title: Candidal mediastinitis: an emerging clinical entity.
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.
authors.affiliation: University of Florida College of Medicine and the Veterans Administration Medical Center, Gainesville 32610, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Clancy
authors.forename: M H
authors.initials: MH
authors.lastname: Nguyen
authors.forename: A J
authors.initials: AJ
authors.lastname: Morris
mesh_terms: D000368:Aged; D002177:Candidiasis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D016469:Fungemia / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013249:Sternum; D019616:Thoracic Surgical Procedures / Q000009:adverse effects