Candida and cardiovascular implantable electronic devices: a case of lead and native aortic valve endocarditis and literature review

Abstract

Use of cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left-sided heart valve and a CIED lead. Here, we report the case of a 70-year-old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED-associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED-associated Candida endocarditis.

Fighting fungus with a laser and a hose: Management of a giant Candida albicans implantable cardioverter‐defibrillator lead vegetation with simultaneous AngioVac aspiration and laser sheath lead extraction

“…Fungal infections of cardiac implantable electronic devices are uncommon and very challenging to manage . They are characterized by the presence of bulky vegetations, recurrent septic emboli, and persistence despite aggressive antimicrobial therapy.…”

Fungal prosthetic aortic valve endocarditis and endarteritis: An unusual cause of aortic root vegetations

“…Candida endocarditis has been known to affect both native and prosthetic valves, and vegetations affecting all four heart valves have been well documented in the literature. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Other, less common, sites of infection have also been described, such as the right atrial septum, right ventricular cavity, and left atrial cavity. [22][23][24][25][26] Exogenous material in the body, such as CEID, are particularly susceptible to infection with C albicans as the microorganism produces a highly organized biofilm covered in an extracellular matrix that facilitates binding.…”

“…[27][28][29] Multiple cases of CEID lead infections have been reported in the literature. 21,[30][31][32][33][34][35][36][37] Infection of left ventricular assist devices (LVAD) has also been reported. 38,39 Extracardiac sites of infection following Candida endocarditis have also been described.…”

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Other, less common, sites of infection have also been described, such as the right atrial septum, right ventricular cavity, and left atrial cavity. Surgical specimen cultures grew C albicans, which was sensitive to fluconazole.…”

“…The patient is currently recovering from his surgery and is undergoing a 6-week course of micafungin, which will be followed by suppressive fluconazole. 21,[30][31][32][33][34][35][36][37] Infection of left ventricular assist devices (LVAD) has also been reported. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Other, less common, sites of infection have also been described, such as the right atrial septum, right ventricular cavity, and left atrial cavity.…”