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Jette N, Gebhardt C, Coustinos D. Case report: cardiac tamponade secondary to candida pericarditis. J Surg Case Rep 2024; 2024:rjae150. [PMID: 38495044 PMCID: PMC10942808 DOI: 10.1093/jscr/rjae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Fungal pericarditis, a rare clinical presentation primarily observed in post-cardiothoracic surgery and immunocompromised patients, requires prompt recognition and effective treatment involving antifungal medications and surgical drainage. We report the case of a 40-year-old female initially diagnosed with infective endocarditis who progressed to cardiac tamponade. Timely surgical drainage significantly improved the patient's clinical status and revealed fungal pericarditis through pathological analysis. This case highlights the importance of considering the diagnosis of fungal pericarditis even in the absence of prior cardiothoracic surgical intervention and emphasizes the crucial role of both intravenous antifungal therapy and surgical drainage in its treatment.
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Affiliation(s)
- Nicholas Jette
- Department of Surgery, University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada
| | - Colin Gebhardt
- Department of Internal medicine, University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada
- Intensive Care, University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada
| | - Dimitri Coustinos
- Department of Thoracic Surgery, University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada
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Salimi M, Davoodi L, Jalalian R, Darayee M, Moslemi A, Faeli L, Mirzakhani R, Shokohi T. A fatal Candida albicans pericarditis presenting with cardiac tamponade after COVID-19 infection and cardiothoracic surgery. J Clin Lab Anal 2023; 37:e24968. [PMID: 37803881 PMCID: PMC10681509 DOI: 10.1002/jcla.24968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 08/08/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Candida pericardial infection is a rare clinical entity usually related to recent cardiothoracic surgery and chronic debilitating conditions. During the COVID-19 pandemic, invasive fungal infections have been on the rise, likely due to a combination of factors such as immunosuppression, underlying conditions like diabetes, and surgical procedures. CASE PRESENTATION Herein, we report a 67-year-old diabetic woman with a history of COVID-19 infection who received a high dose of corticosteroids a few months before admission, and previous myocardial infarction for more than 12 years. The patient had a positive cardiac tamponade with signs of dyspnea, chest pain, and low blood pressure. Echocardiographic data were more in favor of constrictive pericarditis. The patient underwent urgent echocardiography-guided pericardiocentesis and then broad-spectrum antibiotic treatment was prescribed. Repeated echocardiography implied a persistent pericardial effusion 10 days later. Subxiphoid aspirates and biopsied tissues showed budding yeast cells and yeast colonies grew on culture media identified as Candida albicans. CONCLUSION This report should bring to the attention of physicians toward the possibility of Candida pericardial infection presenting with cardiac tamponade after COVID-19 infection and cardiothoracic surgery. Echocardiographic assessment, prompt pericardiotomy, molecular-based identification of causative agent, and early administration of appropriate antifungal treatment should improve the patient's survival.
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Affiliation(s)
- Maryam Salimi
- Student Research CommitteeMazandaran University of Medical SciencesSariIran
| | - Lotfollah Davoodi
- Department of Infectious Diseases, Antimicrobial Resistance Research Center, Communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
| | - Rozita Jalalian
- Department of Cardiology, School of Medicine, Cardiovascular Research CenterMazandaran University of Medical SciencesSariIran
| | - Masood Darayee
- Department of Cardiac Surgery, School of Medicine, Cardiovascular Research CenterMazandaran University of Medical SciencesSariIran
| | - Azam Moslemi
- Student Research CommitteeMazandaran University of Medical SciencesSariIran
| | - Leyla Faeli
- Student Research CommitteeMazandaran University of Medical SciencesSariIran
| | | | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
- Department of Medical Mycology, School of MedicineMazandaran University of Medical SciencesSariIran
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Yanes RR, Malijan GMB, Escora-Garcia LK, Ricafrente SAM, Salazar MJ, Suzuki S, Smith C, Ariyoshi K, Solante RM, Edrada EM, Takahashi K. Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report. Trop Med Health 2022; 50:72. [PMID: 36153612 PMCID: PMC9509570 DOI: 10.1186/s41182-022-00464-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2024] Open
Abstract
