Fungal brain infection—no longer a death sentence

Abstract

The aim of this case series was to provide a modern cohort of patients with cerebral aspergillosis and show the effectiveness of modern treatment concepts. In a 10-year period from January 2009 to January 2019, we identified 10 patients (6 male, 4 female) who received surgery or frameless stereotactic drainage of a cerebral aspergilloma at our center. Patients’ and disease characteristics were recorded. The median age was 65 (range 45 to 83). We conducted 133 cranial surgeries in 100 patients due to cerebral brain abscess (BA) during that time, which leads to a percentage of 10% of aspergilloma within BAs in our patient sample. We performed 3.1 surgeries per patient followed by antifungal treatment for 6 months (= median) according to the microbiological findings. Regarding comorbidities, the mean Charlson comorbidity index (CCI) at the time of admission was 5, representing an estimated 10-year survival of 21%. Six (60%) of 10 patients showed conditions of immunosuppression, one suffered endocarditis after replacement of aortic valves. Four patients showed associated frontobasal bone destruction, mycotic aneurysms, or thromboses. The mean duration of hospital stay was 37 days. Mortality was much lower than in literature. Sixty percent of the patients died during the follow-up period. The outcome of the two immunocompetent patients was more favorable. Cerebral aspergillosis is a rare, but still life-threatening, condition, which predominantly occurs in immunosuppressive conditions. Due to radical surgical and antifungal therapy for several months, mortality can be reduced dramatically.

Orthotopic Heart Transplant Recipient Presenting with Sudden Onset Homonymous Hemianopia

“…Fungal infection is common among heart transplant recipients, and the brain is commonly involved due to a hematogenous spread. 4 Incidence of complicated fungal infections increased during the recent COVID-19 pandemic resulting in increasing morbidity and mortality. 5 Multiple abscess loculi are typical of a fungal abscess, while bacterial abscess is likely to have a single-site lesion.…”

PET Imaging of Active Invasive Fungal Infections with d-[5-11C]-Glutamine

“…Interestingly, d -[5- 11 C]-Gln showed a similar signal-to-background contrast in both SubQ and IM fungal infections, which might imply that PET imaging with d -[5- 11 C]-Gln could perform equally well for the diagnosis of IFIs from fungal myositis and subcutaneous mycosis. Moreover, based on the observed biodistribution profiles of d -[5- 11 C]-Gln in major organs (Figure S3), PET imaging with d -[5- 11 C]-Gln possesses great clinical potential to reveal deep-seated IFIs in the brain, bones, and spine, where its background uptake is low. , Of note, for the in vivo imaging evaluation, we controlled the inoculation number of C. albicans in the range of ∼10 8 CFU.…”

“…Moreover, based on the observed biodistribution profiles of D-[5-11 C]-Gln in major organs (Figure S3), PET imaging with D-[5-11 C]-Gln possesses great clinical potential to reveal deep-seated IFIs in the brain, bones, and spine, where its background uptake is low. 70,71 Of note, for the in vivo imaging evaluation, we controlled the inoculation number of C. albicans in the range of ∼10 8 CFU. In future work, we will test the lowest detection limit for the fungal bioburden with PET imaging using D-[5-11 C]-Gln.…”

Erosion of the sella turcica and pituitary expansion secondary to polymicrobial brain abscesses: a case report

“…Parasitic and fungal etiologies for BA are very rare, comprising less than 1 % of all BA etiologies; fungal brain abscesses most likely suggest an immunocompromised status for the patient [ 3 ]. However, mortality for patients with BA secondary to a fungal infection has been shown to be over 80 % [ 8 ].…”