CANDIDAL MEDIASTINITIS - AN EMERGING CLINICAL ENTITY

Candidal mediastinitis is rare. We report nine cases encountered at ou r institutions since 1985; seven cases were diagnosed since 1993, All cases followed thoracic surgery, with a median time from surgery to di sease onset of 11 days (range, 6-100 days), All patients received prio r antibiotic therapy. Common clinical manifestations mere chest wall e rythema in 4 cases (44%), drainage in 5 (56%), fever in 4 (44%), and s ternal instability in 4 (44%), Failure to obtain appropriate intraoper ative specimens for cultures and the dismissal of cultures positive fo r Candida as contaminants delayed diagnosis in three cases (33%). Medi astinitis was complicated by contiguous or hematogenous spread in seve n cases (78%); five patients (56%) had two or more complications. The mortality rate was 56%. Optimal therapy remains undefined, but on the basis of our experience, aggressive surgical debridement combined with antifungal therapy for at least 6 weeks is recommended. Prompt recogn ition and institution of therapy appear to be the keys to improving pr ognosis.