Cardiac Aspergillosis Research Articles

Invasive cardiac aspergillosis in an immuno-competent patient: distinctive imaging features on 18F-fluorodeoxyglucose (FDG)-PET/CT and 99mTc-sestamibi SPECT myocardial perfusion imaging.

Invasive cardiac aspergillosis in an immuno-competent patient: distinctive imaging features on 18F-fluorodeoxyglucose (FDG)-PET/CT and 99mTc-sestamibi SPECT myocardial perfusion imaging.

Invasive cardiac aspergillosis as contiguous infiltration from mediastinum: Imaging evaluation using cardiac MRI.

Invasive cardiac aspergillosis is a rare, potentially fatal disease which poses a significant diagnostic challenge. Combination of clinical details, imaging features, fungal markers, serology and fungal isolation with demonstration of invasion is usually necessary to establish the diagnosis. High index of suspicion is the key for early diagnosis with potential role of cardiac MRI in its early detection, delineation of extent of involvement and guidance to the appropriate site for tissue sampling, thereby allowing for improved prognosis with early institution of appropriate therapy.

Recurrent Invasive Aspergillosis in Immunocompetent Patient

Invasive cardiac aspergillosis is a rare form of disseminated Aspergillus infection which carries a very high mortality rate even with aggressive treatment. Importantly, patients with pre-existing cardiac lesions, prosthetic valves, stents, coronary bypass grafts, and implanted devices are at greater risk. A case of fatal, recurrent, disseminated Aspergillus infection in an immunocompetent patient with invasion of a structurally normal heart in the context of multiorgan involvement is presented. Supplemental material is available for this article. Keywords: CT, Echocardiography, Infection © RSNA, 2021.

A case series of non-valvular cardiac aspergillosis in critically ill solid organ transplant and non-transplant patients and systematic review.

Non-valvular cardiac aspergillosis is a rare infection of the pericardium, myocardium or endocardium and is associated with a high mortality. There is a paucity of reports of non-valvular cardiac aspergillosis in critically ill and solid organ transplant (SOT) patients. The majority of cases have been reported in haemato-oncology patients, some of whom have undergone a bone marrow transplant. We describe four cases affected by non-valvular cardiac aspergillosis in the intensive care setting including a systematic review of this extremely rare infection which is associated with high mortality. All four-patients died but presented with varying clinical, radiological and microbiological evidence of the disease. Three patients presented following complications after solid organ transplantation, two in the context of acute liver failure and emergency liver transplant and one several years after a double lung transplant. The last patient presented with necrotising gall stone pancreatitis, multi-organ failure and subsequently a prolonged intensive care unit (ICU) stay. On review of the literature, January 1955 to July 2019, 45 cases were identified, with different risk factors, clinical and radiological manifestations, treatment regimen and outcome. Antemortem diagnosis of cardiac aspergillosis is difficult and rare, with no cases reporting positive blood culture results. Galactomannan serology has poor sensitivity in solid organ transplant patients, further reduced by prophylactic antimicrobial treatment, which is common in the ICU setting especially post-transplant patients. Due to the scarcity of cases, treatment is extrapolated from invasive aspergillosis management, with emphasis on early treatment with combination therapy.

Cardiac aspergillosis in a patient with chronic granulomatous disease.

Cardiac aspergillosis in a patient with chronic granulomatous disease.

An unusual case of cardiac aspergillosis

An unusual case of cardiac aspergillosis

AspergillusAortitis: A Case with Near-Complete Occlusion of the Brachial Artery and Large Ascending Aortic Mycotic Pseudoaneurysm in an Immunocompetent Patient

Invasive cardiac aspergillosis is an extremely rare life threatening disease in immunocompetent hosts that has been described in the literature in a few cases Most cases have presented in the setting of an underlying pulmonary aspergillosis in the setting of an immunocompromised status This is to report an exceptionally rare aspergillusaortitis in an immunocompetent patient presenting with near complete occlusion of the brachial artery and a large ascending aortic mycotic pseudoaneurysm To our knowledge this is the first reported case of aspergillus aortitis in an immunocompetent host presenting initially as intraarterial thrombosis without intracardiac thrombosis or valvular vegetation The patient did not have any pre existing pulmonary or mediastinal disease but had a history of coronary artery bypass grafting years prior to the infection nbsp

