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Deng W, Jiang Y, Qin J, Chen G, Lv Y, Lei Y, Luo J, Hong K, Huang B, Qin L, Tang X, Ye L, Dang Y, Wang C, Long F, Wang K, Kong J. Metagenomic Next-Generation Sequencing Assists in the Diagnosis of Mediastinal Aspergillus fumigatus Abscess in an Immunocompetent Patient: A Case Report and Literature Review. Infect Drug Resist 2023; 16:1865-1874. [PMID: 37020798 PMCID: PMC10069495 DOI: 10.2147/idr.s399484] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
Background Aspergillus fumigatus is an opportunistic fungal pathogen, which is commonly found in lungs and rarely causes infections in mediastinum. Mediastinal Aspergillus abscess is a serious infectious condition, and is characterized by difficult diagnosis due to its clinical manifestations being nonspecific. Case Presentation Here, we report a case of a mediastinal Aspergillus fumigatus abscess in an immunocompetent patient. The patient was a 45-year-old woman who presented with a 20-day history of sore throat without any underlying diseases. Chest computed tomography (CT) showed a mass in the anterior superior mediastinum. Metagenomic next-generation sequencing (mNGS) identified Aspergillus fumigatus sequences in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) tissue, indicating the mediastinal Aspergillus fumigatus infection of this patient. The following mediastinal biopsy histological analysis and tissue fungi culture also suggested Aspergillus fumigatus infection, confirming the mNGS detection. The patient was diagnosed with mediastinal aspergillosis caused by Aspergillus fumigatus. After timely voriconazole treatment, the patient was discharged with good condition. Conclusion Our study presented a rare case with mediastinal Aspergillus fumigatus abscess in an immunocompetent patient. As a new clinical diagnostic method, mNGS could assist timely diagnosis and precise treatment of Aspergillus infection.
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Affiliation(s)
- Wusheng Deng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yun Jiang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shaoyang University, Shaoyang, Hunan, People’s Republic of China
| | - Jiaoxia Qin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Gang Chen
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yongjie Lv
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yanmei Lei
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Jing Luo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Kangkang Hong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Bing Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Luhai Qin
- Department of Pulmonology, Hechi Traditional Chinese Medicine Hospital, Hechi, Guangxi, People’s Republic of China
| | - Xiujia Tang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Liumei Ye
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yuhai Dang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Chao Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Feiyang Long
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Ke Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Jinliang Kong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
- Correspondence: Jinliang Kong; Ke Wang, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, People’s Republic of China, Email ;
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Hariri G, Genoud M, Bruckert V, Chosidow S, Guérot E, Kimmoun A, Nesseler N, Besnier E, Daviaud F, Lagier D, Imbault J, Grimaldi D, Bouglé A, Mongardon N. Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome. Crit Care 2023; 27:6. [PMID: 36609390 PMCID: PMC9817255 DOI: 10.1186/s13054-022-04277-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post-cardiac surgery fungal mediastinitis. METHODS Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009-2019). RESULTS Among 73,688 cardiac surgery procedures, 40 patients developed fungal mediastinitis. Five were supported with left ventricular assist device and five with veno-arterial extracorporeal membrane oxygenation before initial surgery. Twelve patients received prior heart transplantation. Interval between initial surgery and mediastinitis was 38 [17-61] days. Only half of the patients showed local signs of infection. Septic shock was uncommon at diagnosis (12.5%). Forty-three fungal strains were identified: Candida spp. (34 patients), Trichosporon spp. (5 patients) and Aspergillus spp. (4 patients). Hospital mortality was 58%. Survivors were younger (59 [43-65] vs. 65 [61-73] yo; p = 0.013), had lower body mass index (24 [20-26] vs. 30 [24-32] kg/m2; p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28-40] vs. 54 [34-61]; p = 0.012). CONCLUSION Fungal mediastinitis is a very rare complication after cardiac surgery, associated with a high mortality rate. This entity should be suspected in patients with a smoldering infectious postoperative course, especially those supported with short- or long-term invasive cardiac support devices, or following heart transplantation.
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Affiliation(s)
- Geoffroy Hariri
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France ,grid.462844.80000 0001 2308 1657Institut Pierre Louis d’épidémiologie et de santé publique, Inserm U1136, Sorbonne Université, 75013 Paris, France
| | - Mathieu Genoud
- grid.150338.c0000 0001 0721 9812Service des urgences, Département de médecine aiguë, Hôpitaux Universitaires de Genève, 1205 Geneva, Switzerland
| | - Vincent Bruckert
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France ,grid.410528.a0000 0001 2322 4179Service d’anesthésie-réanimation, CHU de Nice, 06000 Nice, France
| | - Samuel Chosidow
- grid.412116.10000 0004 1799 3934Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France
| | - Emmanuel Guérot
- grid.414093.b0000 0001 2183 5849Médecine intensive-réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Antoine Kimmoun
- grid.29172.3f0000 0001 2194 6418CHRU de Nancy, Médecine intensive-réanimation Brabois, Inserm U1116, Université de Lorraine, 54000 Nancy, France
| | - Nicolas Nesseler
- grid.411154.40000 0001 2175 0984Service d’anesthésie-réanimation, CHU de Rennes, 35000 Rennes, France ,grid.410368.80000 0001 2191 9284CHU de Rennes, Inra, Inserm, Institut NUMECAN – UMR_A 1341, UMR_S 1241, CIC 1414 (Centre d’Investigation Clinique de Rennes), Univ Rennes, 35000 Rennes, France
| | - Emmanuel Besnier
- grid.41724.340000 0001 2296 5231Département d’anesthésie-réanimation, CHU de Rouen, 76000 Rouen, France ,grid.412043.00000 0001 2186 4076UNIROUEN, Inserm U1096, Normandie Univ, 76000 Rouen, France
| | - Fabrice Daviaud
- grid.417818.30000 0001 2204 4950Service de réanimation, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - David Lagier
- grid.411266.60000 0001 0404 1115Service d’anesthésie réanimation 1, CHU la Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13000 Marseille, France
| | - Julien Imbault
- grid.42399.350000 0004 0593 7118Service d’anesthésie réanimation sud, centre médico-chirurgical Magellan, CHU de Bordeaux, 33600 Pessac, France ,grid.412041.20000 0001 2106 639XInserm, UMR 1034, Biology of Cardiovascular Diseases, Univ. Bordeaux, 33000 Bordeaux, France
| | - David Grimaldi
- Service de réanimation polyvalente, Hôpital Erasme, cliniques universitaires de Bruxelles, 1070 Brussels, Belgium
| | - Adrien Bouglé
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France
| | - Nicolas Mongardon
- grid.412116.10000 0004 1799 3934Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France ,grid.428547.80000 0001 2169 3027U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France ,grid.410511.00000 0001 2149 7878Faculté de Santé, Univ Paris Est Créteil, 94010 Créteil, France
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