Cardiac Aspergillosis

Abstract

Cardiac aspergillosis has been increasingly recognized as a complication of immunocompromise in recent times. The use of progressively more potent immunosuppressive agents and the longer survival times of transplant recipients is likely contributing to an increasing prevalence of the disease. Although still uncommon, the disease has an extremely high mortality rate and management remains difficult. Cardiac aspergillosis can present as combinations of endocarditis, myocardial invasion or pericarditis and commonly occurs in the context of disseminated aspergillosis. Myocardial involvement is most common, followed by endocarditis although the various forms frequently co-exist. Diagnosis is challenging and is frequently only done post-mortem. Culture diagnosis is best achieved with tissue (valve or biopsy), since blood culture is frequently negative. Any cardiac findings on imaging or physical examination in the context of disseminated aspergillosis suspected by culture, histology or antigen assay should be assumed to be cardiac aspergillosis and investigations for endocarditis should be undertaken. Treatment of cardiac aspergillosis is usually not successful and has not been systematically studied. For endocarditis, surgical and medical therapy are indicated, and medical therapy with either combination amphotericin B and flucytocine or the newer triazoles is suggested. Other forms of cardiac involvement are best managed as disseminated aspergillosis, with a low threshold for diagnosis of endocarditis.