Fungal cardiomyopathy: A review and pooled analysis of pathophysiology, diagnosis and clinical management

Abstract

The incidence of invasive fungal disease has dramatically increased over the past few decades corresponding to the rising number of immunocompromised patients – mostly those with Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency syndrome (AIDS) and cancer. The major risk factors for severe cardiac fungal disease are prolonged administration of antibiotics, corticosteroids and cytotoxic agents, invasive medical procedures, and transplant recipients. Invasive fungal infection often affects multiple organs and cardiac involvement frequently occurs in disseminated disease. Ante mortem diagnosis of fungal cardiomyopathy (FCM) is difficult because clinical findings of myocardial involvement are often absent or ambiguous and blood cultures are often negative. Although an uncommon cause of infectious cardiomyopathy (CM), FCM is potentially fatal and thus early diagnosis of the primary infecting fungal pathogen, organs involved and the status of the host immune system is important to guide clinical management. Thus, this paper reviews the major fungal pathogens responsible for CM, clinical setting in which they occur, pathophysiology, diagnosis and management as well as highlights the burden of cardiac fungal infection and the need for additional research to refine current strategies or develop more effective diagnostic and therapeutic strategies. *Correspondence to: Aref Albakri, St-Marien hospital Bonn Venusberg, Department of Internal Medicine, Bonn, Germany, E-mail: arefalbakri@yahoo. com