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[Fatal aspergillosis after cardiac transplantation. About 26 cases]
1Laboratoire d'Anatomie Pathologique, Hôpital Cardiovascularie et Pneumologique, Lyon.
Abstract:
Complications due to infection by aspergillus and favorized by therapeutic immunodepression are a significant cause of mortality after cardiac transplantation, but are only rarely diagnosed before autopsy. A detailed description of the anatomical lesions and their localisation might help the interpretation of symptoms observed in vivo. In a series of 147 autopsies subsequent to cardiac transplantation, aspergillosis appeared as the cause of death in 26 cases. Three anatomoclinical presentations could be identified: early post-operative septic pyohaemia (14 cases), delayed septic pyohemia (7 cases) and forms with predominantly pulmonary involvement (5 cases). In the first category, cardiac lesions are the most evident with myocardial micro-abscesses and intracardiac masses of aspergillus presenting a variable risk of embolism. Pulmonary << target lésions >> (infarctus associated with a variable degree of aspergillus arterial thrombosis) were present in all cases. Visceral involvement completes the picture; the more frequent lesions being acute pancreatitis (9 cases), infarctogenic aspergillus emboli of the kidneys (11 cases), the spleen (9 cases) or the brain (6 cases). In 8 subjects, microscopical examination revealed other germs associated with aspergillus. The serious consequences of aspergillus infection after cardiac transplantation imply that every preventive precaution should be taken, especially in avoiding possible contamination of the air of the operating room by the installation of filters and the regular control of airways and air conditioning systems.
Insights
Aspergillus infections are a major cause of death post-cardiac transplant, often missed before autopsy. Understanding these fungal infections and their anatomical locations can improve in-vivo diagnosis and patient outcomes.
Area of Science:
- Medical Mycology
- Transplantation Immunology
- Pathology
Context:
- Aspergillus infections pose a significant mortality risk in cardiac transplant recipients, often exacerbated by immunosuppressive therapy.
- Diagnosis before autopsy is challenging, highlighting the need for better in-vivo recognition of anatomical lesions.
Purpose:
- To describe the anatomical lesions and localization of aspergillosis in post-cardiac transplantation autopsies.
- To identify distinct anatomoclinical presentations of invasive aspergillosis in this patient population.
Summary:
- A review of 147 autopsies revealed aspergillosis as the cause of death in 26 cases, presenting as early or delayed septic pyohemia or primarily pulmonary disease.
- Common findings included myocardial micro-abscesses, intracardiac fungal masses, pulmonary infarcts with arterial thrombosis, and visceral emboli (kidneys, spleen, brain), along with acute pancreatitis.
- Co-infections with other microorganisms were noted in 8 cases.
Impact:
- The findings underscore the critical need for stringent preventive measures against Aspergillus contamination in operating rooms and air systems.
- Improved understanding of aspergillosis manifestations can aid in earlier clinical diagnosis and management, potentially reducing post-transplant mortality.