med. 1969 Oct;47(4):503–519. doi: 10.1016/0002-9343(69)90181-8. [DOI] [PubMed] [Google Scholar]
  55. Holden M. P., Ionescu M. I., Wooler G. H. Magnesium in patients undergoing open-heart surgery. Thorax. 1972 Mar;27(2):212–218. doi: 10.1136/thx.27.2.212. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Holmes A. M., Hesling C. M., Wilson T. M. Drug-induced secondary hyperaldosteronism in patients with pulmonary tuberculosis. Q J Med. 1970 Apr;39(154):299–315. [PubMed] [Google Scholar]
  57. Iannini P. B., Everett D., Pappas G., LaForce F. M. Candida precipitins as a diagnostic aid in Candida endocarditis. JAMA. 1976 Nov 29;236(22):2518–2520. doi: 10.1001/jama.236.22.2518. [DOI] [PubMed] [Google Scholar]
  58. KARNOVSKY M. L. Metabolic basis of phagocytic activity. Physiol Rev. 1962 Jan;42:143–168. doi: 10.1152/physrev.1962.42.1.143. [DOI] [PubMed] [Google Scholar]
  59. KAY J. H., BERNSTEIN S., FEINSTEIN D., BIDDLE M. Surgical cure of Candida albicans endocarditis with open-heart surgery. N Engl J Med. 1961 May 4;264:907–910. doi: 10.1056/NEJM196105042641804. [DOI] [PubMed] [Google Scholar]
  60. KEMP G., SOLOTOROVSKY M. LOCALIZATION OF ANTIGENS IN MECHANICALLY DISRUPTED CELLS OF CERTAIN SPECIES OF THE GENERA CANDIDA AND TORULOPSIS. J Immunol. 1964 Aug;93:305–314. [PubMed] [Google Scholar]
  61. KENT D. C., KENDALL H. F. SHORT TERM, LOW DOSAGE AMPHOTERICIN B THERAPY FOR RESIDUALS OF COCCIDIOIDOMYCOSIS. Dis Chest. 1965 Mar;47:284–290. doi: 10.1378/chest.47.3.284. [DOI] [PubMed] [Google Scholar]
  62. KROETZ F. W., LEONARD J. J., EVERETT C. R. Candida albicans endocarditis successfully treated with amphotericin b. N Engl J Med. 1962 Mar 22;266:592–595. doi: 10.1056/NEJM196203222661205. [DOI] [PubMed] [Google Scholar]
  63. Kammer R. B., Utz J. P. Aspergillus species endocarditis. The new face of a not so rare disease. Am J Med. 1974 Apr;56(4):506–521. doi: 10.1016/0002-9343(74)90483-5. [DOI] [PubMed] [Google Scholar]
  64. Keating M. J., Sethi M. R., Bodey G. P., Samaan N. A. Hypocalcemia with hypoparathyroidism and renal tubular dysfunction associated with aminoglycoside therapy. Cancer. 1977 Apr;39(4):1410–1414. doi: 10.1002/1097-0142(197704)39:4<1410::aid-cncr2820390409>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  65. Khan R. M., Hodge J. S., Bassett H. F. Magnesium in open-heart surgery. J Thorac Cardiovasc Surg. 1973 Aug;66(2):185–191. [PubMed] [Google Scholar]
  66. Khicha G. J., Berroya R. B., Escano F. B., Jr, Lee C. S. Mucormycosis in a mitral prosthesis. J Thorac Cardiovasc Surg. 1972 Jun;63(6):903–905. [PubMed] [Google Scholar]
  67. Khonsari S., Bahabozorgui S., Cook W. A., Frater R. W. Urgent open-heart surgery for endocarditis of mitral valve. N Y State J Med. 1971 Nov;71(22):2650–2651. [PubMed] [Google Scholar]
  68. Killen D. A., Grogan E. L., 2nd, Gower R. E., Collins H. A. Response of canine plasma-ionized calcium and magnesium to the rapid infusion of acid-citrate-dextrose (ACD) solution. Surgery. 1971 Nov;70(5):736–743. [PubMed] [Google Scholar]
  69. Kirkpatrick C. H., Rich R. R., Bennett J. E. Chronic mucocutaneous candidiasis: model-building in cellular immunity. Ann Intern Med. 1971 Jun;74(6):955–978. doi: 10.7326/0003-4819-74-6-955. [DOI] [PubMed] [Google Scholar]
