CANDIDA PERICARDITIS - CLINICAL PROFILE AND TREATMENT

Background. Candida pericarditis is a rare medical and surgical emerge ncy which, unless treated, leads to impaired cardiac function and deat h. To facilitate early diagnosis, the clinical features of this condit ion should be identified. Methods. Twenty-five cases of Candida perica rditis reported in the last 30 years along with 1 new case were review ed with regard to demographics, precipitating factors, diagnosis, trea tment, and outcome. Results. The syndrome occurred in immunocompromise d (73%), antibiotic-treated (62%), or postpericardiotomy (54%) patient s. The clinical presentation was frequently subtle and nonspecific. Ne vertheless, unexplained fever, an increasing cardiac shadow on chest r oentgenogram, or the development of cardiac tamponade may be suggestiv e. Positive culture for Candida in pericardial fluid or histologic evi dence of yeast forms in pericardial tissue establishes the diagnosis. A combination of pericardiocentesis followed by operative drainage and antifungal agents is the usual treatment. Untreated, Candida pericard itis is 100% lethal, whereas prompt diagnosis and treatment lead to cu re (mean follow-up, 19 months). Conclusions. Fever and evolving cardia c tamponade in immunocompromised or postpericardiotomy patients may be suggestive of Candida pericarditis; the presence of organisms in peri cardial fluid is diagnostic. Pericardiocentesis followed by operative drainage and antifungal agents appears to be the treatment that is mos t likely to be curative. (C) 1997 by The Society of Thoracic Surgeons.