Bradycardia in septic patients as an early sign of fungal bloodstream infection: a case series.

Background: Fungemia has become an increasingly significant cause of morbidity and mortality in hospitalized patients. Sepsis is generally recognized as a hyperdynamic condition, commonly characterized by tachycardia as part of the systemic inflammatory response. However, in rare instances, patients may exhibit a paradoxical response in the form of bradycardia. This atypical presentation should prompt heightened vigilance and consideration of an underlying threat.

Case description: A case series of 3 patients who had unexplained bradycardia with septic shock. Their blood culture showed fungal growth. Fortunately, within a few days of starting antifungal therapy, their bradycardia showed marked improvement. This improvement supports the assumption of relation between bradycardia and fungemia. Data collections were extended continuously over a 24-hour period. To ensure the accuracy and reliability of the recorded heart rate, the average of the three lowest recorded values was calculated. This approach was employed to minimize the potential impact of any isolated, coincidentally bradycardia readings that might not reflect the patient's overall condition.

Conclusions: This study serves to underscore the paramount importance of maintaining a high index of suspicion for fungal pathogens in septic patients presenting with bradycardia, advocating for heightened clinical vigilance and a proactive approach to diagnostic and therapeutic decision-making. Furthermore, it underscores the urgent imperative for robust clinical research endeavors aimed at elucidating the efficacy and therapeutic impact of early antifungal interventions on the clinical outcomes in the context of sepsis.