Fungal endocarditis: need for guidelines in evaluating therapy. Experience with two patients previously reported

Successful treatment of fungal endocarditis is being described with increasing frequency. Two patients, previously reported as free of disease by two different groups of investigators, subsequently died with evidence of continued disease. Both patients had been receiving antifungal chemotherapy at the time their case histories were reported. The lack of clinical signs and symptoms in fungal endocarditis, the suppression of manifestations of infection by chemotherapy, and the uncertain reliability of laboratory aids led us to suggest guidelines in reporting results of therapeutic regimens. These include avoidance of terms implying cure in patients who are concurrently maintained on chemotherapy, indication of attempts to evaluate fungemia, and minimum follow up of 1 to 2 years' duration. The potential utility of serologic studies is illustrated by the course of one of these patients.