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Published on: March 22, 2012
Pacemaker infection due to Aspergillus: report of two cases and literature review
Ricardo Izquierdo1, Clotilde Llorente, Jose Mayo
1Division of Cardiology, Hospital Xeral-Calde, Lugo, Spain. rizqui@wanadoo.es
Background:
Aspergillus infections of pacing systems are extremely uncommon, and most cases reported are characterized by an aggressive behavior that may lead to death of the patient.
Hypothesis:
The study was undertaken to assess the incidence of pacemaker infection due to Aspergillus in a defined population.
Methods:
A retrospective review of the case histories of all patients who underwent pacemaker implantation in the reference center for a defined population over a 13-year period was undertaken. A literature review of pacemaker infections due to Aspergillus was conducted.
Results:
Of the 1,321 patients who required pacemaker implantation at Hospital Xeral-Calde in the Lugo region of northwestern Spain, 38 suffered a pacemaker infection. A pacemaker pocket infection due to Aspergillus fumigatus was found in two patients. Both patients had a previous history of diabetes mellitus. Cultures from pacemaker pocket inflammatory fluid yielded positive results. Following pacemaker explantation and antifungal therapy, clinical improvement was achieved. A literature review showed another five cases of pacemaker infection due to Aspergillus. However, two peculiarities were found in our patients: In both cases an etiological diagnosis was achieved prior to surgery and, to the best of our knowledge, they also constitute the first cases of pacemaker pocket infection due to Aspergillus.
Conclusion:
Although pacemaker infections due to Aspergillus species are uncommon, they should be considered in immunocompromised patients.
Insights
Pacemaker infections from Aspergillus are rare but serious. This study identified two cases of Aspergillus fumigatus pacemaker pocket infection in diabetic patients, highlighting the need for consideration in immunocompromised individuals.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Cardiology
Background:
- Aspergillus infections of cardiac pacing systems are exceptionally rare.
- Reported cases often exhibit aggressive clinical behavior, potentially leading to fatal outcomes.
Observation:
- This study assessed the incidence of pacemaker infection caused by Aspergillus in a specific population over 13 years.
- A retrospective review identified 38 pacemaker infections out of 1,321 implantations; two were Aspergillus fumigatus pocket infections.
Findings:
- Both patients with Aspergillus pacemaker infection had a history of diabetes mellitus.
- Early etiological diagnosis was achieved pre-surgery, and successful treatment involved pacemaker explantation and antifungal therapy.
- A literature review identified five additional Aspergillus pacemaker infection cases, but these two represent the first reported instances of pacemaker pocket infection due to Aspergillus.
Implications:
- Despite their rarity, Aspergillus species should be considered as a potential cause of pacemaker infections, particularly in immunocompromised patients.
- Early diagnosis and prompt treatment, including device removal and antifungal therapy, are crucial for managing these infections.
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