Jancic Predrag, Milutinovic Stefan, Ward Marshall, Radovanovic Milan, Jovanovic Nikola, Antic Marina, Nikolajevic Nikola, Petrovic Marija, Jevtic Dorde, Adam Adam, Dumic Igor
Mayo Clinic Health System, 1221 Whipple Street, Eau Claire, WI 54703, USA.
Internal Medicine Residency Program, Florida State University, Tallahassee, FL 32301, USA.
Microorganisms. 2025 Mar 21;13(4):707. doi: 10.3390/microorganisms13040707.
Fungal pericarditis is a rare disease but its incidence has risen in parallel with the global increase in invasive fungal infections. This systematic review analyzes data from previously reported cases of fungal pericarditis to provide an improved understanding of the etiology, clinical presentation, management, and outcomes of this rare disease. We reviewed Medline and Scopus databases from 1 January 1990 to 29 January 2024 for case reports that documented the isolation of a fungal pathogen from pericardial fluid or tissue. Of the 2330 articles screened, 101 cases met the inclusion criteria. Patients with fungal pericarditis and the involvement of at least one other organ-usually the lungs, brain, or kidney-had worse outcomes than patients with isolated pericardial disease. Immunosuppression was reported in 50% of cases and was associated with worse outcomes in adults. Patients who presented with chest pain, received adequate empiric antifungal therapy, and underwent pericardiocentesis and pericardiectomy had improved survival. The most common isolated pathogens were spp., followed by spp. and spp., with the latter two linked to worse outcomes. Only 35% of patients received empiric antifungal medications before the causative pathogen was identified, and mortality was associated with a delay in appropriate therapy. Immunosuppression, disseminated disease, and presence of shock/multiorgan failure were additional risk factors associated with death. Fungal pericarditis carries a mortality rate of up to 50%, with nearly half of patients being immunocompromised. Clinicians frequently do not consider fungal pericarditis in the differential diagnoses, which leads to delays in treatment and poorer outcomes. Further prospective multicenter studies are urgently needed to better understand the epidemiology, improve diagnostic testing and management, and decrease unacceptably high mortality in patients with fungal pericarditis.
真菌性心包炎是一种罕见疾病，但其发病率随着侵袭性真菌感染在全球范围内的增加而上升。本系统评价分析先前报道的真菌性心包炎病例数据，以更好地了解这种罕见疾病的病因、临床表现、治疗及预后。我们检索了1990年1月1日至2024年1月29日的Medline和Scopus数据库，查找记录从心包液或组织中分离出真菌病原体的病例报告。在筛选的2330篇文章中，101例符合纳入标准。与单纯心包疾病患者相比，真菌性心包炎且至少累及一个其他器官（通常为肺、脑或肾）的患者预后更差。50%的病例报告有免疫抑制，且这与成人患者的较差预后相关。出现胸痛、接受充分经验性抗真菌治疗、接受心包穿刺术和心包切除术的患者生存率有所提高。最常见的分离病原体是 属，其次是 属和 属，后两者与较差预后相关。仅35%的患者在确定致病病原体之前接受了经验性抗真菌药物治疗，死亡率与适当治疗的延迟有关。免疫抑制、播散性疾病以及休克/多器官功能衰竭的存在是与死亡相关的其他危险因素。真菌性心包炎的死亡率高达50%，近一半患者存在免疫功能低下。临床医生在鉴别诊断中常不考虑真菌性心包炎，这导致治疗延迟和预后较差。迫切需要进一步开展前瞻性多中心研究，以更好地了解其流行病学、改进诊断检测和治疗方法，并降低真菌性心包炎患者高得令人无法接受的死亡率。
