Aspergillosis of the central nervous system: Clinicopathological analysis of 17 patients

Walsh, Thomas J.; Hier, Daniel B.; Caplan, Louis R.

doi:10.1002/ana.410180511

Cited by 240 publications

(131 citation statements)

References 72 publications

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“…[38][39][40] In immunocompromised patients aspergillus encephalitis occurs as part of a disseminated infection and invasive aspergillosis is an important cause of death from infection, 41 as confirmed in the present study. We found a mortality of 100% in accordance with former studies.…”

Section: Discussionsupporting

confidence: 77%

“…We found a mortality of 100% in accordance with former studies. 4,[38][39][40][41] In conclusion, the present study showed toxoplasma encephalitis as the major cause of opportunistic CNS infection after allogeneic BMT. There were two types of toxoplasma encephalitis, which differed in time of onset after BMT, clinical and neuroradiological features and mortality.…”

Section: Discussionmentioning

confidence: 92%

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Opportunistic CNS infection after bone marrow transplantation

Maschke

Dietrich

Prumbaum³

et al. 1999

Bone Marrow Transplant

132

100

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Summary:We retrospectively identified opportunistic CNS infections in 655 patients who had undergone allogeneic, syngeneic or autologous BMT or PBSCT between 1990 and 1997. Twenty-seven patients (4%) developed CNS infections. All CNS infections occurred in allogeneic BMT or PBSCT patients. The most common CNS infections were toxoplasma encephalitis (74%) and cerebral aspergillosis (18%). Furthermore, we identified one patient with candida encephalitis and one patient with viral encephalitis. Overall mortality of patients with opportunistic CNS infection was 67%. There were two different groups of toxoplasma encephalitis with a different appearance on MR imaging. The first group showed edema, but no gadolinium enhancement, whereas the second group exhibited typical MRI appearances with the exception of frequent hemorrhagic transformation. The first group had a significant shorter latency between BMT and onset of CNS infection (mean 45 days vs 180 days, P = 0.02), a significant higher daily dose of corticosteroids as treatment for graft-versus-host disease (GVHD) (P = 0.01), more severe GVHD and a higher mortality (71% vs 36%). This study shows that the most common CNS infections in our patient population are toxoplasma encephalitis and cerebral aspergillosis, that there are two distinct subgroups of toxoplasma encephalitis and that CNS infections occur after allogeneic BMT only. Keywords: CNS infection; cerebral toxoplasmosis; cerebral aspergillosis Both allogeneic and autologous BMT are associated with several neurologic complications secondary to the underlying disease and prolonged myelosuppression. [1][2][3][4] The use of immunosuppressive drugs such as corticosteroids and cyclosporine in order to avoid rejection of the allograft and to control graft-versus-host disease (GVHD) is another major risk factor for neurologic complications especially CNS infections. In previous studies the most common complications were cerebral hemorrhage, metabolic encephalopathy and CNS infection. 1-5 Neurologic complications were more frequent in patients when AML was the underlying disease than in other leukemia patients. 4

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 92%

Opportunistic CNS infection after bone marrow transplantation

Maschke

Dietrich

Prumbaum³

et al. 1999

Bone Marrow Transplant

132

100

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“…The CNS manifestation is usually part of a disseminated infection [4]. Patients are often afebrile or only have a low-grade fever and present with nonspecific neurological symptoms such as stroke-like symptoms or seizures [5].…”

