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Donovanosis — SCE Infectious Diseases MCQ

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HardSTIsDonovanosisSCE Infectious Diseases

A patient with a prosthetic aortic valve has persistent Candida glabrata fungaemia and a mobile prosthetic-valve vegetation. Which initial strategy best reflects ESC guidance?

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Correct answer: C — Systemic echinocandin or lipid amphotericin plus early surgical assessment

Explanation lettering: E = shown as C · C = shown as E

E is correct. Candida prosthetic-valve endocarditis has very high mortality and requires combined management: an Endocarditis Team, high-dose echinocandin or lipid amphotericin B with or without flucytosine, and a low threshold for surgery. Short fluconazole or voriconazole monotherapy is inadequate for initial control, seven days is far too brief, and surgery never substitutes for systemic antifungal treatment. Susceptibility, source control, embolic complications and subsequent suppressive therapy must all be addressed.

Reference: ESC 2023 infective endocarditis guideline: https://academic.oup.com/eurheartj/article/44/39/3948/7243107