on endocarditis

Q: A 58-year-old male with End-Stage Renal Disease (ESRD) is admitted to the ICU with septic shock and is found to have Candida endocarditis. Which of the following is more prone to cause peripheral embolization? - select one

A) Bacterial endocarditis

B) Candida endocarditis 

Answer: A

Candida endocarditis differs from bacterial endocarditis in that it causes larger vegetations and therefore has a greater tendency to cause peripheral embolization. That explains the standard of performing an ophthalmic exam in Candida endocarditis to rule out endophthalmitis. This also explains that, in most patients, blood cultures remained positive with persistent candidemia despite treatment.

Risk factors are prosthetic heart valves, intravenous drug abuse, indwelling catheters, and prolonged candidemia.

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References:

1. Jamil Y, Akinleye A, Mirzaei M, Lempel M, Farhat K, Pan S. Candida endocarditis: Update on management considerations. World J Cardiol. 2023 Oct 26;15(10):469-478. doi: 10.4330/wjc.v15.i10.469. PMID: 37900901; PMCID: PMC10600790.

2. Lefort A, Chartier L, Sendid B, Wolff M, Mainardi JL, Podglajen I, Desnos-Ollivier M, Fontanet A, Bretagne S, Lortholary O; French Mycosis Study Group. Diagnosis, management and outcome of Candida endocarditis. Clin Microbiol Infect. 2012 Apr;18(4):E99-E109. doi: 10.1111/j.1469-0691.2012.03764.x. Epub 2012 Feb 13. PMID: 22329526.

3. Meyahnwi D, Siraw B, Issaka Y, Tafesse Y, Zinyandu T, Miftari R, Ahmed A. Candida endocarditis in the United States: contemporary clinical predictors of mortality from a nationwide analysis (2016-2022). Infection. 2026 Jun;54(3):1359-1368. doi: 10.1007/s15010-026-02757-3. Epub 2026 Mar 5. PMID: 41784858.