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Abstract：
BACKGROUND: Non-valvular cardiac aspergillosis is a rare infection of the pericardium, myocardium or endocardium and is associated with a high mortality. There is a paucity of reports of non-valvular cardiac aspergillosis in critically ill and solid organ transplant (SOT) patients. The majority of cases have been reported in haemato-oncology patients, some of whom have undergone a bone marrow transplant.
OBJECTIVE: We describe four cases affected by non-valvular cardiac aspergillosis in the intensive care setting including a systematic review of this extremely rare infection which is associated with high mortality.
RESULTS: All four-patients died but presented with varying clinical, radiological and microbiological evidence of the disease. Three patients presented following complications after solid organ transplantation, two in the context of acute liver failure and emergency liver transplant and one several years after a double lung transplant. The last patient presented with necrotising gall stone pancreatitis, multi-organ failure and subsequently a prolonged intensive care unit (ICU) stay. On review of the literature, January 1955 to July 2019, 45 cases were identified, with different risk factors, clinical and radiological manifestations, treatment regimen and outcome.
CONCLUSIONS: Antemortem diagnosis of cardiac aspergillosis is difficult and rare, with no cases reporting positive blood culture results. Galactomannan serology has poor sensitivity in solid organ transplant patients, further reduced by prophylactic antimicrobial treatment, which is common in the ICU setting especially post-transplant patients. Due to the scarcity of cases, treatment is extrapolated from invasive aspergillosis management, with emphasis on early treatment with combination therapy.
OBJECTIVE: We describe four cases affected by non-valvular cardiac aspergillosis in the intensive care setting including a systematic review of this extremely rare infection which is associated with high mortality.
RESULTS: All four-patients died but presented with varying clinical, radiological and microbiological evidence of the disease. Three patients presented following complications after solid organ transplantation, two in the context of acute liver failure and emergency liver transplant and one several years after a double lung transplant. The last patient presented with necrotising gall stone pancreatitis, multi-organ failure and subsequently a prolonged intensive care unit (ICU) stay. On review of the literature, January 1955 to July 2019, 45 cases were identified, with different risk factors, clinical and radiological manifestations, treatment regimen and outcome.
CONCLUSIONS: Antemortem diagnosis of cardiac aspergillosis is difficult and rare, with no cases reporting positive blood culture results. Galactomannan serology has poor sensitivity in solid organ transplant patients, further reduced by prophylactic antimicrobial treatment, which is common in the ICU setting especially post-transplant patients. Due to the scarcity of cases, treatment is extrapolated from invasive aspergillosis management, with emphasis on early treatment with combination therapy.
摘要：
■非瓣膜性心脏曲霉病是一种罕见的心包感染，心肌或心内膜与高死亡率相关。在危重病和实体器官移植（SOT）患者中，很少有非瓣膜性心脏曲霉病的报道。大多数病例是在血液肿瘤患者中报告的，其中一些人接受了骨髓移植。
■我们描述了4例非瓣膜性心脏曲霉病在重症监护环境中的感染，包括对这种极其罕见的感染的系统评价，这种感染与高死亡率相关。
■所有四名患者均死亡，但临床表现不同，放射学和微生物学证据的疾病。3例患者在实体器官移植后出现并发症，两个在急性肝衰竭和紧急肝移植的背景下，一个在双肺移植后几年。最后一位患者出现坏死性胆结石性胰腺炎，多器官功能衰竭，随后长期入住重症监护病房（ICU）。在文献回顾中，1955年1月至2019年7月，确认了45例病例，不同的风险因素，临床和放射学表现，治疗方案和结果。
■心脏曲霉病的死前诊断困难且罕见，没有病例报告血培养结果阳性。半乳甘露聚糖血清学在实体器官移植患者中的敏感性较差，通过预防性抗菌治疗进一步减少，这在ICU环境中很常见，尤其是移植后的患者。由于案件的稀缺性，治疗是从侵袭性曲霉病的管理推断出来的，强调早期联合治疗。
■我们描述了4例非瓣膜性心脏曲霉病在重症监护环境中的感染，包括对这种极其罕见的感染的系统评价，这种感染与高死亡率相关。
■所有四名患者均死亡，但临床表现不同，放射学和微生物学证据的疾病。3例患者在实体器官移植后出现并发症，两个在急性肝衰竭和紧急肝移植的背景下，一个在双肺移植后几年。最后一位患者出现坏死性胆结石性胰腺炎，多器官功能衰竭，随后长期入住重症监护病房（ICU）。在文献回顾中，1955年1月至2019年7月，确认了45例病例，不同的风险因素，临床和放射学表现，治疗方案和结果。
■心脏曲霉病的死前诊断困难且罕见，没有病例报告血培养结果阳性。半乳甘露聚糖血清学在实体器官移植患者中的敏感性较差，通过预防性抗菌治疗进一步减少，这在ICU环境中很常见，尤其是移植后的患者。由于案件的稀缺性，治疗是从侵袭性曲霉病的管理推断出来的，强调早期联合治疗。
