Prognostic Implications of Influenza Virus Infection in a Cardiac Intensive Care Unit: Potential Impact of a Screening Program.

OBJECTIVES: Our goal was to determine the presentation and prognosis of influenza in an intensive cardiac care unit and to analyze the impact of an active surveillance program in the diagnosis. METHODS: We performed a prospective registry during the flu season in a coronary unit. In the first phase, no systematic screening was performed. Systematic influenza A and B detection was performed in a second phase for all patients admitted. RESULTS: From 227 patients, we identified 17 (7.5%) with influenza. Influenza patients were more likely to have a non-ischemic cause of admission (14 patients [82.4%] vs. 48 patients [40.3%], p = 0.002), fever (8 patients [47.1%] vs. 3 patients [2.6%], p < 0.001), and respiratory failure (7 patients [41.2%] vs. 8 patients [7%], p = 0.001). Influenza infection was an independent predictor of mortality (odds ratio 12.0, 95% confidence interval 1.9-13.6, p < 0.001). The incidence of influenza was 6.6% (6 patients) when no active screening was performed and 7.9% (11 patients) when systematic detection was performed (p = 0.005). The time to diagnosis was shorter in the systematic screening phase (0.92 ± 1.6 vs. 5.2 ± 3.8 days, p = 0.01). CONCLUSIONS: Influenza affects approximately 8% of patients admitted to an intensive cardiac care unit during the flu season, with a high mortality rate. An active surveillance program improves early detection.

Invasive aspergillosis among heart transplant recipients: a 24-year perspective.

BACKGROUND: Invasive aspergillosis is a well-known complication in severely immunosuppressed patients, including heart transplant recipients, and associated mortality is high. Despite the severity of the disease in this population, few recent series with secular trends have addressed the problem. METHODS: We performed a descriptive study of 479 consecutive heart transplant recipients from 1988 to 2011 in a single institution. RESULTS: Overall invasive aspergillosis incidence in heart transplant recipients was 6.5% (31 of 479). Incidence decreased from 8.7% (24 of 277) in the period 1988 to 2000 (historical cohort) to 3.5% (7 of 202) afterward (p = 0.02); 4 of the 7 cases were in the context of an outbreak. The most common presentation was lung infection, but episodes occurring >3 months after transplantation (late aspergillosis) showed a higher frequency of disseminated disease and involvement of the central nervous system and of atypical sites compared with early (first 3 months) episodes. Related mortality was 36%, with a significant decrease between the historical cohort and the present cohort: 46% vs 0% (p = 0.04) and a trend toward lower related death in early vs late cases (26% vs 63%, p = 0.09). CONCLUSIONS: In our series, both incidence and mortality associated with invasive aspergillosis in heart transplant recipients showed a decrease in recent years. Careful environmental management and targeted anti-fungal prophylaxis may minimize the incidence of invasive aspergillosis in this setting.

Parasitic infections in solid-organ transplant recipients.

PURPOSE OF REVIEW: To provide an updated perspective of the most common parasitic infections occurring in solid-organ transplant (SOT) recipients. RECENT FINDINGS: Parasitic infections are an emerging problem in SOT programs and represent a diagnostic and therapeutic challenge. Transplantation in endemic areas - including medical tourism, international travel and migration - justify the necessity of considering parasitic infections in the differential diagnosis of posttransplant complications. Molecular techniques, such as PCR, may improve the diagnostic accuracy and help during the follow-up. SUMMARY: Parasitic infections are an uncommon but potentially severe complication in SOT recipients. An increase of donors emigrated from tropical areas and more posttransplant patients traveling to endemic areas have led to a rise in parasitic infections reported among SOT recipients. Transplant physicians should get familiar with parasitic infections and promote adherence to preventive measures in SOT recipients.

