Key points
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Vegetations are oscillating or nonoscillating intracardiac masses on the valves or other endocardial structures or intracardiac implanted materials.
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Vegetations are typically located on the upstream side of the valves, are usually irregularly and grotesquely shaped, and exhibit disordered motions that are not in pattern with the excursion of the valve leaflets.
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Abscesses are thick, nonhomogeneous, echolucent, or echodense perivalvular areas.
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Three echocardiographic findings are considered to be major criteria for the diagnosis of endocarditis: (1) the presence of vegetations, (2) the presence of abscesses, and (3) the presence of new dehiscence in a valvular prosthesis ( Algorithm 7.1 , Figs. 7.2–7.4 , Tables 7.5 and 7.6 , Figs. 7.7–7.9 , Table 7.10 ).
Table 7.5
Risk factors for fungal endocarditis
Intravenous drug abuse
Prolonged antibiotic therapy
Prolonged indwelling central venous catheter
Prosthetic heart valve
Previous history of endocarditis
Parenteral nutrition
Neutropenia
Diabetes mellitus
Table 7.6
Clinical significance of fungal endocarditis
Fungal endocarditis is a very devastating disease
Timely diagnosis is the key, because it presents mostly with general constitutional symptoms; high index of suspicion is required for early diagnosis. Induction treatment followed by suppressive therapy (in selected patients) is key to management
Surgical replacement of the infected valve is a class I recommendation