Περίληψη:
Invasive aspergillosis(IA) is a potentially lethal complication of Aspergillus infection affecting mainly immunocompromised hosts; however, during the last two decades its incidence was increasingly observed in critically ill immunocompetent patients. The objective of this study is to describe the clinical characteristics of histologically proven endomyocardial and pericardial invasion, in the context of IA, in critically ill patients. Eight critically ill patients with histopathological confirmation of endomyocardial/pericardial aspergillosis were evaluated. Risk factors, clinical and laboratory characteristics, treatment, histopathological characteristics and mortality were recorded. Signs and symptoms of cardiac dysfunction were not observed in any of the patients. Therapy was administered to six of them shortly after the first positive culture. The observed histopathological lesions included haemorrhagic lesions, small vessels with central thrombosis and surrounding consolidated tissue with necrosis. Voriconazole, caspofungin, lipid amphotericin B and itraconazole were the used antifungals. The mortality rate was high (87.5%). Endomyocardial and pericardial aspergillosis are devastating complications of invasive aspergillosis. Clinical suspicion is low making the diagnosis difficult, therefore histopathological examination of tissues are required. The mortality is high. © 2017 Blackwell Verlag GmbH
Συγγραφείς:
Dimopoulos, G.
Frantzeskaki, F.
Kosmopoulos, M.
Taccone, F.S.
Van den Abeele, A.-M.
Bulpa, P.
Forêt, F.
Vogelaers, D.
Blot, S.
AspICU investigators
Blasco-Navalpotro, M.
Brusselaers, N.
Cardoso, T.
Charles, P.-E.
Clause, D.
Courouble, P.
De Laere, E.
Li, D.
Martin, C.
Mashayekhi, S.
Meersseman, W.
Misset, B.
Paiva, J.A.
Pasqualotto, A.
Pérez, M.
Rao, R.
Rello, J.
Souto, J.
Spapen, H.
Vandewoude, K.
Λέξεις-κλειδιά:
amphotericin B lipid complex; antineoplastic agent; caspofungin; corticosteroid; immunosuppressive agent; itraconazole; voriconazole; amphotericin B; antifungal agent; caspofungin; echinocandin; lipopeptide, adult; adult respiratory distress syndrome; aged; antifungal therapy; Article; aspergillosis; case report; chronic obstructive lung disease; clinical feature; critically ill patient; drug substitution; drug withdrawal; dyspnea; endomyocardium aspergillosis; female; fungus culture; heart failure; hematologic malignancy; hemoptysis; histopathology; human; Human immunodeficiency virus infection; human tissue; invasive aspergillosis; major clinical study; male; middle aged; mortality; neutropenia; outcome assessment; pericardium aspergillosis; physical disease by body function; pleural pain; priority journal; respiratory failure; risk factor; thorax radiography; tissue necrosis; x-ray computed tomography; cardiac muscle; critical illness; heart disease; immunocompetence; immunocompromised patient; incidence; microbiology; pathology; pericardium; systemic mycosis, Amphotericin B; Antifungal Agents; Critical Illness; Echinocandins; Female; Heart Diseases; Humans; Immunocompetence; Immunocompromised Host; Incidence; Invasive Fungal Infections; Lipopeptides; Male; Middle Aged; Myocardium; Pericardium; Risk Factors; Voriconazole
