Fungal infections of the heart: Analysis of 51 autopsy cases

The clinical setting, predisposing factors and consequences of fungal involvement of the heart were examined in all patients with this condition who underwent autopsy at The Johns Hopkins Hospital from 1889 through 1977. The 51 patients with cardiac fungal infection were all observed since 1954; they ranged in age from 2 weeks to 80 years; 29 were male. Fungal endocarditis was present in 13 patients, myocarditis in 31, pericarditis in 4 and pancarditis in 3. In only one instance was cardiac fungal infection diagnosed during life. The infecting organisms were Candida in 34 patients, Aspergillus in 13, Cryptococcus in 3 and combined Candida and Aspergillus in 1. The conditions appearing to predispose to fungal infection were abdominal surgery in 20 patients, thoracic surgery in 7 and treatment with corticosteroids, antineoplastic agents or antibiotic drugs, alone or in combination, in 43 cases. Endocarditis was most commonly associated with central venous catheters or prosthetic valve surgery and was often caused by Aspergillus. Myocarditis and pancarditis usually occurred in a setting of gastrointestinal surgery, intense antibiotic therapy and systemic candidiasis. Death could be attributed to fungal infection in 36 patients and specifically to cardiac involvement in 8. Endocarditis was diagnosed once during life. Cardiac fungal infection, especially myocarditis, may be difficult to recognize clinically. It is associated with extensive therapeutic interventions and may in itself produce a fatal outcome.