  70. Kirkpatrick C. H., Rich R. R., Smith T. K. Effect of transfer factor on lymphocyte function in anergic patients. J Clin Invest. 1972 Nov;51(11):2948–2958. doi: 10.1172/JCI107119. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Kitahara M., Seth V. K., Medoff G., Kobayashi G. S. Activity of amphotericin B, 5-fluorocytosine, and rifampin against six clinical isolates of Aspergillus. Antimicrob Agents Chemother. 1976 Jun;9(6):915–919. doi: 10.1128/aac.9.6.915. [DOI] [PMC free article] [PubMed] [Google Scholar]
  72. Kozinn P. J., Hasenclever H. F., Taschdjian C. L., Mackenzie D. W., Protzman W., Seelig M. S. Problems in the diagnosis and treatment of systemic candidiasis. J Infect Dis. 1972 Nov;126(5):548–550. doi: 10.1093/infdis/126.5.548. [DOI] [PubMed] [Google Scholar]
  73. Kozinn P. J., Lynfield J., Seelig M. S. Successful treatment of systemic candidiasis following cardiac surgery. Am J Dis Child. 1974 Jul;128(1):106–108. doi: 10.1001/archpedi.1974.02110260108022. [DOI] [PubMed] [Google Scholar]
  74. Krause W., Matheis H., Wulf K. Fungaemia and funguria after oral administration of Candida albicans. Lancet. 1969 Mar 22;1(7595):598–599. doi: 10.1016/s0140-6736(69)91534-7. [DOI] [PubMed] [Google Scholar]
  75. Law E. J., Kim O. J., Stieritz D. D., MacMillan B. G. Experience with systemic candidiasis in the burned patient. J Trauma. 1972 Jul;12(7):543–552. doi: 10.1097/00005373-197207000-00001. [DOI] [PubMed] [Google Scholar]
  76. Lawrence T., Shockman A. T., MacVaugh H., 3rd Aspergillus infection of prosthetic aortic valves. Chest. 1971 Oct;60(4):406–414. doi: 10.1378/chest.60.4.406. [DOI] [PubMed] [Google Scholar]
  77. Lees A. W., Rao S. S., Garret J. A., Boot P. A. Endocarditis due to Torulopsis glabrata. Lancet. 1971 May 8;1(7706):943–944. doi: 10.1016/s0140-6736(71)91445-0. [DOI] [PubMed] [Google Scholar]
  78. Lehrer R. I., Cline M. J. Interaction of Candida albicans with human leukocytes and serum. J Bacteriol. 1969 Jun;98(3):996–1004. doi: 10.1128/jb.98.3.996-1004.1969. [DOI] [PMC free article] [PubMed] [Google Scholar]
  79. Lehrer R. I., Cline M. J. Leukocyte myeloperoxidase deficiency and disseminated candidiasis: the role of myeloperoxidase in resistance to Candida infection. J Clin Invest. 1969 Aug;48(8):1478–1488. doi: 10.1172/JCI106114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  80. Lerner P. I., Weinstein L. Infective endocarditis in the antibiotic era. N Engl J Med. 1966 Feb 17;274(7):388–concl. doi: 10.1056/NEJM196602172740706. [DOI] [PubMed] [Google Scholar]
  81. MERCHANT R. K., LOURIA D. B., GEISLER P. H., EDGCOMB J. H., UTZ J. P. Fungal endocarditis: review of the literature and report of three cases. Ann Intern Med. 1958 Feb;48(2):242–266. doi: 10.7326/0003-4819-48-2-242. [DOI] [PubMed] [Google Scholar]
  82. MacMillan B. G., Law E. J., Holder I. A. Experience with Candida infections in the burn patient. Arch Surg. 1972 Apr;104(4):509–514. doi: 10.1001/archsurg.1972.04180040123021. [DOI] [PubMed] [Google Scholar]
  83. Maki D. G., Goldman D. A., Rhame F. S. Infection control in intravenous therapy. Ann Intern Med. 1973 Dec;79(6):867–887. doi: 10.7326/0003-4819-79-6-867. [DOI] [PubMed] [Google Scholar]
  84. Mayrer A. R., Brown A., Weintraub R. A., Ragni M., Postic B. Successful medical therapy for endocarditis due to Candida parapsilosis. A clinical and epidemiologic study. Chest. 1978 Apr;73(4):546–549. doi: 10.1378/chest.73.4.546. [DOI] [PubMed] [Google Scholar]
