Postoperative Candida infections of the heart in children: Clinicopathologic study of a continuing problem of diagnosis and therapy

Thomas J. Walsh, Grover M. Hutchins

Research output: Contribution to journalArticle

Abstract

Fungal infections of the heart are infrequentpostoperative complications in children, yet, when present are often fatal. Children autopsied at The Johns Hopkins Hospital from 1889 to the present were studied for cardiac fungal infection. Among the 14 children so identified, 8 developed cardiac fungal infection after surgery. All postoperative cardiac infections were caused by Candida species. All were autopsied since 1959. Gastrointestinal surgery was performed in 6 patients and cardiac surgery in 2. Candida infection was not confined to the endocardium; endocarditis developed in 2 patients, pericarditis in 1, and myocarditis in 5. None received cytotoxic agents or corticosteroids. Two patients died from direct cardiac involvement. Other deaths were related to Candida sepsis or bronchopneumonia. A clinical diagnosis of cardiac fungal infection was never made. Prolonged administration of multiple antibiotics, central venous catheterization, prematurity and immune deficiency predisposed to cardiac and systemic candidiasis. Clinical features facilitating early diagnosis are discussed. Removal of central venous catheters infected with Candida did not eliminate the source of continued sepsis, since Candida-laden vegetations related to the catheter adhered to the superior vena cava and endocardial surface. Postoperative cardiac candidiasis is a relatively new and persistent problem of early diagnosis and therapy. The post-surgical pediatric patient has major predisposing factors for cardiac candidiasis, which, if unrecognized, may be a source for continued dissemination or may in itself be the cause of death.

Original languageEnglish (US)
Pages (from-to)325-331
Number of pages7
JournalJournal of Pediatric Surgery
Volume15
Issue number3
DOIs
StatePublished - 1980
Externally publishedYes

Fingerprint

Candida
Mycoses
Infection
Candidiasis
Early Diagnosis
Sepsis
Central Venous Catheterization
Therapeutics
Bronchopneumonia
Endocardium
Superior Vena Cava
Pericarditis
Central Venous Catheters
Cytotoxins
Myocarditis
Secondary Prevention
Endocarditis
Causality
Thoracic Surgery
Cause of Death

Keywords

  • Candida
  • endocarditis
  • fungal infection
  • myocarditis
  • pericarditis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Postoperative Candida infections of the heart in children : Clinicopathologic study of a continuing problem of diagnosis and therapy. / Walsh, Thomas J.; Hutchins, Grover M.

In: Journal of Pediatric Surgery, Vol. 15, No. 3, 1980, p. 325-331.

Research output: Contribution to journalArticle

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