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Aspergillus mediastinitis after cardiac surgery

Marie-Josée Caballero1, Nicolas Mongardon1, Hakim Haouache1

  • 1Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.

International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases
|February 5, 2016
PubMed
Abstract

Insights

A rare fungal infection, Aspergillus mediastinitis, can occur after heart surgery. Prompt surgical drainage and antifungal treatments, including voriconazole, led to a full recovery in a challenging case.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Mycology

Background:

  • Mediastinitis is a severe post-cardiac surgery complication, with bacterial infections being common and fungal infections, particularly Aspergillus, being rare and often fatal.
  • Postoperative Aspergillus mediastinitis presents a significant challenge due to its rarity and typically poor prognosis.

Observation:

  • A case study details a 42-year-old patient who developed Aspergillus fumigatus mediastinitis following cardiac surgery.
  • Key risk factors identified included cardiogenic shock necessitating veno-arterial extracorporeal life support and sternal wound closure failure.

Findings:

  • The patient achieved a complete recovery through surgical debridement, antifungal therapy (liposomal amphotericin B, followed by voriconazole and caspofungin), with no relapse over 18 months.
  • Literature review indicates that postoperative Aspergillus mediastinitis can be paucisymptomatic, necessitating a high index of suspicion for culture-negative or indolent infections.

Implications:

  • This case highlights the possibility of favorable outcomes in Aspergillus mediastinitis with aggressive management.
  • Effective antifungal strategies should incorporate amphotericin B or voriconazole alongside surgical intervention.
  • Early recognition and treatment are crucial for improving patient survival and recovery from this rare but serious complication.
Keywords:
AspergillosisAspergillus fumigatusCardiac surgeryMediastinitisNosocomial infection

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