Pacemaker lead infection caused by Aspergillus fumigatus

Yglesias, P. J. Marchena; Rodríguez, José Antonio; G, Garcia; Sanchis, David Vañó; Muños, Natividad Sánchez-Manjavacas; Nuñez, José Francisco Dimas

doi:10.1016/j.ejim.2005.11.017

Cited by 4 publications

(3 citation statements)

References 5 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

View full text Add to dashboard Cite

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“…It is particularly abundant in the air of buildings with deficient ventilation systems and near construction sites. It most commonly affects the respiratory tract, but other sites, including skin, have also been identified as portals of entry [ 4 ] and many times, the source of infection remains unknown [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment includes appropriate anti-fungal therapy, even before confirming the diagnosis with culture results. Anti-fungal agents like Amphotericin B, flucytosine and itraconazole have been used, but Voriconazole remains the first-choice [ 10 ]. Additionally, removal of the CIED system is strongly recommended, because of the possibility of large intravascular vegetations, for which plain medical therapy may be insufficient [ 13 ].…”

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

Cobo

Ramos

Toquero

et al. 2007

Eur J Clin Microbiol Infect Dis

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Presented here is a case of implantable-cardioverter-defibrillator infection caused by Aspergillus flavus and a review of 14 previously reported Aspergillus infections of pacemakers or implantable cardioverter-defibrillators. Among all 15 cases, fever was the most common presenting feature (11 patients). Three patients presented with generator-pocket inflammation. Transthoracic echocardiography was performed on eight of 13 patients with endocarditis, revealing vegetations in only one. Transesophageal echocardiography demonstrated the presence of vegetations in all eight of the patients on whom it was performed (p < 0.01). Death was due to the Aspergillus infection in five cases. Patients who presented with unexplained fever had a higher mortality rate (60%) than patients with other clinical presentations (20%, p = 0.166).

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Pacemaker lead infection caused by Aspergillus fumigatus

Cited by 4 publications

References 5 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

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

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