Management of granulomatous cerebral aspergillosis in immunocompetent adult patients: a review

Abstract

Cerebral aspergillosis, is an infrequent, opportunistic infection of the central nervous system that accounts for 5-10% of all intracranial fungal pathology. It is uncommon in immunocompetent patients and has a significant disease burden, with high morbidity and mortality, even with appropriate treatment. Basic principles of abscess management should be employed, including aspiration and targeted anti-fungal therapy for 12-18 months. However, reported outcomes with a purely minimally invasive approach are poor and there should be a low threshold for surgical excision, especially in resource poor settings and in patients with deteriorating neurology harbouring sizeable masses. Evidence favouring gross total excision over subtotal resection is lacking, however. It is notable that these recommendations are largely based on retrospective case series and isolated case reports. There is a need therefore for international collaboration to evaluate management strategies for immunocompetent patients with cerebral aspergillosis.

Necrotizing Liver Granuloma/Abscess and Constrictive Aspergillosis Pericarditis with Central Nervous System Involvement: Different Remarkable Phenotypes in Different Chronic Granulomatous Disease Genotypes

“…In more than 50% of cases, lungs or paranasal sinuses are primary foci of infection [24]. Hematogenous dissemination from lungs can cause meningitis, abscess formation, or vascular pathology in the form of thrombosis and infarction [25]. CNS aspergillosis constitutes 10% of IFD episodes in CGD patients, while it has a frequency of less than 5% in overall infections [14, 15].…”

“…CNS aspergillosis constitutes 10% of IFD episodes in CGD patients, while it has a frequency of less than 5% in overall infections [14, 15]. Patients may present with seizures, headaches, fever, focal neurological signs per the pathology, and localization [14, 25]. Radiologically edema, hemorrhage, and ring enhancement are cardinal findings and nonspecific hyperintense foci are also defined [19, 24, 25].…”

Previously unknown species of Aspergillus

“…Meanwhile, A. penicillioides has only rarely been reported as a human pathogen; it has caused fatal disseminated aspergillosis in an infant with cystic fibrosis [42]. Severe clinical entities include the rare and lifethreatening cerebral aspergillosis, for which the fatality rate is greater than 90% [43,44]. Aspergillus fumigatus and A. flavus are the most frequently involved species, although isolation of A. terreus misled neuro-oncologists in a patient with glioblastoma [45,46].…”

Cerebral Aspergillosis in a Patient with p-ANCA Vasculitis: Serial Imaging Observation over 15 Months

“…Cerebral aspergillosis occurs primarily in patients with severe immunodeficiency, but can happen in a previously healthy or influenza-affected patient [10,11]. Cerebral aspergillosis accounts for 5-10% of all intracranial fungal pathology and may require anti-fungal therapy for 12-18 months [10]. Our case had experienced confirmed IPA and probably cerebral aspergillosis over a 15-month observation period with antifungal therapy ( Table 1).…”

“…Angiogenesis inhibitor but not an immunosuppressive agent could be a potential tool for the treatment of vasculitis [8,9]. Cerebral aspergillosis occurs primarily in patients with severe immunodeficiency, but can happen in a previously healthy or influenza-affected patient [10,11]. Cerebral aspergillosis accounts for 5-10% of all intracranial fungal pathology and may require anti-fungal therapy for 12-18 months [10].…”