Aspergillus pacemaker lead endocarditis

Pillai, Jeewan; Mubeen, Mohammad; Chaudhari, Amit; Dalmia, Basant

doi:10.1177/0218492312450448

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…However, if the vegetations are larger than 1 cm, the risk of fatal embolic events during retraction is too high so that thoracotomy should be preferred. 61 Extensive surgery and complete recovery was reported by Reis et al [63] in a case report from 2005. The patient received an aortic root bioprosthesis after bacterial endocarditis, however, about 3 months after surgery he developed postoperative endocarditis due to Aspergillus, manifesting in several severe embolic events and peri-root abscess with extension of infected material to the aortic wall.…”

Section: Endocarditismentioning

confidence: 87%

“…For removal ether intravascular retraction methods or thoracotomy are performed. However, if the vegetations are larger than 1 cm, the risk of fatal embolic events during retraction is too high so that thoracotomy should be preferred . Extensive surgery and complete recovery was reported by Reis et al .…”

Section: Endocarditismentioning

confidence: 94%

“…Especially the surface of prosthetic valves is often the origin of valvular vegetations by Aspergillus spp., however, affected native valves have been reported in intravenous drug addicts. Case reports from 2013 and from 2011 also described Aspergillus vegetations on the wire of a pacemakers . The aortic and mitral valves are most commonly affected in Aspergillus endocarditis.…”

Section: Endocarditismentioning

confidence: 99%

“…Case reports from 2013 and from 2011 also described Aspergillus vegetations on the wire of a pacemakers. 60,61 The aortic and mitral valves are most commonly affected in Aspergillus endocarditis. Surgery in the management of Aspergillus endocarditis aims to remove endocardial vegetations, since they are responsible for the catastrophic complications and contribute to the high mortality rates in Aspergillus endocarditis.…”

Section: Endocarditismentioning

confidence: 99%

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The role of surgical debridement in different clinical manifestations of invasive aspergillosis

Reischies

Hoenigl

2014

Mycoses

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SummaryInvasive aspergillosis (IA) has a wide spectrum of clinical presentations and is associated with high mortality rates. Early initiation of systemic antimould therapy remains the most important measure to reduce mortality. Surgical debridement is an important additional therapeutic option mainly in cases of extrapulmonary IA. The main intention for surgical intervention in IA is to obtain material for diagnosis and antifungal susceptibility testing. There are, however, also therapeutic implications for surgical interventions in rare manifestation of IA such as endocarditis or mycotic aneurysm. Here, we will review the role of surgical interventions in the treatment of different clinical manifestations of IA.

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Section: Endocarditismentioning

confidence: 87%

Section: Endocarditismentioning

confidence: 94%

Section: Endocarditismentioning

confidence: 99%

Section: Endocarditismentioning

confidence: 99%

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The role of surgical debridement in different clinical manifestations of invasive aspergillosis

Reischies

Hoenigl

2014

Mycoses

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“…Diagnosing fungal endocarditis remains elusive because of negative blood cultures [ 13 , 14 ]. It has been reported that they are positive only in about 11% of cases [ 15 ], thus accounting for the high mortality. Once there is suspicion of Aspergillus infection , or when confirmed, immediate anti-fungal therapy should be initiated.…”

Section: Discussionmentioning

confidence: 99%

A Case of Late Implantable Cardiac Device Infection with Aspergillus in an Immunocompetent Host

Kodali

Khalighi

2015

Am J Case Rep

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Patient: Female, 67Final Diagnosis: Infected pacemaker device secondary to Aspergillus fumigatusSymptoms: Swelling over the left pectoral regionMedication: VoriconazoleClinical Procedure: Pacemaker explantationSpecialty: CardiologyObjective:Unusual clinical courseBackground:With the increasing use of cardiac implantable electronic devices (CIED), there has been an associated increase in rate of complications. Infection accounts for about 1% of these, of which only a handful were reported secondary to Aspergillus fumigatus. All of these were seen in chronically-ill patients with several co-morbid conditions within a few years of implantation. None have been reported in an otherwise immunocompetent patient at 7 years after CIED implantation.Case Report:A 67-year-old woman with symptomatic sick sinus syndrome required a pacemaker 15 years ago with subsequent revision 7 years prior due to battery depletion. She now presented with a left pectoral non-tender mass that developed over several weeks. She denied history of recent fever, trauma, or infection. An elective pacemaker revision and pocket exploration led to the drainage of 150 cc of serosanguineous discharge from the pocket. She received peri-procedural prophylaxis with Vancomycin, but later, wound cultures grew Aspergillus fumigatus. She underwent complete removal of the pacemaker system along with a 6-week course of voriconazole and is doing well.Conclusions:Even though Staphylococcus aureus causes most CIED infections, there should be a suspicion for fungal organisms, especially in culture-negative infections, in immunocompromised states like diabetes mellitus or with minimal improvement on antibiotics. If not treated appropriately, aspergillosis may have catastrophic outcomes, including endocarditis, often leading to death. Appropriate treatment should include immediate initiation of antifungals and removal of the CIED. It is still unclear why an immunocompetent patient developed aspergillosis, but appropriate management helped avoid a grave outcome.

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