  85. Medoff G., Dismukes W. E., Meade R. H., 3rd, Moses J. M. A new therapeutic approach to Candida infections. A preliminary report. Arch Intern Med. 1972 Aug;130(2):241–245. [PubMed] [Google Scholar]
  86. Meister H., Heymer B., Schäfer H., Haferkamp O. Role of Candida albicans in granulomatous tissue reactions. II. In vivo degradation of C. albicans in hepatic macrophages of mice. J Infect Dis. 1977 Feb;135(2):235–242. doi: 10.1093/infdis/135.2.235. [DOI] [PubMed] [Google Scholar]
  87. Merz W. G., Evans G. L., Shadomy S., Anderson S., Kaufman L., Kozinn P. J., Mackenzie D. W., Protzman W. P., Remington J. S. Laboratory evaluation of serological tests for systemic candidiasis: a cooperative study. J Clin Microbiol. 1977 Jun;5(6):596–603. doi: 10.1128/jcm.5.6.596-603.1977. [DOI] [PMC free article] [PubMed] [Google Scholar]
  88. Miller R. C., Grogan J. B. Incidence and source of contamination of intravenous nutritional infusion systems. J Pediatr Surg. 1973 Apr;8(2):185–190. doi: 10.1016/s0022-3468(73)80083-1. [DOI] [PubMed] [Google Scholar]
  89. Miyamoto K. Phagocytic activity of leucocytes in premature infants. I. Comparison of the phagocytic activity of leucocytes between premature infants and full-term infants. Hiroshima J Med Sci. 1965 Mar;14(1):9–17. [PubMed] [Google Scholar]
  90. Montague N. T., Sugg W. L. Candida endocarditis with femoral emboli. Treatment with surgery and 5-fluorocytosine. J Thorac Cardiovasc Surg. 1974 Feb;67(2):322–327. [PubMed] [Google Scholar]
  91. Montes L. F., Ceballos R., Cooper M. D., Bradley M. N., Bockman D. E. Chronic mucocutaneous candidiasis, myositis, and thymoma. A new triad. JAMA. 1972 Dec 25;222(13):1619–1623. [PubMed] [Google Scholar]
  92. Murray I. G., Buckley H. R., Turner G. C. Serological evidence of Candida infection after open-heart surgery. J Med Microbiol. 1969 Nov 4;2(4):463–469. doi: 10.1099/00222615-2-4-463. [DOI] [PubMed] [Google Scholar]
  93. Naveh Y., Friedman A., Merzbach D., Hashman N. Endocarditis caused by Rhodotorula successfully treated with 5-fluorocytosine. Br Heart J. 1975 Jan;37(1):101–104. doi: 10.1136/hrt.37.1.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  94. Norenberg R. G., Sethi G. K., Scott S. M., Takaro T. Opportunistic endocarditis following open-heart surgery. Ann Thorac Surg. 1975 May;19(5):592–604. doi: 10.1016/s0003-4975(10)64440-2. [DOI] [PubMed] [Google Scholar]
  95. Pierach C. A., Gülmen G., Dhar G. J., Kiser J. C. Letter: Phialophora mutabilis endocarditis. Ann Intern Med. 1973 Dec;79(6):900–901. doi: 10.7326/0003-4819-79-6-900_2. [DOI] [PubMed] [Google Scholar]
  96. Premsingh N., Kapila R., Tecson F., Smith L. G., Louria D. B. Candida endocarditis in two patients. Arch Intern Med. 1976 Feb;136(2):208–212. [PubMed] [Google Scholar]
  97. Prinsloo J. G., Pretorius P. J. Candida albicans endocarditis. Case successfully treated with amphotericin B. Am J Dis Child. 1966 Apr;111(4):446–447. doi: 10.1001/archpedi.1966.02090070144024. [DOI] [PubMed] [Google Scholar]
  98. Quie P. G. Intraleukocyte bactericidal mechanisms. J Pediatr. 1969 Sep;75(3):532–533. doi: 10.1016/s0022-3476(69)80294-5. [DOI] [PubMed] [Google Scholar]
