Fungal infections of the heart: a clinicopathologic study of 50 autopsy cases.
Cardiac fungal infection (CFI) is relatively uncommon, but its incidence is increasing. It is associated with a grim prognosis, but some CFI patients can survive given an early diagnosis and aggressive therapy. To clarify the clinicopathologic features of CFI, a retrospective autopsy study was conducted. Among a total of 4396 autopsy cases collected over a 33-year period (1973-2005), 50 CFI patients (1.1%) were selected and studied clinicopathologically. The study subjects were 32 males and 18 females with a mean age of 65.5 years. Underlying diseases for CFI included solid malignant neoplasms (n=23), hematologic disorders (n=10), chronic renal diseases (n=7), liver diseases (n=5), diabetes mellitus (n=5), and other miscellaneous ailments. Antibiotics were given to 47 patients, while corticosteroids, antineoplastic drugs, and antifungal agents were used for 21, 12, and 12 patients, respectively. None of the patients was diagnosed to have CFI antemortem. Most patients (n=45) demonstrated multi-organ fungal infections with myocardial involvement. Causative pathogens were Candida (n=36), Aspergillus (n=9), Mucor (n=4), and Cryptococcus (n=1). Comparisons between previous CFIs (1973-1989) and recent CFIs (1990-2005) revealed an increasing proportion of non-candidal CFIs (p=0.004) in the latter. Our results point to the clinical importance of defining diagnostic criteria and therapeutic strategies for CFIs, especially for non-candidal CFIs.
Chinen
Katsuya
K
Department of Pathology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan. kchinen@kyorin-u.ac.jp
Tokuda
Yasuharu
Y
Sakamoto
Atsuhiko
A
Fujioka
Yasunori
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D053821:Cardiovascular Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006321:Heart / Q000382:microbiology*; D006331:Heart Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies