Biography:

Uma Nahar Saikia served as Professor in the Department of Histopathology, Post-graduate Institute of Medical Education and Research, Chandigarh, India. She has been a recipient of many awards and grants. Her international experience includes various programs, contributions and participation in different countries for diverse fields of study. Her research interests in Dermatopathology, Cardiovascular Pathology, Endocrine Pathology and Ocular Pathology as a Professor reflect in her wide range of publications in various national and international journals. She serves as a member of various associations like International Medical Science Academy, International Society of Dermatopathologists’, Indian Society of Heart Research, Indian Association of Pathologists and Microbiologists, apart from being an author for many books.

Abstract:

Introduction: Systemic mycotic infections result from inhalation of the spores of dimorphic fungi that have their mold forms in the soil. Th e spores differentiate into yeasts or other specialized forms within lungs and mostly asymptomatic and self-limited. Malignancy, hematologic disorders, and use of antibiotics and/or corticosteroids are major underlying conditions for disseminated disease-causing a destructive lesion that may result in death. Cardiac mycotic infection is relatively uncommon with increasing incidence in immunocompromised patients with poor prognosis.

Material & Methods: A total of 12,000 autopsy cases were reviewed retrospectively over a period of 20 years i.e. 1996-2015. Sections from heart stained with hematoxylin-eosin (H&E) and confirmed with histochemical stains including methenamine silver, periodic acid-Schiff (PAS), and mucicarmine stains with confirmed histopathologic findings for fungal identification were included in the study.

Results: Of 23 cases of cardiac mycotic infection, 19 were male and only one female patient with a mean age of 29.5 years (range: 3 months–58 years). Underlying diseases included leukemia and lymphoproliferative disorders receiving antineoplastic drugs (5), post renal transplantation (5) cases, liver disease (3), diabetes mellitus (5) and once each of ABPA and thymoma with viral meningoencephalitis. None of the patients had experienced cardiac surgery, although one patient had a cardiac pacemaker implanted for the sick sinus syndrome. None of the patients were positive for the human immunodeficiency virus. All patients received antibiotic therapy antemortem with high dose corticosteroids given to 21 (44.5%). Most common fungal infection found was aspergillus (11) followed by mucormycosis (5), candida (2) and Cryptococcus (1). The disseminated disease was seen in 11 cases and one case had a dual infection (candida and mucormycosis).

Conclusion: The present study suggests increasing incidence of high mortality of cardiac involvement by aspergillus and mucormycosis with dissemination to other organs. This highlights the clinical importance of early diagnosis and designs new therapeutic strategies for cardiac mycotic infection to reduce mortality, especially in non-candidal infections.