Background Pericardial effusion is a late manifestation of HIV more commonly observed in individuals with depressed CD4 counts. Although Mycobacterium tuberculosis remains to be one of the most frequently identified pathogens in the pericardial fluid among people living with HIV, less commonly described etiologies include SARS-CoV-2 that causes coronavirus disease and human herpesvirus-8 which is associated with Kaposi sarcoma. Isolation of more than one pathogen in normally sterile sites remains challenging and rare. We report the first documentation of both SARS-CoV-2 and HHV-8 in the pericardial fluid. Case presentation We present the case of a young man in his 20s with a recent history of clinically diagnosed pulmonary tuberculosis who was admitted for progressive dyspnea and cough. He had multiple violaceous cutaneous lesions on the face, neck, and trunk and diffused lymphadenopathies. He tested positive for SARS-CoV-2 on admission. The patient was clinically diagnosed with pneumonia, Kaposi sarcoma, and HIV/AIDS. Empiric broad spectrum antimicrobial regimen was subsequently initiated. HIV with low CD4 count was confirmed during hospitalization. Echocardiography revealed a large pericardial effusion, in impending cardiac tamponade. Frond-like fibrin strands, extending to the parietal pericardium, were also observed. Pericardiostomy yielded hemorrhagic, exudative effusion with lymphocytic predominance. SARS-CoV-2 and HHV-8 were detected in the pericardial fluid, and bacterial, fungal, and tuberculous studies were negative. The patient had clinical improvement after pericardial drainage. However, despite our best clinical care, he developed a nosocomial infection leading to clinical deterioration and death. Conclusion Detection of SARS-CoV-2 and HHV-8 in the pericardial fluid is rare, and interpretation of their significance in clinical care is challenging. However, coronavirus disease and Kaposi sarcoma must be considered and adequately addressed in immunocompromised adults presenting with large pericardial effusion.
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Siller RA, Skubic JJ, Almeda JL, Villarreal JF, Kaplan AE. Candida pericarditis presenting with cardiac tamponade and multiple organ failure after combined damage control thoracotomy and laparotomy with splenectomy in a trauma patient: Case report and review of literature. Trauma Case Rep 2021; 37:100564. [PMID: 34917734 PMCID: PMC8669452 DOI: 10.1016/j.tcr.2021.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 12/04/2022] Open
Abstract
Candida pericarditis is a rare condition which has previously been described after cardiothoracic surgery and immunosuppressive states (Geisler et al., 1981; Eng et al., 1981; Kraus et al., 1988; Kaufman et al., 1988; Tang et al., 2009; Glower et al., 1990; Carrel et al., 1991; Rabinovici et al., 1997; Canver et al., 1998; Farjah et al., 2005; Gronemeyer et al., 1982 [1-11]). We describe the case of a 19-year-old male blunt trauma patient, who survived a damage control thoracotomy and laparotomy with splenectomy, who later developed a loculated Candida pericardial effusion, complicated with cardiac tamponade and multiple organ failure, and required antifungals and surgical reintervention with thoracotomy for drainage. A literature search of the reported cases demonstrates that Candida pericarditis is indeed a rare but fatal condition if not identified and treated appropriately. This article discusses the difficulties we encountered while recognizing the disorder in our patient and proposes a guideline to adequately treat the condition in an effective and timely manner. Candida pericarditis poses a special challenge for the physician since its correct diagnosis and management requires a multidisciplinary approach.
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Affiliation(s)
- R A Siller
- University of Texas at Rio Grande Valley - General Surgery Residency at Doctors Hospital at Renaissance, 5321 S, McColl Road, Edinburg, TX 78569, United States of America
| | - J J Skubic
- DHR Health Surgery Institute, Department of Trauma and Critical Care, 1100 E. Dove Ave, Suite 201, McAllen, TX 78504, United States of America
| | - J L Almeda
- DHR Health Transplant Institute, Hepatobiliary, Pancreas and Organ Transplantation Center, 5540 Raphael Drive, Edinburg, TX 78539, United States of America
| | - J F Villarreal
- DHR Health Heart Institute, 224 Lindberg Ave, McAllen, TX 78501, United States of America
| | - A E Kaplan
- Pulmonary Sleep Center of the Rio Grande Valley, 5300 N, McColl Rd, McAllen, TX 78504, United States of America
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Sung J, Perez IE, Feinstein A, Stein DK. A case report of purulent pericarditis caused by Candida albicans: Delayed complication forty-years after esophageal surgery. Medicine (Baltimore) 2018; 97:e11286. [PMID: 29995762 PMCID: PMC6076085 DOI: 10.1097/md.0000000000011286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Candida pericarditis is a rare condition with high mortality. Risk factors include thoracic surgery and immunosuppression. We report a case of candida pericarditis which developed forty-years after esophageal reconstruction surgery. PATIENT CONCERNS A 42-year-old female presented with nausea, abdominal discomfort, and chest pain, and was found to have a cardiac tamponade secondary to candida pericarditis. Her notable risk factor was colonic interposition done during her infancy for esophageal atresia. DIAGNOSES The patient underwent emergent pericardial window where 500cc of purulent fluid was drained. The pericardial fluid culture grew Candida albicans. INTERVENTIONS Esophagram did not show any visible leak and the patient improved with surgical drainage and antifungal treatment with Caspofungin. Caspofungin was continued intravenously for a total of four weeks and was switched to fluconazole. OUTCOMES An Echocardiogram performed one month after pericardial window revealed trivial pericardial effusion. Serum beta-D-glucan at the time was negative. LESSONS This report highlights that candida pericarditis infection could occur as a late complication of colonic interposition. We also demonstrate the utility of using an echinocandin in treating this entity.
