Special scenarios in the management of central nervous system aspergillosis: a case series and review of literature

Postgrad Med J. 2019 Jul;95(1125):382-389. doi: 10.1136/postgradmedj-2018-136095. Epub 2019 Jun 20.

Abstract

Aspergillus is a rare but important opportunistic pathogen to invade the central nervous system (CNS). It is a significant pathogen of not only immunocompromised but also immunocompetent patients. Its manifestations are pleiotropic, reflecting multiple mechanisms of pathogenesis and host interactions. Despite significant advances in diagnostic methods and therapeutic options, the mortality remains high. Several advances have been made in medications and surgical management, yet, current treatment practices lack uniformity. Patient woes are further heightened by the high costs of treatment and prolonged duration of therapy. In view of the challenging aspects of this disease, we present a short review of four challenging cases touching on the varied aspects of management of CNS aspergillosis covering pathogenesis, diagnostic pitfalls, surgical and medical options and evidence-based guidelines for the management of the same.

Keywords: CNS aspergillosis; amphotericin; antifungal; aspergillosis; debridement; debulking surgery; epitope; nitrogen cycling; pathogen; pathogenesis; rhinocerebral; voriconazole.

Publication types

  • Review

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use*
  • Aspergillus / drug effects
  • Aspergillus / pathogenicity*
  • Brain / diagnostic imaging*
  • Brain / microbiology
  • Brain / pathology
  • Databases, Factual
  • Disease Management
  • Follow-Up Studies
  • Humans
  • Immunocompromised Host
  • Magnetic Resonance Imaging / methods*
  • Male
  • Neuroaspergillosis / diagnosis*
  • Neuroaspergillosis / drug therapy*
  • Neuroaspergillosis / epidemiology
  • Retrospective Studies
  • Risk Assessment
  • Sampling Studies
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Antifungal Agents