title: Fungal infection of implantable cardioverter-defibrillators: case series of five patients managed over 22 years.
abstract: BACKGROUND
  With the increasing use of implantable cardioverter-defibrillators (ICDs), device complications are becoming more common. Fungal-related ICD infections have rarely been reported, and little is known about the presentation, prevalence, and treatment options for these morbid infections.
  
  
  OBJECTIVE
  The purpose of this study was to characterize the clinical features, treatment, and outcomes of patients with fungal ICD infections.
  
  
  METHODS
  We performed a retrospective review of ICD procedures performed at a single academic center and identified all ICD-related infections managed between 1983 and 2005.
  
  
  RESULTS
  Among a total of 3,648 ICD-related procedures performed between 1983 and 2005, we identified 47 (1.3%) cases of ICD infections, of which 5 (0.1%) were due to a fungal pathogen. Fungal infections were more likely to be associated with abdominal devices, to have a local rather than systemic infection, and to have a longer duration from the original implant to presentation. All patients were treated with ICD system explantation and antifungal therapy.
  
  
  CONCLUSIONS
  Fungal infection of ICDs is a rare but serious complication of device implantation that must be treated aggressively with complete hardware explantation and prolonged antifungal therapy. Because most infections are late complications and have indolent onsets, a high level of clinical suspicion is required for early diagnosis.
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, 02114, USA.
authors.forename: Ivan C K
authors.initials: IC
authors.lastname: Ho
authors.forename: David J
authors.initials: DJ
authors.lastname: Milan
authors.forename: Moussa C
authors.initials: MC
authors.lastname: Mansour
authors.forename: Theofanie
authors.initials: T
authors.lastname: Mela
authors.forename: Mary L
authors.initials: ML
authors.lastname: Guy
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Ellinor
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D001234:Aspergillus niger; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012107:Research Design; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014693:Ventricular Fibrillation / Q000628:therapy
chemical_list: D000935:Antifungal Agents