Aspergillus Infection in a Large Thrombus of a Permanent Ventricular Pacing Lead

Abstract

Pacemaker lead infection is a rare but a dangerous complication. Diagnosis can usually be established by the clinical picture and blood cultures. Transesophageal two dimensional echocardiography might be crucial in the diagnosis by visualizing pacing lead vegetations. Medical treatment alone is rarely successful, and several studies have suggested the infected pacemaker systems should be removed quickly for optimal management. We describe a case of Aspergillus infection in a permanent ventricular pacing lead, which appears to be the first reported case in Korea. A 30-yr-old man was evaluated for the symptoms and signs of congestive heart failure 3 yr after DDD pacemaker implantation. The transthoracic and transesophageal echocardiogram showed a large movable round shaggy mass attached to a ventricular lead in the right atrium. The atrial and ventricular leads were removed during cardiopulmonary bypass, and a new epicardial pacing system was implanted. The functional ventricular pacemaker lead was encased in a large organized thrombus. Histological findings were consistent with Aspergillus infection in a large thrombus attached to a pacemaker lead.

Septic Pulmonary Embolism Caused by Infected Pacemaker Leads After Replacement of a Cardiac Resynchronization Therapy Device

“…Other isolated microorganisms were coagulase-negative Staphylococci , gram-negative bacilli, Pseudomonas aeruginosa, and Corynebacterium species [ 13 , 15 ]. Not only bacterial infections have been incriminated in pacemaker lead endocarditis, but also fungal Aspergillus infection has been reported [ 13 , 16 ]. Moreover, several microorganisms were shown in asymptomatic carriers: Pseudomonas (16%), Staphylococcus (11%), Stenotrophomonas (10%), Rhizobium (9%) , and Propionibacterium (7%) [ 12 ].…”

Aspergillus pacemaker endocarditis presenting as pulmonary embolism

“…Fungal PME is extremely rare. In these cases, Candida spp is the most frequent pathogen found, 6 while Aspergillus spp has been reported in very few cases of PME 7–10 …”

“…In these cases, Candida spp is the most frequent pathogen found, 6 while Aspergillus spp has been reported in very few cases of PME. [7][8][9][10] Fever is the most common clinical sign of PME. Embolic episodes do not seem to be particularly frequent.…”

“…She did not have any recognized predisposing factor for Aspergillus infection, but this is not exceptional; while disseminated infection due to Aspergillus species is seen, as a rule, in patients with immunosupression, Aspergillus endocarditis can be found in patients with prosthetic cardiac valves or permanent pacemakers who are not immunosupressed. 10 Pacemaker generator replacement was carried out in another hospital 3 years earlier, and we are not aware of any other possible nosocomial cases of fungal infection in that center during the same period. Our patient was not systematically screened for fungal lesions (e.g.…”

Pacemaker infection due to Aspergillus: report of two cases and literature review

“…The clinical picture of pacemaker infections may comprise local inflammatory phenomena, endocarditis, septic embolism, septic phlebitis, pacemaker dysfunction, or sepsis. 5,[11][12][13] When the pathogen is a fungus, the evidence of local inflammation may be subtle, and the vegetations are usually large and tend to undergo embolization. 7,10 In one of our patients, the pacing system was seen to malfunction but we could not correlate this fact with the infectious process.…”