Aspergillus infection of implantable cardioverter-defibrillators and pacemakers: case report and literature review

Cobo, Marta; Ramos, António; Toquero, Jorge; Múñez, Elena; Alvarez-Espejo, T.; Muñoz, M.; Fernández, Inmaculada

doi:10.1007/s10096-007-0292-6

Cited by 9 publications

(3 citation statements)

References 20 publications

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“…Nearly all articles included small numbers of patients that satisfied the inclusion criteria, ranging from one to eight patients. We identified 48 cases from 41 individual studies that satisfied the prespecified inclusion criteria 9–49 . Among these patients, the mean age was 58 years, and 31% were female.…”

Section: Resultsmentioning

confidence: 99%

Management of systemic fungal infections in the presence of a cardiac implantable electronic device: A systematic review

Baman

Medhekar

Jain

et al. 2020

Pacing Clinical Electrophis

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Evidence to inform the management of systemic fungal infections in the setting of a cardiac implantable electronic devices (CIED), such as a permanent pacemaker or implantable cardioverter‐defibrillator, is scant and limited to case reports and series. The available literature suggests high morbidity and mortality. To better characterize the shared experience of these cases and their outcomes, we performed a systematic review. We investigated all published reports of systemic fungal infections—fungemia and fungal vegetative disease—in the context of CIED, drawing from PubMed, EMBASE, and the Cochrane database of systematic reviews, inclusive of patients who received treatment between January 2000 and May 2020. Exclusion criteria included presence of ventricular assist device and concurrent bacteremia, bacterial endocarditis, bacterial vegetative infection, or viremia. Among 6261 screened articles, 48 cases from 41 individual studies were identified. Candida and Aspergillus species were the most commonly isolated fungi. There was significant heterogeneity in antifungal medication selection and duration. CIED extraction—either transvenous or surgical—was associated with increased survival to hospital discharge (92%) and clinical recovery at latest follow‐up (81%), compared to cases where CIED extraction was deferred (56% and 40%, respectively). Importantly, there were no prospective data, and the data were limited to individual case reports and one small case series. In summary, CIED extraction is associated with improved fungal clearance and patient survival. Reported antifungal regimens are heterogeneous and nonuniform. Prospective studies are needed to verify these results and define optimal antifungal regimens.

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Section: Resultsmentioning

confidence: 99%

Management of systemic fungal infections in the presence of a cardiac implantable electronic device: A systematic review

Baman

Medhekar

Jain

et al. 2020

Pacing Clinical Electrophis

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“…The majority of these cases have been seen with lead infections and endocarditis often with tricuspid valve vegetations [ 4 ]. An article published in 2007 [ 6 ] reviewed 15 cases of Aspergillus associated pacemaker and ICD infections, of which only two had pocket infections. So far only four cases have been reported in association with pacemaker pocket infection and all of these occurred either acutely or sub-acutely.…”

Section: Discussionmentioning

confidence: 99%

“…Like Pincus et al, their cases also had risk factors like diabetes, but eventually did well with surgical and medical treatment. Cobo et al [ 6 ] reported a 74-year-old woman presenting with pocket infection, which was later found to be from Aspergillus favus . An Echocardiogram in addition showed vegetations in the cardiac leads.…”

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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Fungal Endocarditis Observed Over an 8-Year Period and a Review of the Literature

et al. 2014

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Aspergillus infection of implantable cardioverter-defibrillators and pacemakers: case report and literature review

Cited by 9 publications

References 20 publications

Management of systemic fungal infections in the presence of a cardiac implantable electronic device: A systematic review

Management of systemic fungal infections in the presence of a cardiac implantable electronic device: A systematic review

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

Fungal Endocarditis Observed Over an 8-Year Period and a Review of the Literature

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