Central nervous system aspergillosis in immunocompetent patients Case series and literature review

被引:21
作者
Ma, Yubao [1 ]
Li, Wanjun [1 ]
Ao, Ran [1 ]
Lan, Xiaoyang [1 ]
Li, Yang [1 ]
Zhang, Jiatang [1 ]
Yu, Shengyuan [1 ]
机构
[1] Chinese Peoples Liberat Army Gen Hosp, Med Ctr 1, Dept Neurol, 28 Fuxing Rd, Beijing 100853, Peoples R China
关键词
aspergillosis; aspergillus infection; central nervous system; next-generation sequencing; voriconazole; CEREBRAL ASPERGILLOSIS; INTRACRANIAL ASPERGILLOSIS; INVASIVE ASPERGILLUS; INFECTION; SINUS;
D O I
10.1097/MD.0000000000022911
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The aim of this study was to investigate the clinical characteristics of central nervous system (CNS) aspergillosis in immunocompetent patients. This study enrolled six immunocompetent patients diagnosed with CNS aspergillosis. Additionally, we reviewed the clinical profiles for 28 cases reported in the literature. The age, gender, etiology of Aspergillus infection, clinical manifestations, location of the lesion, treatment, and prognosis were analyzed. There were 19 men (average age, 54.6 +/- 14.3 years) and 15 women (average age, 47.0 +/- 19.4 years). The clinical manifestations included headache (55.9%; n = 19), visual impairment (32.4%; n = 11), diplopia (32.4%; n = 11), hemiplegia (20.6%; n = 7), fever (17.6%; n = 6), and epilepsy (8.8%; n = 3). According to the radiological features, CNS aspergillosis lesions were divided into two subtypes: parenchymal lesions in the cerebral lobes (n = 11), and meningeal lesions in the meninges (n = 23). The patients with meningeal lesions are easy to be complicated with more serious cerebrovascular diseases, such as subarachnoid hemorrhage and massive infarction. Most of the lesions in brain parenchyma were abscess formation, and magnetic resonance imaging showed ring enhancement. The clinical diagnosis of Aspergillus infection was mainly based on brain biopsy (n = 14), autopsy (n = 8), pathological examination of adjacent brain tissues (n = 7), cerebrospinal fluid (CSF) or tissue culture (n = 3), and second-generation sequencing analysis of the CSF (n = 3). Clinical improvement was achieved in 23 cases, and 11 patients succumbed to the disease. Voriconazole treatment was effective in 24 (70.6%) cases. Immunocompetent subjects are also at risk for Aspergillus infections. Concomitant cerebrovascular diseases are common in patients with CNS aspergillosis, especially in patients with meningeal aspergillosis. Parenchymal aspergillosis lesions are usually localized and manifest as brain abscesses with annular enhancement on magnetic resonance imaging. Biopsy, CSF culture, and next-generation sequencing are mainstream diagnostic modalities. Voriconazole is an effective treatment for Aspergillus infection, and early diagnosis and treatment should be highlighted.
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页数:9
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共 28 条
  • [1] ASPERGILLOSIS
    BODEY, GP
    VARTIVARIAN, S
    [J]. EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 1989, 8 (05) : 413 - 437
  • [2] Isolated Cerebral Aspergillosis in Immunocompetent Patients
    Bokhari, Rakan
    Baeesa, Saleh
    Al-Maghrabi, Jaudah
    Madani, Tariq
    [J]. WORLD NEUROSURGERY, 2014, 82 (1-2) : E325 - E333
  • [3] Invasive fungal sinusitis of isolated sphenoid sinus in immunocompetent subjects
    Chopra, H
    Dua, K
    Malhotra, V
    Gupta, RP
    Puri, H
    [J]. MYCOSES, 2006, 49 (01) : 30 - 36
  • [4] DeLone DR, 1999, AM J NEURORADIOL, V20, P1597
  • [5] Invasive aspergillosis presenting as swelling of the buccal mucosa in an immunocompetent individual
    Ganesh, Praveen
    Nagarjuna, Muralidhara
    Shetty, Samarth
    Kumar, Pradeep
    Bhat, Venkatraman
    Salins, Paul C.
    [J]. ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY ORAL RADIOLOGY, 2015, 119 (02): : E60 - E64
  • [6] Gonzales Zamora JA, 2018, DISEASES, V6
  • [7] Optic Neuropathy and Stroke Secondary to Invasive Aspergillus in an Immunocompetent Patient
    Hersh, Carrie M.
    John, Seby
    Subei, Adnan
    Willis, Mary A.
    Kosmorsky, Gregory S.
    Prayson, Richard A.
    Bhimraj, Adarsh
    [J]. JOURNAL OF NEURO-OPHTHALMOLOGY, 2016, 36 (04) : 404 - 407
  • [8] Central nervous system aspergiilosis: A 20-year retrospective series
    Kleinschmidt-DeMasters, BK
    [J]. HUMAN PATHOLOGY, 2002, 33 (01) : 116 - 124
  • [9] CNS aspergilloma mimicking tumors: Review of CNS aspergillus infection imaging characteristics in the immunocompetent population
    Kumar, Devendra
    Nepal, Pankaj
    Singh, Sumit
    Ramanathan, Subramaniyan
    Khanna, Maneesh
    Sheoran, Rakesh
    Bansal, Sanjay Kumar
    Patil, Santosh
    [J]. JOURNAL OF NEURORADIOLOGY, 2018, 45 (03) : 169 - 176
  • [10] CEREBRAL VASCULITIS CAUSED BY ASPERGILLUS SIMULATING ISCHEMIC STROKE IN AN IMMUNOCOMPETENT PATIENT
    Martins, Herlon Saraiva
    da Silva, Thiago Rodrigo
    Scalabrini-Neto, Augusto
    Velasco, Irineu Tadeu
    [J]. JOURNAL OF EMERGENCY MEDICINE, 2010, 38 (05) : 597 - 600