Systemic Candidiasis and Cytomegalovirus Infection in the Setting of Artificial Cardiac Device Deployment

Heart failure is a serious cause of morbidity and mortality worldwide. The advent of implantable cardiac assist devices has generated a new arsenal for treating severe heart failure. However, the potential ramifications of ventricular assist device (VAD) usage are not fully understood. Immune modulation resulting from VAD implantation is an area of growing research. Although we do not fully understand the mechanisms contributing to host immune alteration, changes in cytokine concentrations, deceased lymphocyte activity, and the local effects of device materials have been shown to down regulate immune function. Infection is a serious complication that affects prognosis in this patient population. Malnutrition, critical status, and cardiovascular stress are additional predisposing factors in this fragile group. Driveline and surgery-associated infections are the most commonly identified culprits. However, decreased host immune function facilitates atypical infections including systemic fungemia and viremia. This case is an interesting example of a VAD associated immune system compromise.