Risk factors for FE
| Category | Risk factor | Associated risk | Reference |
|---|---|---|---|
| Cardiac history | Prosthetic heart valves | 35% of FE cases are prosthetic valve endocarditis | [4, 5, 14] |
| Cardiac device implants (pacemakers, defibrillators) | Predisposes to biofilm formation; increases embolic risk | [14, 38] | |
| Previous valve surgery or congenital heart disease | Endocardial injury provides a nidus for fungal adhesion | [5, 6, 15, 23] | |
| Immunesuppresion | Hematologic malignancy, transplant recipients, and biologic therapy | 64% of Aspergillus endocarditis cases involve severe immunosuppression | [1, 9, 15] |
| Chronic corticosteroids (> 1 month) | Increases the risk of mold infections (e.g., Aspergillus) | [9, 15] | |
| HIV/AIDS | Associated with disseminated fungal infections | [15] | |
| Healthcare exposures | Indwelling central venous catheters | Risk of candidemia; biofilm colonization (especially C. parapsilosis) | [9, 16, 17] |
| Total parenteral nutrition (TPN) | Linked to candidemia—secondary FE | [16, 17] | |
| Prolonged broad-spectrum antibiotics (> 7 days) | Disrupts normal flora; facilitates fungal overgrowth | [9, 19] | |
| Hemodialysis (via central catheter) | Turbulent flow on calcified valves; 2 times higher mortality in CE | [11, 19] | |
| Extended ICU/hospital stay | Correlates with invasive fungal exposure | [9] | |
| Comorbidities | Chronic kidney disease (CKD) | Hemodialysis independently increases FE risk and mortality | [11, 19] |
| Acute/Chronic liver disease | Strongest mortality predictor (OR ≈ 9) in CE | [11] | |
| Diabetes mellitus | Favors C. glabrata | [6] | |
| Gastrointestinal tract/Genitourinary tract malignancies | Emerging extracardiac risk factors | [9] | |
| Behavioral | Intravenous drug abuse (IVDU) | Introduces Candida/molds; paradoxically, lower short-term mortality due to younger age and right-sided involvement | [9, 11, 20] |
FE: fungal endocarditis; IVDU: intravenous drug use; CE: Candida endocarditis; C. parapsilosis: Candida parapsilosis; C. glabrata: Candida glabrata
I would like to acknowledge Krupa Sara Thomas for her valuable assistance in reviewing and going through the manuscript.
SE: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. The author has read and approved the submitted version.
The author declares that there are no conflicts of interest.
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