A case of Aspergillus myocarditis associated with septic shock

Aspergillosis myocarditis in the immunocompromised host

Invasive cardiac aspergillosis has been rarely described in immunocompromised patients. This disease is difficult to diagnose by conventional laboratory, microbiologic, and imaging techniques, and is often recognized only post-mortem. The authors present the case of a 60-year-old woman admitted with an exacerbation of eosinophilic granulomatosis with polyangitiis (EGPA) who subsequently died from Aspergillus myocarditis, and compare the patient’s case to prior literature. This serves as an up-to-date literature review on the topic of invasive cardiac aspergillosis.

Invasive nosocomial aspergillosis associated with heart failure and complete heart block following recovery from dengue shock syndrome

OBJECTIVE

To report a case of invasive aspergillosis, associated with complete heart block and heart failure, in an immunocompetent child recovering from dengue shock syndrome.

DESIGN

Case report and literature review.

SETTING

Pediatric intensive care unit in a tertiary care center.

PATIENT AND RESULTS

A 9-yr-old boy was admitted to our pediatric intensive care unit with dengue shock syndrome, for which he was successfully managed. During the recovery phase, the child developed recurrence of fever and signs of congestive heart failure. Thereafter, he developed complete heart block and died. Myocardial biopsy revealed myocarditis and invading fungal elements with branching septate hyphae suggestive of Aspergillus. A renal biopsy specimen also showed glomerular invasion with Aspergillus and patchy necrosis. This suggested the diagnosis of invasive aspergillosis.

CONCLUSIONS

This case highlights an unusual manifestation of invasive aspergillosis in a critically ill immunocompetent child.

Levitronix Ventricular Assist Devices as a Bridge to Recovery After Profound Biventricular Heart Failure Associated With Pulmonary Aspergillosis

A patient with multisystem organ failure and refractory cardiopulmonary shock stemming from Aspergillus pneumonia was treated with 2 Levitronix ventricular assist devices as a bridge-to-recovery. After ventricular assist device placement, the patient recovered myocardial function. The ventricular assist devices were removed on post-implant Day 7, and the patient made a full long-term recovery. Ventricular assist devices should be strongly considered, as bridges to recovery, to support patients with acute myocardial dysfunction associated with sepsis while the underlying infection is treated.

Pathophysiology of unilateral pulmonary aspergillosis in an experimental rat model

Because little is known about the pathophysiology of invasive pulmonary aspergillosis (IPA), we examined changes in pulmonary and general physiology during this disease in an animal model. In a model of fatal left-sided IPA, 19 persistently neutropenic rats were monitored for clinical signs including body temperature, body weight and respiratory distress. A separate group of nine rats with IPA was used for measurements of arterial blood pressure, arterial O2 and CO2 pressure, lung compliance and surfactant function. Body temperature and body weight decreased, whereas respiratory distress increased during progression of the disease. Compared to uninfected controls, in rats with IPA arterial blood pressure and lung compliance were significantly lower, and left lung minimal surface tension was significantly higher. Right lung surfactant function was not affected. Arterial O2 and CO2 pressures were not different between rats with IPA and uninfected controls. Infection with Aspergillus fumigatus in neutropenic rats resulted in hypothermia, body weight loss and respiratory distress. Loss of left lung function was probably compensated by the uninfected right lung, even in a late stage of the disease. Circulatory failure was a major feature in the terminal phase of the infection.