Section: Introductionmentioning

confidence: 99%

CT and MRI Findings in Cerebral Aspergilloma

Gärtner

Forstenpointner²,

Ertl‐Wagner

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNG Ziel Zerebrale Aspergillose betrifft meist immunsupprimiertePatienten und weist aufgrund der oftmals unspezifischen Klinik ein hohes Morbiditäts-und Mortalitätsrisiko auf. Eine frühe Diagnosestellung ermöglicht die effektivere Einleitung der Therapiemaßnahmen und die Verbesserung des Outcome.Material und Methoden Die CT-und MRT-Aufnahmen von neun Patienten aus zwei Zentren wurden ausgewertet. Die Diagnose der zerebralen Aspergillose wurde mittels Biopsie und histopathologischer Begutachtung verifiziert. Die MRT wurde an 1,5T-und 3T-Geräten durchgeführt, die Untersuchungsprotokolle enthielten jeweils DWI, T2-und T1-gewichtete Bilder mit und ohne Kontrastmittel.Ergebnisse In der CT wiesen die Aspergillome kein typisches Erscheinungsbild auf. In der MRT waren die Aspergillome zu 100 % randständig diffusionsgestört (9/9). Mehrere hypointense Schichten in der Aspergilluswand, insbesondere an der Innenseite, waren typisch in den Aufnahmen mit T2-Wichtung (100 %, 9/9). Die Aspergillome waren sowohl T1-hypointens (66 %, 6/9), sowie in 33 % anteilig T1-hyperintens (3/9). In 78 % (7/9) der Fälle fand sich ein randständiges Enhancement nach Gadoliniumapplikation.Schlussfolgerung Aspergillome weisen typischerweise eine kräftige, ringförmige Diffusionsrestriktion auf (9/9). Typische Befunde in Aufnahmen der T2-gewichteten Bilder sind zwiebelschalenartig angeordnete hypointense Schichten, die innere Zone der Aspergilluswand ist aufgrund paramagnetischer Effekte besonders signalarm (9/9). Der Großteil der Aspergillome weist nach Kontrastmittelapplikation ein ringförmiges Enhancement auf (7/9). ABSTR AC TPurpose Invasive aspergillosis usually affects immunocompromised patients. It carries a high risk of morbidity and mortality and usually has a nonspecific clinical presentation. Early diagnosis is essential in order to start effective treatment and improve clinical outcome. Materials and MethodsIn a retrospective search of the PACS databases from two medical centers, we identified 9 patients with histologically proven cerebral aspergilloma. We systematically analyzed CT and MRI imaging findings to identify typical imaging appearances of cerebral aspergilloma.Results CT did not show a typical appearance of the aspergillomas. In 100 % (9/9) there was a rim-attenuated diffusion restriction on MRI imaging. Multiple hypointense layers in the aspergillus wall, especially on the internal side, were detected in 100 % on T2-weighted imaging (9/9). Aspergillomas were T1-hypointense in 66 % of cases (6/9) and partly T1-hyperintense in 33 % (3/9). In 78 % (7/9) of cases, a rim-attenuated diffusion restriction was detected after contrast agent application.Conclusion Nine cases were identified. Whereas CT features were less typical, we observed the following imaging features on MRI: A strong, rim-attenuated diffusion restriction (9/9); onion layer-like hypointense zones, in particular in the innermost part of the abscess wall on T2-weighted images (9/9). Enhancement of the lesion border was present in the majority of the cas...

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“…Positive CSF cultures to Aspergillus are rare. 12 Aspergillus rarely invades the meninges, and the absence of diffuse meningeal involvement might be the reason for relative paucity of CSF findings. 13 Diagnosis of CNS aspergillosis is challenging.…”

Section: Discussionmentioning

confidence: 99%

Rare Case of Meningoencephalitis Due to Aspergillus and Acanthamoeba Coinfection

2015

Human Parasitic Diseases

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Aspergillus and Acanthamoeba cause central nervous system (CNS) infection mostly in immunocompromised hosts, disseminating via the hematogenous route from a primary focus in the respiratory tract. We are presenting a case of an immunocompetent patient diagnosed with Aspergillus and Acanthamoeba coinfection of the CNS, a rare finding. A positive cerebrospinal fluid (CSF) galactomannan antigen test confirmed the presence of Aspergillus, and direct visualization in CSF sample and culture confirmed the presence of Acanthamoeba.

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Aspergillosis of the central nervous system: Clinicopathological analysis of 17 patients

Cited by 240 publications

References 72 publications

Opportunistic CNS infection after bone marrow transplantation

Opportunistic CNS infection after bone marrow transplantation

CT and MRI Findings in Cerebral Aspergilloma

Rare Case of Meningoencephalitis Due to Aspergillus and Acanthamoeba Coinfection

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