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Khillan V, Rathore N, Kathuria S, Chowdhary A. A rare case of breakthrough fungal pericarditis due to fluconazole‐resistant Candida auris in a patient with chronic liver disease. JMM Case Rep 2014. [DOI: 10.1099/jmmcr.0.t00018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Vikas Khillan
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Neha Rathore
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shallu Kathuria
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Ruiz-Cano MJ, Fernández-Ruiz M, Sánchez V, López-Medrano F. Constrictive pericarditis due to Candida albicans: an unexpected cause of pericardial effusion after heart transplantation. Rev Clin Esp 2012; 212:551-2. [PMID: 22795439 DOI: 10.1016/j.rce.2012.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 05/18/2012] [Accepted: 05/26/2012] [Indexed: 11/18/2022]
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Mutluay MM, Oğuz S, Ørstavik D, Fløystrand F, Doğan A, Söderling E, Närhi T, Olsen I. Experiments on in vivo biofilm formation and in vitro adhesion of Candida species on polysiloxane liners. Gerodontology 2011; 27:283-91. [PMID: 19804557 DOI: 10.1111/j.1741-2358.2009.00329.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Microorganisms may colonise polysiloxane soft liners leading to bio-deterioration. The aim of this study was to investigate in vitro adhesion and in vivo biofilm formation of Candida species on polysiloxane surfaces. METHODS The materials used in this study were Molloplast B, GC Reline soft, Mollosil Plus, Silagum Comfort and Palapress Vario. The in vitro retention of clinical isolates of Candida albicans to the relining and denture-base materials by microscopic (scanning electron microscopy, SEM), conventional culturing methods and antimicrobial properties of these materials were studied. Candida found on materials and mucosa following long-term use were identified and quantified, and biofilms covering the surfaces were investigated by SEM. RESULTS There was a significant decrease in the number of cells attached in vitro to saliva-coated surfaces compared with non-treated surfaces. An oral Candida carriage of 78% was found. Candida albicans, C. glabrata, C. intermedia and C. tropicalis were identified. In vivo biofilm formation on the liners appeared as massive colonisation by microorganisms. CONCLUSIONS The results of the in vitro experiments suggest that salivary film influences early colonisation of different C. albicans strains. The film layer also minimises the differences among different strains. The Candida carriage of these patients was similar to denture-wearing patients without soft liners.
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Affiliation(s)
- Mustafa Murat Mutluay
- Department of Prosthodontics, Faculty of Dentistry, University of Oslo, Oslo, Norway.
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Mohri T, Takashima K, Yamane T, Sato H, Yamane Y. Purulent pericarditis in a dog administered immune-suppressing drugs. J Vet Med Sci 2009; 71:669-72. [PMID: 19498298 DOI: 10.1292/jvms.71.669] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 5-year-old castrated mongrel dog was brought to our hospital with anorexia and vomiting. Laboratory testing revealed immune-mediated hemolytic anemia (IMHA), and so treatment was initiated with multiple immune-suppressing drugs, achieving partial remission from IMHA. However, cardiac tamponade due to purulent pericarditis was identified as a secondary disease. Culture of pericardial fluid yielded numerous Candida albicans and multidrug-resistant Acinetobacter sp. Pericardiocentesis was performed, and the condition of the dog improved. However, the dog died the next day.
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Emergency Department Presentation of Heart Transplant Recipients with Acute Heart Failure. Heart Fail Clin 2009; 5:129-43, viii. [DOI: 10.1016/j.hfc.2008.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Hollenbach E. Invasive candidiasis in the ICU: evidence based and on the edge of evidence. Mycoses 2008; 51 Suppl 2:25-45. [DOI: 10.1111/j.1439-0507.2008.01571.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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