Right atrial aspergilloma mimicking atrial mixomax

Infective endocarditis is a serious but relatively rare infection that is associated with high morbidity and mortality rates. Aspergillus endocarditis is an uncommon entity and invasive cardiac aspergillosis is a severe and extremely life threatening disease. Prolonged use of intravascular catheters, anatomical cardiac conditions, exposure to multiple broad-spectrum antibiotics, intravenous drug abuse, and previous history of surgery are the most common risk factors of fungemia and fungal endocarditis. Diagnosis is based on the isolation of etiologic agents from cardiac and blood samples or specimens from other sterile sites or positive histopathological findings of pathologic specimens. Echocardiographic findings of endocardial involvement can lead to diagnosis. Echocardiographically, differencial diagnosis of tumor extensions, especially myxoma, atipically located bacterial vegetations, thrombus or fungal masses is very difficult as thrombi and infective verrus can mimic myxomas. Treatment of fungal endocarditis only with antifungal agents is generally unsuccessful and additional surgical intervention is usually required. In this case report we present an fungal endocarditis caused by Aspergillus species that mimicked an atrial myxoma echocardiographically in a patient who had a history of treatment with wide spectrum antibiotics for a long time. We suggest that patients who had broad spectrum antibiotic treatment for a long time should be scanned for fungal infections and if intracardiac mass is determined, fungal endocarditis should be considered in differential diagnosis.

Multimodality Diagnosis Approach of Cardiac Aspergillosis

Mini‐AbstractA 56‐year‐old patient with a history of bilateral lung transplantation for idiopathic interstitial pneumonia not responding to corticosteroids therapy had a good initial postoperative outcome. One month later, subcutaneous nodules appeared and histopathology revealed septate hyphae in the nodules and Aspergillus fumigatus in bronchial lavage. FDG PET/CT and CMR revealed multiple left and right ventricles abscesses consistent with cardiac aspergillosis. The combination of FDG PET/CT and CMR was useful to detect the cardiac localization of systemic aspergillosis, to define the precise morphological details of myocardial lesions and to evaluate the response to treatment.

Invasive Cardiac Aspergillosis With Postinfectious Left Ventricular Aneurysm in a Patient With Acute Myeloid Leukemia

Invasive Cardiac Aspergillosis With Postinfectious Left Ventricular Aneurysm in a Patient With Acute Myeloid Leukemia

Aspergillus endocarditis: a case of near complete left ventricular outflow obstruction

A 60-year old woman presented with dyspnoea and fatigue. She was frail and cachectic (BMI 17.5) with a pancytopenia. Previously she had received chemotherapy for chronic lymphatic leukaemia. She relapsed one year ago necessitating a reduced intensity conditioning allogeneic haematopoietic cell transplantation. Subsequently, graft versus host disease required high-dose immunosuppressants. Computerized tomography on admission showed bilateral lung nodules and a suspicious cardiac mass. Bronchial biopsies demonstrated abundant hypae consistent with Aspergillus fumigatus infection. Echocardiography demonstrated a large fungus ball attached to the right coronary cusp of the aortic valve with near complete obliteration of the left ventricular outflow tract. Due to the high risk of embolization this was resected under cardiopulmonary bypass. The mass was attached subvalvularly to the ventricular septal free wall and eroding through it. It peeled off leaving intact aortic leaflets. Unresectable fungal deposits were discovered on the interventricular septum, the left ventricle free wall and posterior aortic wall. High-dose systemic antifungal therapy (Voriconazole and Amphoteracin B) was given for 4 months. After discharge she remained well till a 4-month follow-up, after which she eventually succumbed to her disease. We discuss the clinical difficulties in managing patients with fungal infective endocarditis and present a brief review of cardiac aspergillosis management.

Aspergilosis cardíaca en una paciente trasplantada de corazón

Background: Solid organ transplant recipients are a population at risk of invasive aspergillosis. The lung and the central nervous system are usually affected. Objectives: We report the case of a patient with proven cardiac invasive aspergillosis two years after heart transplantation, and perform a review of cardiac aspergillosis in solid organ transplant recipients. Case report A 52-year old woman received a heart transplant. Several complications appeared in the post-operative period, including the development of invasive aspergillosis in the surgical wound. She was readmitted two years later with dyspnea. A thoracic CT-scan revealed multiple lung embolisms and a mass in the retroxiphoid, invading the right atrium and the tricuspid valve. Septated hyphae invading this tissue were observed and Aspergillus fumiga-tus was subsequently isolated. Serum galactomannan determinations were negative. Antifungal therapy with vori-conazole was started. Two months later, the patient visited the hospital for a routine check-up control in good clinical condition, but with undetectable voriconazole serum levels. These levels were associated to the concomitant use of omeprazole. One year later, the patient was still receiving voriconazole and remained asymptomatic. Conclusions Invasive aspergillosis affecting the mediastinum can progress and affect the heart tissues. The use of omeprazole may be associated with the undetectable voriconazole serum levels.

