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Surgical management of fungal peripheral thrombophlebitis
C J Hauser1, P Bosco, M Davenport
1Division of Vascular Surgery, Infectious Diseases, and Critical Care Medicine, Hollywood Presbyterian Medical Center, Los Angeles, CA 90027.
Abstract:
Fungal infection of central venous catheters is well described. Peripheral fungal thrombophlebitis, however, has only been recognized recently, is thought rare, and is poorly characterized as to clinical presentation and treatment. We report the cases of eight patients with peripheral Candida thrombophlebitis. Patients were elderly and critically ill. All had received broad-spectrum antibiotics. Skin colonization appeared the source of contamination. Sepsis, shock, and organ failure were frequent. Physical findings of fungal phlebitis may be subtle, and diagnosis is often delayed. Multiple sites are frequently involved. Treatment necessitates radical excision of suspected veins and systemic antifungal chemotherapy. Persistent fungemia suggests inadequate phlebectomy or the existence of further affected veins. Peripheral thrombophlebitis is probably a common source of fungal sepsis and should be considered in all patients with fungemia. Without aggressive surgical intervention, survival is unlikely.
Insights
Peripheral fungal thrombophlebitis, a rare condition, can lead to severe sepsis. Early diagnosis and aggressive surgical treatment, alongside antifungal chemotherapy, are crucial for survival in elderly, critically ill patients.
Area of Science:
- Infectious Diseases
- Vascular Surgery
- Mycology
Background:
- Fungal infection of central venous catheters is common.
- Peripheral fungal thrombophlebitis is a recently recognized, poorly characterized condition.
- This condition is likely underdiagnosed and associated with significant morbidity.
Purpose of the Study:
- To describe the clinical presentation and treatment of peripheral Candida thrombophlebitis.
- To highlight the importance of considering this condition in patients with fungemia.
- To emphasize the necessity of aggressive management for improved survival.
Main Methods:
- Case series of eight patients with peripheral Candida thrombophlebitis.
- Review of clinical presentation, diagnostic challenges, and treatment outcomes.
- Analysis of potential sources of infection and associated complications.
Main Results:
- Patients were elderly, critically ill, and often on broad-spectrum antibiotics.
- Skin colonization was a frequent source of Candida infection.
- Sepsis, shock, and organ failure were common complications.
- Diagnosis was often delayed due to subtle physical findings and multifocal involvement.
- Aggressive surgical excision and antifungal chemotherapy were required for treatment.
Conclusions:
- Peripheral fungal thrombophlebitis is a significant, likely underrecognized, source of fungal sepsis.
- Early consideration in patients with fungemia is critical.
- Prompt surgical intervention and systemic antifungal therapy are essential for survival.
- Persistent fungemia may indicate inadequate surgical debridement or additional affected sites.