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Candida PVE Management — SCE Infectious Diseases MCQ

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HardBone & Joint InfectionCandida PVE ManagementSCE Infectious Diseases

A 60-year-old man with a prosthetic aortic valve develops endocarditis. Blood cultures grow Candida albicans. TOE shows a 15 mm vegetation. What is the management?

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Correct answer: C — Echinocandin IV (Caspofungin or Micafungin) PLUS early surgical valve replacement — fungal prosthetic valve endocarditis has very high mortality without surgery; lifelong suppressive Fluconazole after initial treatment

Candida PVE is one of the most serious endocarditis presentations with mortality >50% even with optimal treatment. Management requires: (1) systemic antifungal therapy — echinocandin (or Liposomal Amphotericin B) initially, (2) EARLY surgical valve replacement (recommended in virtually all cases of fungal PVE), (3) post-operative antifungal therapy (Fluconazole step-down if C. albicans is susceptible) for at least 6 weeks, followed by (4) LIFELONG oral Fluconazole suppressive therapy (to prevent late relapse from residual fungal biofilm).

Reference: ESC 2023 – Endocarditis; IDSA 2016 – Candidiasis; ESCMID 2024