  99. Rabinovich S., Smith I. M., January L. E. The changing pattern of bacterial endocarditis. Med Clin North Am. 1968 Sep;52(5):1091–1101. [PubMed] [Google Scholar]
  100. Ratcliffe J. G., Pryce D. M. Disseminated candidosis following aortic valve homograft replacement and tracheostomy. J Med Microbiol. 1968 Nov;1(2):220–223. doi: 10.1099/00222615-1-2-220. [DOI] [PubMed] [Google Scholar]
  101. Record C. O., Skinner J. M., Sleight P., Speller D. C. Candida endocarditis treated with 5-fluorocytosine. Br Med J. 1971 Jan 30;1(5743):262–264. doi: 10.1136/bmj.1.5743.262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  102. Remington J. S., Gaines J. D., Gilmer M. A. Demonstration of Candida precipitins in human sera by counterimmunoelectrophoresis. Lancet. 1972 Feb 19;1(7747):413–413. doi: 10.1016/s0140-6736(72)90860-4. [DOI] [PubMed] [Google Scholar]
  103. Renoux G., Renoux M. Restauration par le phenylimidothiazole de la réponse immunologique des souri âgées. C R Acad Sci Hebd Seances Acad Sci D. 1972 May 29;274(22):3034–3035. [PubMed] [Google Scholar]
  104. Rotheram E. B., Jr, Magovern G. J. Two-year cure of Candida infection of prosthetic mitral valve. Postgrad Med. 1977 Apr;61(4):237–246. doi: 10.1080/00325481.1977.11714560. [DOI] [PubMed] [Google Scholar]
  105. Rothlin M., Baumann P. C., Ratti R., Senning A. Infektiöse Endokarditis nach Operationen am Herzen. Dtsch Med Wochenschr. 1969 Apr 11;94(15):750–755. doi: 10.1055/s-0028-1111113. [DOI] [PubMed] [Google Scholar]
  106. Rubinstein E., Noriega E. R., Simberkoff M. S., Holzman R., Rahal J. J., Jr Fungal endocarditis: analysis of 24 cases and review of the literature. Medicine (Baltimore) 1975 Jul;54(4):331–334. [PubMed] [Google Scholar]
  107. Rubinstein E., Noriega E. R., Simberkoff M. S., Rahal J. J., Jr Tissue penetration of amphotericin B in Candida endocarditis. Chest. 1974 Oct;66(4):376–377. doi: 10.1378/chest.66.4.376. [DOI] [PubMed] [Google Scholar]
  108. SALVIN S. B., PETERSON R. D., GOOD R. A. THE ROLE OF THE THYMUS IN RESISTANCE TO INFECTION AND ENDOTOXIN TOXICITY. J Lab Clin Med. 1965 Jun;65:1004–1022. [PubMed] [Google Scholar]
  109. SANGER P. W., TAYLOR F. H., ROBICSEK F., GERMUTH F., SENTERFIT L., McKINNON G. Candida infection as a complication of heart surgery. Review of literature and report of two cases. JAMA. 1962 Jul 14;181:88–91. doi: 10.1001/jama.1962.03050280018004. [DOI] [PubMed] [Google Scholar]
  110. SCHAUBLE M. K., BAKER R. D. The inflammatory response in acute alloxan diabetes; enhanced proliferation of Rhizopus and Micrococcus in cutaneous lesions of rabbits. AMA Arch Pathol. 1957 Nov;64(5):563–569. [PubMed] [Google Scholar]
  111. SHELDON W. H., BAUER H. The development of the acute inflammatory response to experimental cutaneous mucormycosis in normal and diabetic rabbits. J Exp Med. 1959 Dec 1;110:845–852. doi: 10.1084/jem.110.6.845. [DOI] [PMC free article] [PubMed] [Google Scholar]
  112. SUGA J., HAGAI A., KASHIMA H. [Autopsy case of disseminated mucormycosis with ocular involvement]. Rinsho Ganka. 1963 Mar;17:365–373. [PubMed] [Google Scholar]
  113. Sande M. A., Bowman C. R., Calderone R. A. Experimental Candida albicans endocarditis: characterization of the disease and response to therapy. Infect Immun. 1977 Jul;17(1):140–147. doi: 10.1128/iai.17.1.140-147.1977. [DOI] [PMC free article] [PubMed] [Google Scholar]
