Mycotic diseases of the heart

There has been an increasing frequency of deep mycotic infections over the last years complicating mostly disease states with immunosuppression. During the last 30 years, 54 cases of mycotic infection of the heart were identified at the Fingerland Department of Pathology in Hradec Králové, with 32 cases during the last 10 years alone (prevalence 0.2% of 28 199 autopsies). A review of the sex, age, etiology, source of infection, principal disease and morphological cardiac findings is presented. There was male predominance (74%). The mean age of the patients was 48 years (ranging from 15 days to 87 years). Yeasts of genus Candida dominated, followed in incidence by genus Aspergillus. The postmortem haemocultivation was positive in only 25% of all cases, while cultivation from a vegetation or a myocardial abscess was positive in 61%. The probable source of infection was detected in 28 patients; very often it was bronchopneumonia or an infected central venous catheter. Endocarditis was found in 28 cases, including six cases on a prosthetic valve and four cases on mural endocardium. Isolated myocarditis was found in 25 patients. There was also one case of isolated mycotic pericarditis. In more than half of all patients there was a state of immunosuppression, usually caused by a haematologic malignancy.