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Cited by 53Antifungal resistance and susceptibilityOtolaryngology and Infectious DiseasesInfectious Aortic and Vascular Conditions

Candidal Mediastinitis: An Emerging Clinical Entity

Clancy, Cornelius J., Nguyen, M. Hong, Morris, Arthur J.·1997·Clinical Infectious Diseases
DOI 10.1086/513770
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Abstract

Candidal mediastinitis is rare. We report nine cases encountered at our institutions since 1985; seven cases were diagnosed since 1993. All cases followed thoracic surgery, with a median time from surgery to disease onset of 11 days (range, 6-100 days). All patients received prior antibiotic therapy. Common clinical manifestations were chest wall erythema in 4 cases (44%), drainage in 5 (56%), fever in 4 (44%), and sternal instability in 4 (44%). Failure to obtain appropriate intraoperative specimens for cultures and the dismissal of cultures positive for Candida as contaminants delayed diagnosis in three cases (33%). Mediastinitis was complicated by contiguous or hematogenous spread in seven cases (78%); five patients (56%) had two or more complications. The mortality rate was 56%. Optimal therapy remains undefined, but on the basis of our experience, aggressive surgical debridement combined with antifungal therapy for at least 6 weeks is recommended. Prompt recognition and institution of therapy appear to be the keys to improving prognosis.

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  • Candida mediastinitis may be treated successfully with surgical debridement followed by either amphotericin B or fluconazole therapy.

    “On the basis of a small number of cases, Candida mediastinitis may be treated successfully with surgical debridement followed by either amphotericin B or fluconazole therapy [185, 199] (III-C).”

    From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [199]

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Research works printed but not linked: 2

  1. Robert Muder, M.D., and Victor L. Yu, M.D., for their thorough drug therapy with 5-fluorocytosine. Ann Thorac Surg 1977; 23:163 -6.
  2. Ihde DC, Roberts WC, Marr KC, et al. Cardiac candidiasis in cancer patients. Cancer 1978; 41:2364 -71. References

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Authors
Clancy, C. J., Nguyen, M. H., & Morris, A. J.
Affiliations
University of Florida (US)
Corresponding author
Nguyen, M. Hong
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
1997-09
Volume
25
Issue
3
Pages
608-613
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1086/513770
OpenAlex
W2020449027
Cited by
53
References
45
Citations by year
2025: 2 · 2024: 1 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 1 · 2018: 3 · 2016: 2 · 2015: 5 · 2012: 3
FWCI
0.87
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Infectious Diseases › Otolaryngology and Infectious Diseases
  • Health Sciences › Medicine › Surgery › Infectious Aortic and Vascular Conditions
Keywords
Candida, thoracic surgery complications, postoperative infection, delayed diagnosis, surgical debridement, antifungal therapy, mortality, hematogenous spread
MeSH terms
Aged, Candidiasis, Female, Humans, Infant, Infant, Newborn, Male, Mediastinitis, Middle Aged, Osteomyelitis, Postoperative Complications, Sternum, Fungemia, Fatal Outcome, Thoracic Surgical Procedures

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