[Fatal aspergillosis after cardiac transplantation. About 26 cases].
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.
Laboratoire d'Anatomie Pathologique, Hôpital Cardiovascularie et Pneumologique, Lyon.
R
R
Loire
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A
Tabib
O
O
Bastien
D000038:Abscess / Q000150:complications / Q000473:pathology; D001228:Aspergillosis / Q000209:etiology / Q000473:pathology*; D004617:Embolism / Q000150:complications / Q000473:pathology; D006331:Heart Diseases / Q000150:complications / Q000473:pathology; D016027:Heart Transplantation; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000473:pathology; D013492:Suppuration