  114. Schacter L. P., Owellen R. J., Rathbun H. K., Buchanan B. Letter: Antagonism between miconazole and amphotericin B. Lancet. 1976 Aug 7;2(7980):318–318. doi: 10.1016/s0140-6736(76)90774-1. [DOI] [PubMed] [Google Scholar]
  115. Seelig M. S., Speth C. P., Kozinn P. J., Taschdjian C. L., Toni E. F., Goldberg P. Patterns of Candida endocarditis following cardiac surgery: Importance of early diagnosis and therapy (an analysis of 91 cases). Prog Cardiovasc Dis. 1974 Sep-Oct;17(2):125–160. doi: 10.1016/0033-0620(74)90027-9. [DOI] [PubMed] [Google Scholar]
  116. Seelig M. S., Speth C. P., Kozinn P. J., Toni E. F., Taschdjian C. L. Candida endocarditis after cardiac surgery. Clues to earlier detection. J Thorac Cardiovasc Surg. 1973 Apr;65(4):583–601. [PubMed] [Google Scholar]
  117. Seelig M. S. The rationale for preventing antibacterial-induced fungal overgrowth. Med Times. 1968 Jul;96(7):689–710. [PubMed] [Google Scholar]
  118. Seelig M. S. The role of antibiotics in the pathogenesis of Candidainfections. Am J Med. 1966 Jun;40(6):887–917. doi: 10.1016/0002-9343(66)90204-x. [DOI] [PubMed] [Google Scholar]
  119. Sharpe D. N., Singh B. N., Cornere B. M., Allwood G. K. Torulopsis glabrata endocarditis complicating aortic homograft valve treated with 5-fluorocytosine: case report with discussion of antifungal chemotherapy. N Z Med J. 1975 Mar 26;81(536):294–298. [PubMed] [Google Scholar]
  120. Sheldon W. H., Bauer H. TISSUE MAST CELLS AND ACUTE INFLAMMATION IN EXPERIMENTAL CUTANEOUS MUCORMYCOSIS OF NORMAL, 48/80-TREATED, AND DIABETIC RATS. J Exp Med. 1960 Nov 30;112(6):1069–1084. doi: 10.1084/jem.112.6.1069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  121. Silver M. D., Tuffnell P. G., Bigelow W. G. Endocarditis caused by Paecilomyces varioti affecting an aortic valve allograft. J Thorac Cardiovasc Surg. 1971 Feb;61(2):278–281. [PubMed] [Google Scholar]
  122. Simon C. Uber eine durch Amphotericin B geheilte Candidasepsis eines Frühgeborenen. Ann Paediatr. 1965;204(6):406–413. [PubMed] [Google Scholar]
  123. Stein P. D., Folkens A. T., Hruska K. A. Saccharomyces fungemia. Chest. 1970 Aug;58(2):173–175. doi: 10.1378/chest.58.2.173. [DOI] [PubMed] [Google Scholar]
  124. Stein P. D., Harken D. E., Dexter L. The nature and prevention of prosthetic valve endocarditis. Am Heart J. 1966 Mar;71(3):393–407. doi: 10.1016/0002-8703(66)90482-0. [DOI] [PubMed] [Google Scholar]
  125. Stone D. L. Candida endocarditis treated with a combination of antifungal chemotherapy and aortic valve replacement. Br Heart J. 1975 Nov;37(11):1191–1194. doi: 10.1136/hrt.37.11.1191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  126. Stone H. H., Geheber C. E., Kolb L. D., Kitchens W. R. Alimentary tract colonization by Candida albicans. J Surg Res. 1973 Apr;14(4):273–276. doi: 10.1016/0022-4804(73)90028-0. [DOI] [PubMed] [Google Scholar]
  127. Stone H. H., Kolb L. D., Currie C. A., Geheber C. E., Cuzzell J. Z. Candida sepsis: pathogenesis and principles of treatments. Ann Surg. 1974 May;179(5):697–711. doi: 10.1097/00000658-197405000-00024. [DOI] [PMC free article] [PubMed] [Google Scholar]
  128. Stone H. H. Studies in the pathogenesis, diagnosis, and treatment of Candida sepsis in children. J Pediatr Surg. 1974 Feb;9(1):127–133. doi: 10.1016/0022-3468(74)90019-0. [DOI] [PubMed] [Google Scholar]
