<原著>剖検における心臓真菌症27例の臨床病理学的検討

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Twenty seven autopsy cases with fungal infections of the heart were studied. The patients ranged in age from 19 to 86 years old ; 16 were male, and 11 female. Underlying diseases to the infections were leukemia in 8 patients, other blood diseases in 5,cancer in 6 and miscellaneous in 9. Antineoplastic agents, antibiotic drugs and/or corticosteroid were administered to 24 of the patients. Fungal endocarditis was observed in 1 of the patients, myocarditis in 20 and pancarditis in 3. The myocardium and the endocardium were involved in 2 of the patients, and the myocardium and the epicardium also in 2. Candida (18/27) was the organism most frequently found in our cases. Aspergillus was found in 7 of the patients and Trichosporon in 1. The lungs and kidneys were most frequently involved in the infections besides the heart. New ECG changes, in the clinical course, were observed in 7 of the patients, a vegetation view by echocardiography in 1 and a heart murmur in 1. Antemortem cultures for fungi were positive in 6 of the patients, and all the organisms found in the cultures were Candida. Only one of the 27 cases was diagnosed as endocarditis in life. Establishing the diagnosis of mycotic infection in life is so important that specific therapy for the case is available, which is summarized in the following : repeated blood culture, echocardiography and ECG should be more frequently adopted as a means of early diagnosis in such cases.
1988-09-25