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[Mycotic diseases of the heart]
1Fingerlandův ústav patologie LF UK a FN, Hradec Králové.
Abstract:
There has been an increasing frequency of deep mycotic infections over the last years complicating mostly disease states with immunosuppression. During the last 30 years, 54 cases of mycotic infection of the heart were identified at the Fingerland Department of Pathology in Hradec Králové, with 32 cases during the last 10 years alone (prevalence 0.2% of 28 199 autopsies). A review of the sex, age, etiology, source of infection, principal disease and morphological cardiac findings is presented. There was male predominance (74%). The mean age of the patients was 48 years (ranging from 15 days to 87 years). Yeasts of genus Candida dominated, followed in incidence by genus Aspergillus. The postmortem haemocultivation was positive in only 25% of all cases, while cultivation from a vegetation or a myocardial abscess was positive in 61%. The probable source of infection was detected in 28 patients; very often it was bronchopneumonia or an infected central venous catheter. Endocarditis was found in 28 cases, including six cases on a prosthetic valve and four cases on mural endocardium. Isolated myocarditis was found in 25 patients. There was also one case of isolated mycotic pericarditis. In more than half of all patients there was a state of immunosuppression, usually caused by a haematologic malignancy.
Insights
Deep mycotic infections affecting the heart are increasing, particularly in immunocompromised patients. Candida and Aspergillus yeasts were the most common causes, often linked to bronchopneumonia or central venous catheters.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Context:
- Deep mycotic infections are increasingly prevalent, especially in immunocompromised individuals.
- A 30-year retrospective study analyzed 54 cases of cardiac mycoses at a specific pathology department.
- The prevalence of cardiac mycoses was found to be 0.2% of autopsies.
Purpose:
- To review the characteristics of cardiac mycotic infections, including patient demographics, etiology, infection sources, and cardiac pathology.
- To analyze trends in cardiac mycoses over a 30-year period.
- To compare diagnostic yield of postmortem blood cultures versus direct cultivation from cardiac lesions.
Summary:
- The study identified 54 cases of cardiac mycoses, with a notable increase in the last decade.
- Male patients predominated (74%), with a mean age of 48 years.
- Candida yeasts were the most frequent pathogens, followed by Aspergillus.
- Common sources included bronchopneumonia and infected central venous catheters.
- Endocarditis (28 cases) and myocarditis (25 cases) were the primary cardiac manifestations.
- Immunosuppression, often due to hematologic malignancies, was a significant underlying factor in over half the patients.
- Direct cultivation from cardiac lesions (61%) was more sensitive than postmortem hemoculture (25%).
Impact:
- Highlights the rising incidence and clinical significance of cardiac fungal infections.
- Underscores the importance of considering fungal etiologies in immunocompromised patients with cardiac symptoms.
- Provides insights into diagnostic challenges and optimal specimen sources for identifying cardiac mycoses.
- Informs clinical practice regarding prevention, diagnosis, and management of these severe infections.