Repeated pulmonary embolism in an infant with subacute Candida endocarditis of the right side of the heart

Neonatal and infant pulmonary thromboembolism: a literature review

Pulmonary thromboembolism (PTE) is rare in neonates and infants; however evidence suggests it is underdiagnosed. The primary objective is to conduct a scientific review to determine if the presentation, diagnosis, treatment and outcomes of neonates and infants with PTE are consistent across studies. Secondly, to develop an algorithm to establish the diagnosis and management of the condition based on current information. Two authors searched the literature independently using existing databases and verified that identical articles were assembled. Infants aged less than 1 year with PTE were included and further categorized into neonates 28 days or less and infants 29 days to 1 year or less. Forty-five articles with 157 cases (121 neonates; 36 infants) were identified with PTE. All of the reports were descriptive and neither randomized controlled trials nor prospective or case-control studies were identified. The reports are sub-classified into cases of pulmonary air embolism (PAE) with a higher mortality rate and patients with PTE. Diagnostic and treatment strategies varied widely and were individually case-based, dependent on clinical findings, which influenced patient outcomes. Scientific data to guide an evidence-based, diagnostic and treatment approach to PTE is limited because of the absence of rigorous clinical trials. Large scale, multicenter collaborative studies are required to firmly establish the management of PTE in this population.

The effects of administering hyperalimentation solutions into the atrium and pulmonary artery

Pulmonary hypertension, edema, and congestion have been found in three infants who died after infusion of chronic TPN solutions through catheters placed into the right atrium (RA) or pulmonary artery (PA). In 24 anesthetized dogs receiving varying concentrations of dextrose and water through catheters placed into the RA, the endothelium of the RA evidenced injury only when concentrations of 20% DW or greater were infused. Both the main PA and distal PA endothelium showed evidence of injury only when concentrations higher than 40% DW were infused. When solutions were infused directly into the main PA, the main PA endothelium revealed injury if more than 15% DW was infused, and the distal PA showed moderate endothelial injury when 10% DW or greater was infused. The distal PA evidenced more severe endothelial injury after concentrated dextrose solution infusion than either the RA or main PA. Pulmonary congestion, edema, and hypertension became increasingly prominent when 24-hour infusions of 10% DW or more were placed into the main PA, or concentrations higher than 40% were infused into the RA. Distal PA endothelial injury appears to correlate directly with the severity of pulmonary congestion, suggesting endothelial cell emboli.

Echocardiographic diagnosis of Candida endocarditis of the tricuspid valve and of the right atrium in a young infant

Systemic candidiasis developed in a seven-week-old premature baby after 6 weeks treatment with antibiotics for suspected septicemia. At that time the echocardiogram showed a dense layer of echoes posteriorly to the anterior tricuspid leaflet during atrial systole. The diagnosis of Candida endocarditis with vegetations on the tricuspid valve and with right atrial thrombus secondary to the Candida infection was verified by autopsy.

Pulmonary disease caused by Candida species

Candida species are often found in sputum specimens. Their role as a possible cause of pulmonary disease is a frequent consideration, particularly in patients receiving immunosuppressive or long-standing antimicrobial therapy. At Memorial Hospital and New York Hospital, 30 patients with histologic evidence of Candida pulmonary infection were identified over a two year period. These infections reached the lungs by hematogenous spread in 10 patients and by aspiration in 16 patients. Most the patients had malignant neoplastic disease. The Candida pulmonary disease appeared to be significant clinical factor in only three cases. Experience from our institutions and from the literature indicates that Candida species rarely cause significant pulmonary disease. When such involvement is extensive, the patient is usually terminally ill from multiple other factors.

Myocardial infarction complicating bacterial endocarditis in rheumatic heart disease. Report of a case and review of the literature

A case of rheumatic heart disease with massive myocardial infarction from coronary embolism complicating bacterial endocarditis is reported. The rarity of this complication in the pediatric age group as compared to the adult age group remains unexplained. Early recognition depends on serial electrocardiographic and enzymatic determinations.