Whilst it used to affect mostly intravenous drug users and patients who underwent valvular surgery with suboptimal infection control procedures, fungal
endocarditis is now mostly observed in patients with severe immunodeficiency (onco-haematology), in association with chronic central venous access and broad-spectrum
antibiotic use. The incidence of fungal
endocarditis has probably decreased in most developed countries with access to harm-reduction policies (i.e. needle exchange programmes) and with improved infection control procedures during cardiac surgery. Use of specific blood culture bottles for diagnosis of fungal
endocarditis has decreased due to optimisation of media and automated culture systems. Meanwhile, the advent of rapid techniques, including
fungal antigen detection (
galactomannan,
mannan/anti-
mannan antibodies and β-1,3-d-
glucans) and PCR (e.g. universal fungal PCR targeting
18S rRNA genes), shall improve sensitivity and reduce diagnostics delays, although limited data are available on their use for the diagnosis of fungal
endocarditis. New
antifungal agents available since the early 2000s may represent dramatic improvement for fungal
endocarditis: (i) a new class, the
echinocandins, has the potential to improve the management of Candida
endocarditis owing to its fungicidal effect on yeasts as well as tolerability of increased dosages; and (ii) improved survival in patients with invasive
aspergillosis with
voriconazole compared with
amphotericin B, and this may apply to Aspergillus sp.
endocarditis as well, although its prognosis remains dismal. These achievements may allow selected patients to be cured with prolonged medical treatment alone when surgery is considered too risky.