Aspergillus flavus-infection of a pacemaker wire: continuing evidence for active management of infected pacemakers

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Mycology

Background:

• Fungal endocarditis is a rare but serious complication, particularly in patients with implanted devices.
• Permanent pacemakers can serve as a nidus for microbial colonization and infection.
• Aspergillus flavus is an opportunistic pathogen that can cause invasive infections.

Observation:

• A patient presented with symptoms suggestive of endocarditis on a permanent pacemaker.
• Blood cultures were negative, and echocardiographic findings were non-specific, complicating the diagnosis.
• Histologic examination of the surgically explanted pacemaker was crucial for definitive diagnosis.

Findings:

• The case confirmed fungal endocarditis caused by Aspergillus flavus involving a permanent pacemaker.
• Diagnosis was challenging due to negative blood cultures and non-specific imaging.
• Histopathology of the explanted device provided the conclusive evidence.

Implications:

• This case underscores the need for considering fungal infections in pacemaker endocarditis, especially with negative routine cultures.
• Active surgical management and device explantation are critical for successful treatment.
• Histologic examination of removed devices is vital for diagnosing rare pacemaker infections.