CASE 3—2010 Dynamic Partial Obstruction of the Tricuspid Valve Inlet Produced by Anterior Mediastinal Aspergillosis Invading the Right Atrium

INVASIVE PULMONARY INFECTIONS caused by the opportunistic fungus Aspergillus fumigatus are common in immunocompromised patients and are notoriously difficult to treat successfully.1-4 Such infections frequently are encountered after solid organ or bone marrow transplantation5,6 and may also occur in patients with severe acquired immunodeficiency syndrome7 or those receiving chronic corticosteroid therapy for other indications.8 Primary cardiac aspergillosis or the spread of invasive pulmonary A fumigatus to the mediastinum, pericardium, or heart is exceedingly rare in the absence of previous cardiac surgery and carries a very high mortality rate.

Successful management of invasive aspergillosis presenting as pericarditis in an adult patient with chronic granulomatous disease

Invasive aspergillosis (IA) is a major cause of death among patients with chronic granulomatous disease (CGD). Few cases of cardiac aspergillosis have been published on CGD patients. Diagnosis of IA in CGD patients can be hampered by lack of characteristic symptoms and clinical signs and the serum galactomannan assay is often negative. We report the first CGD patient with IA presenting as pericarditis where combined antifungal therapy resulted in a successful outcome.

Galactomannan Detection as a Tool for the Diagnosis and Management of Cardiac Aspergillosis in 2 Immunocompetent Patients

Serum galactomannan antigen detection was used for the diagnosis and follow-up of cardiac aspergillosis after surgery in 2 nonneutropenic patients. The galactomannan index, developed in response to surgical and antifungal therapies, could prove to be a valuable method for the diagnosis and follow-up of fungal infections in such patients.

Myocardial Infarction Caused by Aspergillus Embolization in a Patient with Aplastic Anemia

A 38-year-old Japanese man with severe aplastic anemia had invasive pulmonary aspergillosis as a complication. He was treated with amphotericin B for six weeks, but the aspergillosis did not improve. Then he experienced a fatal myocardial infarction. An autopsy revealed disseminated aspergillosis involving pericarditis and Aspergillus embolization to the coronary arteries. This led to the acute myocardial infarction. Cardiac aspergillosis is rare, but should be included within the differential diagnosis when chest pain of unknown origin occurs in an immunosuppressed patient.

Cardiac Aspergillosis in Patients With Acquired Immunodeficiency Syndrome: A Case Report and Review of the Literature

Cardiac aspergillosis is uncommon in patients with acquired immunodeficiency syndrome (AIDS) in the absence of open heart surgery. We report a unique case of a 62-year-old man with AIDS who developed Aspergillus pancarditis with Aspergillus vegetations on mitral valve without evidence of pulmonary aspergillosis. There was extensive embolization to the brain and multiple foci of Aspergillus infection in kidneys and adrenal glands. There are only 10 documented cases of cardiac aspergillosis in the literature (1966-2003) in severely immunocompromised AIDS patients with CD4 T-lymphocyte counts ranging from 10 to 121 cells/muL. The cardiac aspergillosis could result from invasive pulmonary aspergillosis, either by hematogenous dissemination or by direct invasion, and skin Aspergillus infection can be carried through the bloodstream to the right heart in intravenous drug abusers. Most of the reported cases of cardiac aspergillosis were diagnosed at autopsy. Mortality among AIDS patients with cardiac aspergillosis is 100%, despite appropriate therapy.

Isolated Cardiac Aspergillosis After Bone Marrow Transplantation

A 15-year-old girl developed isolated cardiac aspergillosis after allogeneic bone marrow transplantation. Predisposing factors included severe graft-vs-host disease with gastrointestinal tract involvement and immunosuppressive therapy including cyclosporine. The patient died of cardiopulmonary failure 11 weeks after transplantation.

Isolated cardiac aspergillosis after bone marrow transplantation

Isolated cardiac aspergillosis after bone marrow transplantation

Cardiac aspergillosis in acquired immune deficiency syndrome

Cardiac aspergillosis has not been described in patients with the acquired immune deficiency syndrome (AIDS). In this report we describe such a case.