Clinical manifestations, diagnosis, and treatment outcome of CNS aspergillosis: A systematic review of 235 cases

Meena, Durga Shankar; Kumar, Deepak; Gaurav, Kumar

doi:10.1016/j.idnow.2021.04.002

Cited by 28 publications

(53 citation statements)

References 47 publications

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“…Classic microbiological techniques like microscopy and culture perform poorly in the setting of CNS IFI, for example culture positivity in CNS aspergillosis was reported to be as low as 9-24%. 3,[7][8][9] Molecular methods like PCR have also not fulfilled the hopes placed in them to date. 13,14 Contrarily, antigen testing is a well-established tool for diagnosis of IFI and can be performed from an easily available specimen, that is serum.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Contrarily, CNS aspergillosis is either caused by secondary haematogenous dissemination or by contiguous growth originating from the paranasal sinuses. [6][7][8][9] Notably, some authors report CNS involvement in up to 20% of IA cases. 5 In contrast to pulmonary IA, diagnosis of CNS aspergillosis is particularly challenging: clinical presentation is non-specific and can vary between brain abscess, cerebritis, meningitis, cranial sinus thrombosis, mycotic aneurysm, infarction and ventriculitis.…”

Section: Introductionmentioning

confidence: 99%

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Serologic biomarkers in Candida and Aspergillus infections of the central nervous system: A comparison of galactomannan, mannan and β‐1,3‐D‐gucan testing from serum and cerebrospinal fluid

Förster

Hoenigl

Suerbaum

et al. 2022

Mycoses

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Background The incidence of Aspergillus and Candida CNS infection, which are characterised by high mortality rates, is underestimated. This underdiagnosis presumably results from the limitations of available diagnostic tools and the need for invasive sampling. Little is known about the role of serologic biomarkers in the setting of CNS aspergillosis and candidiasis. Patients, materials and methods: Serum and cerebrospinal fluid (CSF; 10) samples of 19 patients, whose CNS specimens yielded growth of Aspergillus or Candida, were analysed for different biomarkers for fungal infection, that is galactomannan (GM), galactomannoprotein (GP), mannan, anti‐mannan‐antibodies and β‐1,3‐D‐glucan (BDG). Serum and CSF specimens of time‐matched patients (two each for every case of fungal CNS infection) were included as controls. Results Galactomannan, GP and BDG seropositivity was found in one, two and three of five cases of CNS aspergillosis. BDG and mannan/anti‐mannan‐antibody sensitivity in proven CNS candidiasis was 40% and 20%, respectively. Applying the serum cut‐off, sensitivity in CSF testing was 100% for GM and BDG and 50% for mannans. While serum specificity for all assays ranged from 89 to 97%, specificity for CSF BDG was only 70%. No false‐positive GM results from CSF were obtained. Conclusion Sensitivity for diagnosing CNS aspergillosis and CNS candidiasis from serum is mediocre for all serological biomarkers. GM testing in CSF proved excellent performance. With a sensitivity of 100% but a specificity of only 70%, CSF BDG might be most useful when used in patients with a high pre‐test probability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serologic biomarkers in Candida and Aspergillus infections of the central nervous system: A comparison of galactomannan, mannan and β‐1,3‐D‐gucan testing from serum and cerebrospinal fluid

Förster

Hoenigl

Suerbaum

et al. 2022

Mycoses

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“…Although it only comprises about 5% of all CNS fungal infections, the overall prognosis is poor. Mortality rates can be 45% overall [1] and as high as 72% in immunocompromised patients [2].…”

Section: Discussionmentioning

confidence: 99%

“…However, other predisposing factors, including intravenous drug use disorder (IVDU) and hepatitis C virus (HCV) infection, can increase susceptibility to cerebral aspergillosis. With the mortality rate of Aspergillus infection estimated to be 45% overall [1] and as high as 72% in immunocompromised patients [2], early identification and treatment is essential to prevent increased morbidity and mortality. Indeterminate cerebrospinal fluid (CSF) studies and poorly elucidated radiographic features of central nervous system (CNS) in Aspergillus infection are the reasons why tissue biopsy is often required to finalize a diagnosis and should not be delayed, especially when a target amendable to biopsy is identified on CNS imaging.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Dilemma of Aspergillus Meningitis in Patients With Hepatitis C Virus Co-Infection: A Case Series

