Cardiac
fungal infection (
CFI) is relatively uncommon, but its incidence is increasing. It is associated with a grim prognosis, but some
CFI patients can survive given an early diagnosis and aggressive
therapy. To clarify the clinicopathologic features of
CFI, a retrospective autopsy study was conducted. Among a total of 4396 autopsy cases collected over a 33-year period (1973-2005), 50
CFI patients (1.1%) were selected and studied clinicopathologically. The study subjects were 32 males and 18 females with a mean age of 65.5 years. Underlying diseases for
CFI included solid
malignant neoplasms (n=23), hematologic disorders (n=10),
chronic renal diseases (n=7),
liver diseases (n=5),
diabetes mellitus (n=5), and other miscellaneous ailments.
Antibiotics were given to 47 patients, while
corticosteroids,
antineoplastic drugs, and
antifungal agents were used for 21, 12, and 12 patients, respectively. None of the patients was diagnosed to have
CFI antemortem. Most patients (n=45) demonstrated multi-organ
fungal infections with myocardial involvement. Causative pathogens were Candida (n=36), Aspergillus (n=9), Mucor (n=4), and Cryptococcus (n=1). Comparisons between previous CFIs (1973-1989) and recent CFIs (1990-2005) revealed an increasing proportion of non-candidal CFIs (p=0.004) in the latter. Our results point to the clinical importance of defining diagnostic criteria and therapeutic strategies for CFIs, especially for non-candidal CFIs.