Mycotic emboli of the peripheral vessels: analysis of forty-four cases

Surgery. 1981 Sep;90(3):541-5.

Abstract

Two cases of mycotic emboli of the peripheral vessels are presented, and 42 additional cases from the literature are analyzed. Male patients predominate 3:1. Candida and Aspergillus are the usual pathogens. Initial presentation as large vessel peripheral emboli is characteristic (77%), with emboli originating from either the aortic or mitral valves. Cerebral emboli may proceed of follow the peripheral embolization. Predisposing factors include open-heart surgery, antibiotic therapy, concomitant infection, and intravenous drug abuse. Early symptoms of fungemia are nonspecific, with blood cultures positive in only 43% of cases. The overall mortality rate was 84%-73% in patients who did not undergo previous open-heart surgery, and 96% in patients who underwent previous open-heart surgery. Patients with Candida infection seem to do better than those with Aspergillus endocarditis (19% survival versus 5%). Aggressive therapy, including embolectomy, early valve replacement, and prolonged antifungal drug therapy, is advised.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aspergillosis / diagnosis*
  • Aspergillosis / therapy
  • Aspergillus fumigatus
  • Candidiasis / diagnosis*
  • Candidiasis / therapy
  • Cardiac Surgical Procedures
  • Embolism / etiology
  • Endocarditis / etiology*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications
  • Risk