Seemiller

Malik

2022

J Neurol Res

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Aspergillus meningitis can occur in immunocompromised and immunocompetent patients. The diagnostic yield is only 39% in immunocompromised patients and 69% in immunocompetent patients. Diagnosis can be challenging, as repeated cerebrospinal fluid (CSF) cultures can be negative. Even with multiple cultures, the diagnostic yield is meager, sometimes requiring a tissue diagnosis. However, prompt recognition and treatment initiation are crucial to minimize morbidity. We present two cases of patients with a history of intravenous drug use disorder (IVDU) co-infected with hepatitis C virus (HCV) and Aspergillus. Two young Caucasian patients with untreated HCV infection and a history of IVDU, presented with fevers and headaches. Their imaging and multiple CSF samples showing pleocytosis with negative fungal cultures led to a diagnostic dilemma. Due to progressive decline and to ascertain a definitive diagnosis, a brain biopsy resulted in a tissue diagnosis of fungal meningitis secondary to Aspergillus, with hyphae and granulomas, in both individuals. In the workup of chronic meningitis, Aspergillus infection should be strongly considered in patients with IVDU and HCV co-infection. In patients with chronic meningitis lacking definitive diagnosis from spinal fluid, tissue sampling should be pursued as soon as possible to ensure rapid treatment and prevent disability. HCV is associated with a reduction in cellular immunity; our two cases support that HCV and a history of IVDU carry risks of immunosuppression, warranting early and expedited workup for chronic fungal meningitis.

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“…In this case study, the patient received voriconazole twice for six months and showed significant improvement each time, thus demonstrating the efficacy of this drug in treating fungal infections especially aspergillosis in HIES patients. 16 Despite the interventions, the patient could not survive due to extensive disseminated fungal infection superimposed on her primary immunodeficiency.…”

Section: Discussion Discussionmentioning

confidence: 99%

Fungal Neurological Sequelae in a Hyper Immunoglobulin E Syndrome From Peshawar, Pakistan: An Unusual Presentation

Ijaz

Hanif

Rehman

et al. 2021

GJMS

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Hyper IGE syndrome is one of the primary immunodeficiency syndromes characterized by the presence of abnormally raised serum IGE levels (2000 IU/ml) with defective humoral and cell mediated immunity presenting in infancy or early childhood. It is a rare disease with only about 200 cases reported in literature. Usually, it is diagnosed clinically and by raised serum IGE levels. Mostly, it presents with recurrent staphylococcal skin abscesses, sinopulmonary infections, and opportunistic mycotic infections due to the immunodeficient state. Rarely, the central nervous system is involved by this condition.This case study deals with an 11-year-old girl who was diagnosed as a case of hyper IGE syndrome. She presented with low GCS and focal neurological deficits which were attributed to aspergillus fumigatus infection spreading to the brain resulting in multiple abscesses and eventually to death of the patient despite treatment interventions. This case emphasizes the likelihood of dissemination of fungal infections to multiple organs including the brain and the potential role of early neuroimaging to detect such lesions. Moreover, it shows significance of serial imaging in admitted patients particularly with the onset of new and unusual neurological symptoms. With more extensive studies, we may be able to diagnose and treat such infections and their complications on time with better outcomes.

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Clinical manifestations, diagnosis, and treatment outcome of CNS aspergillosis: A systematic review of 235 cases

Cited by 28 publications

References 47 publications

Serologic biomarkers in Candida and Aspergillus infections of the central nervous system: A comparison of galactomannan, mannan and β‐1,3‐D‐gucan testing from serum and cerebrospinal fluid

Serologic biomarkers in Candida and Aspergillus infections of the central nervous system: A comparison of galactomannan, mannan and β‐1,3‐D‐gucan testing from serum and cerebrospinal fluid

Diagnostic Dilemma of Aspergillus Meningitis in Patients With Hepatitis C Virus Co-Infection: A Case Series

Fungal Neurological Sequelae in a Hyper Immunoglobulin E Syndrome From Peshawar, Pakistan: An Unusual Presentation

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