真菌性心内膜炎:病理生理学,流行病学,临床表现,诊断和管理。

IF 19 1区 医学 Q1 MICROBIOLOGY
Clinical Microbiology Reviews Pub Date : 2023-09-21 Epub Date: 2023-07-13 DOI:10.1128/cmr.00019-23
George R Thompson, Jeffrey D Jenks, John W Baddley, James S Lewis, Matthias Egger, Ilan S Schwartz, Johannes Boyer, Thomas F Patterson, Sharon C-A Chen, Peter G Pappas, Martin Hoenigl
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引用次数: 0

摘要

真菌性心内膜炎占所有感染性心内膜炎病例的1%至3%,与高发病率和死亡率(>70%)有关,并在临床护理中提出了许多挑战。念珠菌属是真菌性心内膜炎最常见的病因,超过50%的病例涉及念珠菌属,其次是曲霉菌属和组织浆菌属。真菌性心内膜的重要风险因素包括人工瓣膜、既往心脏手术和注射药物使用。真菌性心内膜炎的体征和症状是非特异性的,诊断需要高度的临床怀疑和明智的诊断测试。除了微生物诊断(例如,念珠菌属的血液培养或曲霉属的半乳甘露聚糖检测和聚合酶链式反应),超声心动图对于评估潜在感染性心内膜炎仍然至关重要,尽管放射性核素成像模式,如18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描正在越来越多地使用。多模式治疗方法是必要的:通常需要手术,并应伴有长期的全身抗真菌治疗,如棘白菌素治疗念珠菌心内膜炎或伏立康唑治疗曲霉菌心内膜炎。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management.

Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.

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来源期刊
Clinical Microbiology Reviews
Clinical Microbiology Reviews 医学-微生物学
CiteScore
54.20
自引率
0.50%
发文量
38
期刊介绍: Clinical Microbiology Reviews (CMR) is a journal that primarily focuses on clinical microbiology and immunology.It aims to provide readers with up-to-date information on the latest developments in these fields.CMR also presents the current state of knowledge in clinical microbiology and immunology.Additionally, the journal offers balanced and thought-provoking perspectives on controversial issues in these areas.
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