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Candidal mediastinitis: an emerging clinical entity
C J Clancy1, M H Nguyen, A J Morris
1University of Florida College of Medicine and the Veterans Administration Medical Center, Gainesville 32610, USA.
Abstract:
Candidal mediastinitis is rare. We report nine cases encountered at our institutions since 1985; seven cases were diagnosed since 1993. All cases followed thoracic surgery, with a median time from surgery to disease onset of 11 days (range, 6-100 days). All patients received prior antibiotic therapy. Common clinical manifestations were chest wall erythema in 4 cases (44%), drainage in 5 (56%), fever in 4 (44%), and sternal instability in 4 (44%). Failure to obtain appropriate intraoperative specimens for cultures and the dismissal of cultures positive for Candida as contaminants delayed diagnosis in three cases (33%). Mediastinitis was complicated by contiguous or hematogenous spread in seven cases (78%); five patients (56%) had two or more complications. The mortality rate was 56%. Optimal therapy remains undefined, but on the basis of our experience, aggressive surgical debridement combined with antifungal therapy for at least 6 weeks is recommended. Prompt recognition and institution of therapy appear to be the keys to improving prognosis.
Insights
Candidal mediastinitis, a rare fungal infection post-thoracic surgery, presents with varied symptoms. Early diagnosis and aggressive treatment combining surgery and antifungals are crucial for improving patient outcomes.
Area of Science:
- Medical Mycology
- Thoracic Surgery
Background:
- Candidal mediastinitis is a rare but serious complication following thoracic surgery.
- Diagnosis is often delayed due to challenges in specimen collection and interpretation of Candida cultures.
Observation:
- Nine cases of candidal mediastinitis were identified, all occurring post-thoracic surgery.
- Common symptoms included chest wall erythema, drainage, fever, and sternal instability.
- A significant delay in diagnosis was noted in one-third of cases.
Findings:
- The mortality rate for candidal mediastinitis was 56%.
- Complications such as contiguous or hematogenous spread occurred in 78% of patients.
- Delayed diagnosis and treatment contributed to poor outcomes.
Implications:
- Aggressive surgical debridement combined with a minimum of 6 weeks of antifungal therapy is recommended.
- Prompt recognition and initiation of appropriate treatment are critical for improving prognosis.
- Further research is needed to define optimal therapeutic strategies for this rare condition.