Aspergilosis cardíaca en una paciente trasplantada de corazón / Cardiac invasive aspergillosis in a heart transplant recipient

Antecedentes: Los receptores de órgano sólido se consideran población de riesgo de aspergilosis invasora, afectándose fundamentalmente el pulmón o el sistema nervioso central. Objetivos: Describimos el caso de una paciente con aspergilosis cardíaca invasora probada 2 años después de un trasplante cardíaco y revisamos la aspergilosis cardíaca en el paciente trasplantado. Caso clínico: La paciente, de 52 años, recibió un trasplante de corazón. En el posoperatorio surgieron múltiples complicaciones, entre ellas el desarrollo de una aspergilosis invasora en la herida quirúrgica. La paciente reingresó 2 años después por disnea. En la tomografía computarizada toracoabdominal se observaron múltiples tromboem-bolismos pulmonares y una masa en la región retroxifoidea que invadía gran parte de la aurícula derecha y afecta-ba a la válvula tricúspide. En la biopsia de la masa se observaron hifas septadas invasoras, y se aisló posteriormente Aspergillusfumigatus. Las determinaciones de galactomanano sérico resultaron negativas. Se inició tratamiento con voriconazol y a los 2 meses acudió a revisión en buena situación clínica, pero con niveles séricos de voriconazol indetectables, aparentemente debido a la administración concomitante de omeprazol. La paciente está siendo se-guida ambulatoriamente y permanece en tratamiento con voriconazol y asintomática más de un año después. Conclusiones: La aspergilosis invasora con origen en el mediastino puede progresar y afectar al corazón. El uso de omeprazol puede conducir a la presencia de valores indetectables de voriconazol en suero. © 2011 Revista Iberoamericana de Micología. Publicado por Elsevier España, S.L. Todos los derechos reservados(AU)

Background: Solid organ transplant recipients are a population at risk of invasive aspergillosis. The lung and the central nervous system are usually affected. Objectives: We report the case of a patient with proven cardiac invasive aspergillosis two years after heart transplantation, and perform a review of cardiac aspergillosis in solid organ transplant recipients. Case report. A 52-year old woman received a heart transplant. Several complications appeared in the post-operative period, including the development of invasive aspergillosis in the surgical wound. She was readmitted two years later with dyspnea. A thoracic CT-scan revealed multiple lung embolisms and a mass in the retroxiphoid, invading the right atrium and the tricuspid valve. Septated hyphae invading this tissue were observed and Aspergillus fumiga-tus was subsequently isolated. Serum galactomannan determinations were negative. Antifungal therapy with vori-conazole was started. Two months later, the patient visited the hospital for a routine check-up control in good clinical condition, but with undetectable voriconazole serum levels. These levels were associated to the concomitant use of omeprazole. One year later, the patient was still receiving voriconazole and remained asymptomatic. Conclusions. Invasive aspergillosis affecting the mediastinum can progress and affect the heart tissues. The use of omeprazole may be associated with the undetectable voriconazole serum levels(AU)

[Cardiac invasive aspergillosis in a heart transplant recipient]. / Aspergilosis cardíaca en una paciente trasplantada de corazón.

BACKGROUND: Solid organ transplant recipients are a population at risk of invasive aspergillosis. The lung and the central nervous system are usually affected. OBJECTIVES: We report the case of a patient with proven cardiac invasive aspergillosis two years after heart transplantation, and perform a review of cardiac aspergillosis in solid organ transplant recipients. CASE REPORT: A 52-year old woman received a heart transplant. Several complications appeared in the post-operative period, including the development of invasive aspergillosis in the surgical wound. She was readmitted two years later with dyspnea. A thoracic CT-scan revealed multiple lung embolisms and a mass in the retroxiphoid, invading the right atrium and the tricuspid valve. Septated hyphae invading this tissue were observed and Aspergillus fumigatus was subsequently isolated. Serum galactomannan determinations were negative. Antifungal therapy with voriconazole was started. Two months later, the patient visited the hospital for a routine check-up control in good clinical condition, but with undetectable voriconazole serum levels. These levels were associated to the concomitant use of omeprazole. One year later, the patient was still receiving voriconazole and remained asymptomatic. CONCLUSIONS: Invasive aspergillosis affecting the mediastinum can progress and affect the heart tissues. The use of omeprazole may be associated with the undetectable voriconazole serum levels.