Emerging trends in fungal endocarditis: clinical complexity, diagnostic challenges, and therapeutic implications - a case series and literature review.

Background: Fungal infective endocarditis (IE) is a rare, yet increasingly recognised condition associated with substantial mortality rates. Objectives: This study was undertaken to examine the clinical profiles, diagnostic challenges, treatment modalities, and outcomes of four compelling cases involving Methods & Design: This was a descriptive case series study conducted from July 2021 to July 2023. All patients with definite/possible endocarditis diagnosed based on modified Duke's criteria were reviewed in this study. Data on demographics, risk factors, clinical signs and symptoms, echocardiography findings, microbiological aetiology, complications, treatment, and outcomes were collected. Results: Among 212 suspected IE cases reviewed, 54 met the modified Duke's criteria for possible or definite IE, with four instances identified as fungal endocarditis. Conclusion: This study highlights the criticality of early suspicion, prompt diagnosis, and a multidisciplinary approach to managing fungal endocarditis. While recognising the limitations in current diagnostic tools and therapeutic options, the study underscores the urgent need for enhanced diagnostic modalities and novel treatment strategies to improve outcomes in these challenging cases.