The Treatment of Septicemia in Pacemaker Patients

Böhm, Ádám; Bányai, F; Préda, István; Zámolyi, Károly

doi:10.1111/j.1540-8159.1996.tb03420.x

Cited by 30 publications

(24 citation statements)

References 16 publications

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“…The most common presentations of fungal endocarditis are fever, changing cardiac murmurs, heart failure, sepsis and systemic emboli (1,2,16). These findings are often inconsistent and rarely occur together.…”

Section: Discussionmentioning

confidence: 99%

“…Blood cultures for Aspergillus species endocarditis have been reported to be positive in only 11% of cases, whereas Candida species-positive blood cultures range from 83% to 95% (16,17). Major emboli are present in approximately 68% of all fungal endocarditis cases and up to 83% of Aspergillus species cases (16,17). Culture of these peripheral emboli, when present, may be an effective method of establishing a diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, unacceptably high mortality rates persist. Despite aggressive surgical and antimycotic therapy, the overall mortality rates for fungal endocarditis range from 50% to 94% (1,2,16,17). Aspergillus species endocarditis mortality rates are greater than 90%, regardless of treatment modality (1,10).…”

Section: Discussionmentioning

confidence: 99%

“…The low sensitivity of TTE in comparison with TEE is a possible explanation for our patient's negative TTE at initial clinical presentation. Although rare cases of fungal endocarditis have been effectively treated with antimycotic therapy alone (17), combined medical therapy and surgical removal of infected valves and any accompanying hardware are the mainstay of treatment (7)(8)16,17). Amphotericin B is the antimycotic of choice, with recommended total doses of 2 g to 3 g (50 mg/kg) (16,17).…”

Section: Discussionmentioning

confidence: 99%

“…Although rare cases of fungal endocarditis have been effectively treated with antimycotic therapy alone (17), combined medical therapy and surgical removal of infected valves and any accompanying hardware are the mainstay of treatment (7)(8)16,17). Amphotericin B is the antimycotic of choice, with recommended total doses of 2 g to 3 g (50 mg/kg) (16,17). For pacemaker lead endocarditis, most authors advocate thoracotomy when vegetations exceed 1.0 cm in size because the risk of embolization is significantly increased with intravascular traction methods (8,18).…”

Section: Discussionmentioning

confidence: 99%

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Aspergillus fumigatus pacemaker lead endocarditis: A case report and review of the literature

Leong¹,

Gannon²,

Childs³

et al. 2006

Canadian Journal of Cardiology

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Fungal endocarditis is an uncommon complication of pacemaker implantation and is associated with high mortality rates (1). Survival is largely dependent on early diagnosis and treatment. However, late diagnosis is common due to the frequency of nonspecific clinical symptoms, negative blood cultures and delays in obtaining appropriate imaging studies. A high index of suspicion for fungal endocarditis should be maintained in individuals with implantable pacemakers and fever of an uncertain source, especially in the context of negative blood cultures. We report a patient with rare pacemaker lead endocarditis due to Aspergillus fumigatus, and review the diagnostic and treatment considerations. CASE PRESENTATIONA 71-year-old man was admitted with a two-week history of chest pain and a one-week history of low-grade fever (less than 39°C). His medical history was significant for myocardial infarction, atrial fibrillation and asystolic arrest, leading to pacemaker insertion 23 years previously. Numerous pacemakerrelated complications had led to five pacemaker revisions. Superior vena cava (SVC) syndrome, secondary to pacemaker lead fibrosis, was treated on two separate occasions with percutaneous catheter dilation and stenting, most recently performed four months before presentation. He was receiving chronic anticoagulation with warfarin, and antiplatelet therapy consisting of acetylsalicylic acid and clopidogrel. He had no history of being immunocompromised.Physical examination revealed a temperature of 38.5°C. Chronic plethora due to longstanding SVC obstruction was observed. There were no cardiac murmurs or extra heart sounds. No stigmata of infectious endocarditis were observed. The remainder of the physical examination was unremarkable. Pertinent laboratory data included a hemoglobin count of 113 g/L, white blood cell count of 3.8×10 9 /L, platelet count of 153×10 9 /L, erythrocyte sedimentation rate of 102 mm/h, C-reactive protein concentration of 163 mg/L and international normalized ratio of 2.8. There was no biochemical or electrocardiographic evidence of myocardial infarction. Multiple blood cultures performed during the patient's sixweek admission were negative and no antimicrobial therapy was initiated. The diagnosis of fungal endocarditis requires a high index of clinical suspicion. Rarely, pacemaker implantation may be a risk factor for the development of fungal endocarditis. A 71-year-old man with a history of multiple transvenous pacemaker manipulations and fever of an uncertain source is described. A diagnosis of culture-negative pacemaker endocarditis was established only after repeat transthoracic echocardiography. Amphotericin B was instituted; however, the patient developed a cerebral infarct and died. Postmortem examination demonstrated Aspergillus fumigatus within a large pacemaker lead thrombus, tricuspid and aortic valve vegetations, and septic pulmonary and renal emboli. The present report describes the clinical and pathological features of a rare case of Aspergillus fumigatus pacemaker lead en...

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Section: Discussionmentioning

confidence: 99%