Mycotic emboli of the peripheral vessels: analysis of forty-four cases.
Two cases of mycotic emboli of the peripheral vessels are presented, and 42 additional cases from the literature are analyzed. Male patients predominate 3:1. Candida and Aspergillus are the usual pathogens. Initial presentation as large vessel peripheral emboli is characteristic (77%), with emboli originating from either the aortic or mitral valves. Cerebral emboli may proceed of follow the peripheral embolization. Predisposing factors include open-heart surgery, antibiotic therapy, concomitant infection, and intravenous drug abuse. Early symptoms of fungemia are nonspecific, with blood cultures positive in only 43% of cases. The overall mortality rate was 84%-73% in patients who did not undergo previous open-heart surgery, and 96% in patients who underwent previous open-heart surgery. Patients with Candida infection seem to do better than those with Aspergillus endocarditis (19% survival versus 5%). Aggressive therapy, including embolectomy, early valve replacement, and prolonged antifungal drug therapy, is advised.
D000328:Adult; D001228:Aspergillosis / Q000175:diagnosis* / Q000628:therapy; D001232:Aspergillus fumigatus; D002177:Candidiasis / Q000175:diagnosis* / Q000628:therapy; D006348:Cardiac Surgical Procedures; D004617:Embolism / Q000209:etiology; D004696:Endocarditis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012306:Risk