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Not just vegetations: focal myocardial changes in patients with fungal infections

Published online by Cambridge University Press:  13 November 2020

Nicole M. Cresalia Open the ORCID record for Nicole M. Cresalia [Opens in a new window] ,
Sonal T. Owens ,
Terri L. Stillwell ,
Mark D. Norris ,
Sunkyung Yu ,
Lauren Retzloff  and
Gregory J. Ensing
Nicole M. Cresalia*
Affiliation:
Division of Pediatric Cardiology, University of California San Francisco, UCSF Benioff Children’s Hospital, San Francisco, CA94158, USA
Sonal T. Owens
Affiliation:
Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI48109, USA
Terri L. Stillwell
Affiliation:
Michigan Medicine Pediatric Infectious Disease, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, MI48109, USA
Mark D. Norris
Affiliation:
Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI48109, USA
Sunkyung Yu
Affiliation:
Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI48109, USA
Lauren Retzloff
Affiliation:
Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI48109, USA
Gregory J. Ensing
Affiliation:
Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI48109, USA
*
Author for correspondence: Nicole M. Cresalia, MD, Division of Pediatric Cardiology, University of California San Francisco, Campus Box 0544, 550 16th Street, 5th Floor, San Francisco, CA94143, USA. Tel: +1 503 830 0112. E-mail: [email protected]
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Abstract

Background:

Fungal endocarditis classically involves dense heterogenous vegetations. However, several patients with fungal infections were noted to have myocardial changes ranging from focal brightening to nodular thickening of chordae or papillary muscles. This study evaluates whether these findings are associated with fungal infections.

Methods:

In a retrospective case–control study, paediatric inpatients with fungal infections (positive blood, urine, or catheter tip culture) in a 5-year period were matched 1:1 to inpatients without positive fungal cultures. Echocardiograms were scored on a 5-point scale by two independent readers for presence of myocardial brightenings, nodular thickenings, and vegetations. Clinical data were compared.

Results:

Of 67 fungal cases, positive culture sites included blood (n = 44), vascular catheter tip (n = 7), and urine (n = 29); several had multiple positive sites. “Positive” echo findings (score ≥ 2+) were more frequent in the Fungal Group (33 versus 18%, p = 0.04). Fungal Group patients with “positive” versus “negative” echo findings had similar proportion of bacterial infections. Among fungal cases, those with “positive” echo findings had longer hospital length of stay than cases with “negative” echos (median 58 versus 40 days, p = 0.03) but no difference in intensive care unit admission, extracorporeal membranous oxygenation support, or mortality.

Conclusions:

Myocardial and papillary muscle brightening with nodular thickening on echocardiogram appear to be associated with fungal infections. There may be prognostic implications of these findings as patients with “positive” echo have longer length of stay. Further studies are needed to better understand the mechanism and temporal progression of these changes and determine the prognostic value of this scoring system.

Keywords

Fungal infectionmyocardiumechocardiographic findingspaediatricvegetations
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 2 , February 2021 , pp. 199 - 204
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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