Aspergillus mediastinitis after cardiac surgery

• Main Authors: Marie-Josée Caballero, Nicolas Mongardon, Hakim Haouache, Dominique Vodovar, Issam Ben Ayed, Lauriane Auvergne, Marie-Line Hillion, Françoise Botterel, Gilles Dhonneur
• Format: Article
• Language: English
• Published: Elsevier 2016-03-01
• Series: International Journal of Infectious Diseases
• Subjects: Mediastinitis; Aspergillosis; Aspergillus fumigatus; Cardiac surgery; Nosocomial infection
• Online Access: http://www.sciencedirect.com/science/article/pii/S1201971216000151

Background: Mediastinitis is a serious complication after cardiac surgery. While bacteria are the more common pathogens, fungal infections are rare. In particular, several cases of postoperative Aspergillus mediastinitis have been reported, the majority of which had an extremely poor outcome. Methods: A case of mediastinitis in a 42-year-old patient due to Aspergillus fumigatus after cardiac surgery is described. Two main risk factors were found: cardiogenic shock requiring veno-arterial extracorporeal life support and failure of primary closure of the sternum. A full recovery was attained after surgical drainage and antifungal therapy with liposomal amphotericin B, followed by a combination of voriconazole and caspofungin. The patient was followed for 18 months without relapse. Results: This is an extremely rare case of postoperative Aspergillus mediastinitis exhibiting a favourable outcome. Based on a systematic review of the literature, previous cases were examined with a focus on risk factors, antifungal therapies, and outcomes. Conclusion: The clinical features of postoperative Aspergillus mediastinitis may be paucisymptomatic, emphasizing the need for a low index of suspicion in cases of culture-negative mediastinitis or in indolent wound infections. In addition to surgical debridement, the central component of antifungal therapy should include amphotericin B or voriconazole.