  129. TORACK R. M. Fungus infections associated with antibiotic and steroid therapy. Am J Med. 1957 Jun;22(6):872–882. doi: 10.1016/0002-9343(57)90023-2. [DOI] [PubMed] [Google Scholar]
  130. Taschdjian C. L., Seelig M. S., Kozinn P. J. Serological diagnosis of candidal infections. CRC Crit Rev Clin Lab Sci. 1973 Jul;4(1):19–59. doi: 10.3109/10408367309151683. [DOI] [PubMed] [Google Scholar]
  131. Taschdjian C. L., Toni E. F., Hsu K. C., Seelig M. S., Cuesta M. B., Kozinn P. J. Immunofluorescence studies of candida in human reticuloendothelial phagocytes: implications for immunogenesis and pathogenesis of systemic candidiasis. Am J Clin Pathol. 1971 Jul;56(1):50–58. doi: 10.1093/ajcp/56.1.50. [DOI] [PubMed] [Google Scholar]
  132. Tillotson J. R., Finland M. Bacterial colonization and clinical superinfection of the respiratory tract complicating antibiotic treatment of pneumonia. J Infect Dis. 1969 Jun;119(6):597–624. doi: 10.1093/infdis/119.6.597. [DOI] [PubMed] [Google Scholar]
  133. Toala P., Schroeder S. A., Daly A. K., Finland M. Candida at Boston City Hospital. Clinical and epidemiological characteristics and susceptibility to eight antimicrobial agents. Arch Intern Med. 1970 Dec;126(6):983–989. doi: 10.1001/archinte.126.6.983. [DOI] [PubMed] [Google Scholar]
  134. Tripodi D., Parks L. C., Brugmans J. Drug-induced restoration of cutaneous delayed hypersensitivity in anergic patients with cancer. N Engl J Med. 1973 Aug 16;289(7):354–357. doi: 10.1056/NEJM197308162890707. [DOI] [PubMed] [Google Scholar]
  135. Tumulty P. A. Management of bacterial endocarditis. Geriatrics. 1967 Jun;22(6):122–139. [PubMed] [Google Scholar]
  136. Turnier E., Kay J. H., Bernstein S., Mendez A. M., Zubiate P. Surgical treatment of Candida endocarditis. Chest. 1975 Mar;67(3):262–268. doi: 10.1378/chest.67.3.262. [DOI] [PubMed] [Google Scholar]
  137. UYS C. J., DON P. A., SCHRIRE V., BARNARD C. N. ENDOCARDITIS FOLLOWING CARDIAC SURGERY DUE TO THE FUNGUS PAECILOMYCES. S Afr Med J. 1963 Dec 21;37:1276–1280. [PubMed] [Google Scholar]
  138. Uhr J. W. Delayed hypersensitivity. Physiol Rev. 1966 Jul;46(3):359–419. doi: 10.1152/physrev.1966.46.3.359. [DOI] [PubMed] [Google Scholar]
  139. Utley J. R., Mills J., Roe B. B. The role of valve replacement in the treatment of fungal endocarditis. J Thorac Cardiovasc Surg. 1975 Feb;69(2):255–258. [PubMed] [Google Scholar]
  140. VIALATTE J., SATGE P., ROIDOT M., MESCHAKA G. [A case of Candida albicans septicemia with retinal lesions and endocarditis]. Arch Fr Pediatr. 1961 Oct;18:1211–1216. [PubMed] [Google Scholar]
  141. WILKINS D. J., BANGHAM A. D. THE EFFECT OF SOME METAL IONS ON IN VITRO PHAGOCYTOSIS. J Reticuloendothel Soc. 1964 Jul;1:233–242. [PubMed] [Google Scholar]
  142. Wain W., Ahmed M., Thompson R., Yacoub M. The role of chemotherapy in the management of fungal endocaridits following homograft valve replacement. Postgrad Med J. 1979 Sep;55(647):629–631. doi: 10.1136/pgmj.55.647.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  143. Watanakunakorn C. Changing epidemiology and newer aspects of infective endocarditis. Adv Intern Med. 1977;22:21–47. [PubMed] [Google Scholar]
  144. Weinstein L. "Modern" infective endocarditis. JAMA. 1975 Jul 21;233(3):260–263. [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES