{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T13:39:54Z","timestamp":1763559594495,"version":"3.45.0"},"reference-count":23,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Fungal endocarditis, despite being a rare diagnosis, has a higher morbidity and mortality rate compared to bacterial endocarditis. Candida species are the most common isolated pathogens involved in fungal endocarditis. Diagnosis is suspected in patients with underlying conditions such as cancer, myelodysplastic syndrome, diabetes, or intravascular catheters, where the modified Duke criteria apply. Management of the patient requires a multidisciplinary team (cardiologist, infectious diseases consultant, cardiac surgeon) along with antifungal treatment. We present the case of a 60-year-old male with biological prosthetic aortic valve replacement in the previous year for bicuspid aortic stenosis, admitted for a 5-day history of fever, nausea and minor urinary symptoms. The blood cultures were positive for Candida parapsilosis. Transthoracic cardiac ultrasound revealed a hypoechogenic mass attached to the aortic valve at the prosthetic fixation site. Although diagnosis was rapidly confirmed and treatment was administered shortly after first suspected, the patient developed, at first, cavernous sinus thrombosis and, later, fatal ST elevation myocardial infarction. The patient died despite efficient antifungal therapy, initially with Anidulafungin in monotherapy and later in combination with Fluconazole. The reported case emphasizes the importance of managing fungal endocarditis, the need for urgent diagnostic attention and multidisciplinary team approach by infectious diseases specialist, cardiologist, neurologist and heart surgeon.<\/jats:p>","DOI":"10.3390\/jof11110817","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:55:31Z","timestamp":1763556931000},"page":"817","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fatal Complications in Candida parapsilosis Endocarditis\u2014A Case Report"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3527-9116","authenticated-orcid":false,"given":"Sebastian George","family":"Smadu","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania"},{"name":"\u201dVictor Babes\u201d Clinical Hospital for Infectious and Tropical Diseases, 281 Mihai Bravu Street, 030303 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9704-2953","authenticated-orcid":false,"given":"Simona Camelia","family":"Tetradov","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania"},{"name":"\u201dVictor Babes\u201d Clinical Hospital for Infectious and Tropical Diseases, 281 Mihai Bravu Street, 030303 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1608-8575","authenticated-orcid":false,"given":"Luminita","family":"Ene","sequence":"additional","affiliation":[{"name":"\u201dVictor Babes\u201d Clinical Hospital for Infectious and Tropical Diseases, 281 Mihai Bravu Street, 030303 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6482-3386","authenticated-orcid":false,"given":"Simin Aysel","family":"Florescu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania"},{"name":"\u201dVictor Babes\u201d Clinical Hospital for Infectious and Tropical Diseases, 281 Mihai Bravu Street, 030303 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9772-2482","authenticated-orcid":false,"given":"Dragos Stefan","family":"Lazar","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania"},{"name":"\u201dVictor Babes\u201d Clinical Hospital for Infectious and Tropical Diseases, 281 Mihai Bravu Street, 030303 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1001\/archinternmed.2008.603","article-title":"Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: The International Collaboration on Endocarditis-Prospective Cohort Study","volume":"169","author":"Murdoch","year":"2009","journal-title":"Arch. Intern. Med."},{"key":"ref_2","first-page":"252","article-title":"Fungal Endocarditis","volume":"31","author":"Yuan","year":"2016","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1111\/j.1469-0691.2006.01512.x","article-title":"Post-operative aspergillosis","volume":"12","author":"Pasqualotto","year":"2006","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_4","unstructured":"Bennett, J.E., Dolin, R., and Blaser, M.J. (2020). Mandell, Douglas, and Bennett\u2019s Principles and Practice of Infectious Diseases, Elsevier. [4th ed.]."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1093\/cid\/cix913","article-title":"Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis-The ESCAPE Study","volume":"66","author":"Rivoisy","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1161\/CIRCULATIONAHA.119.040228","article-title":"Multimodality Imaging in Infective Endocarditis: An Imaging Team Within the Endocarditis Team","volume":"140","author":"Erba","year":"2019","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC Guidelines for the management of endocarditis","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1161\/CIR.0000000000000296","article-title":"Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association","volume":"132","author":"Baddour","year":"2015","journal-title":"Circulation"},{"key":"ref_9","unstructured":"Wilson, M.L. (2022). Principles and Procedures for Blood Cultures, Clinical and Laboratory Standards Institute (CLSI). [2nd ed.]."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kurland, S., Furebring, M., L\u00f6wdin, E., Olaison, L., and Sj\u00f6lin, J. (2025). Antifungal therapy in Candida infective endocarditis: A comparison of echinocandins and other treatment regimens in a nation-wide cohort study. Clin. Infect. Dis., ciaf312.","DOI":"10.1093\/cid\/ciaf312"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1128\/AAC.04867-14","article-title":"Candida infective endocarditis: An observational cohort study with a focus on therapy","volume":"59","author":"Arnold","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1378\/chest.122.1.302","article-title":"Fungal endocarditis, 1995\u20132000","volume":"122","author":"Pierrotti","year":"2002","journal-title":"Chest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s10096-008-0466-x","article-title":"Candida infective endocarditis","volume":"27","author":"Baddley","year":"2008","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E99","DOI":"10.1111\/j.1469-0691.2012.03764.x","article-title":"Diagnosis, management and outcome of Candida endocarditis","volume":"18","author":"Lefort","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e017347","DOI":"10.1161\/JAHA.120.017347","article-title":"Infective Endocarditis After Surgical and Transcatheter Aortic Valve Replacement: A State of the Art Review","volume":"9","author":"Alexis","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1080\/13693780500107554","article-title":"Candida biofilm: A well-designed protected environment","volume":"43","author":"Mukherjee","year":"2005","journal-title":"Med. Mycol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1093\/mmy\/myz104","article-title":"Risk factors predicting Candida infective endocarditis in patients with candidemia","volume":"58","author":"Foong","year":"2020","journal-title":"Med. Mycol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2472","DOI":"10.1056\/NEJMoa066906","article-title":"Anidulafungin versus fluconazole for invasive candidiasis","volume":"356","author":"Reboli","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1469-0691.2010.03448.x","article-title":"Anidulafungin for the treatment of invasive candidiasis","volume":"17","author":"Mayr","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1111\/j.1469-0691.2012.03784.x","article-title":"Anidulafungin for the treatment of candidaemia\/invasive candidiasis in selected critically ill patients","volume":"18","author":"Ruhnke","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/j.1574-6976.2011.00278.x","article-title":"Candida glabrata, Candida parapsilosis and Candida tropicalis: Biology, epidemiology, pathogenicity and antifungal resistance","volume":"36","author":"Silva","year":"2012","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1128\/JCM.00131-07","article-title":"Biofilm production by Candida species and inadequate antifungal therapy as predictors of mortality for patients with candidemia","volume":"45","author":"Tumbarello","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"469","DOI":"10.4330\/wjc.v15.i10.469","article-title":"Candida endocarditis: Update on management considerations","volume":"15","author":"Jamil","year":"2023","journal-title":"World J. Cardiol."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/11\/817\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T13:36:33Z","timestamp":1763559393000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/11\/817"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":23,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jof11110817"],"URL":"https:\/\/doi.org\/10.3390\/jof11110817","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,18]]}}}