Role of Voriconazole in the Management of Invasive Central Nervous System Aspergillosis: A Case Series from a Tertiary Care Centre in India

Abstract

Invasive central nervous system (CNS) aspergillosis is acquired by either hematogenous dissemination or direct spread from a sinus infection. We describe a series of nine patients with CNS aspergillosis from a tertiary care teaching institute in North India who were treated with voriconazole alone or in combination with surgery. All patients who had clinical and radiological features consistent with fungal CNS infection, showed the presence of septate hyphae on histopathology/microscopy and were either culture positive for Aspergillus spp. or had serum galactomannan positivity were diagnosed as CNS aspergillosis. Clinical features, risk factors, diagnostic modalities, treatment details and outcome at last follow-up were recorded for all patients diagnosed with CNS aspergillosis. A total of nine patients were diagnosed with CNS aspergillosis. The median duration of presentation at our hospital was six months (IQR-2-9 months). Six patients had concomitant sinus involvement, while two patients had skull-base involvement as well. All patients were treated with voriconazole therapy, and three of these patients underwent surgery. All but one patient survived at the last follow-up (median duration was 14 months (IQR- 8-21.5). Two patients had complete resolution, and voriconazole was stopped at the last follow-up, and the rest of the patients were continued on voriconazole. Of the six patients who were continued on voriconazole, all but one had more than 50% radiological resolution on follow-up imaging. Invasive CNS aspergillosis is an important cause of CNS fungal infection that is often diagnosed late and requires long-term voriconazole-based therapy.

Chronic Granulomatous Invasive Fungal Sinusitis in Patients With Immunocompetence: A Review

“…Several other studies found that the outcome is better with voriconazole. 8,16,23,28 Indirect evidence for the superiority of azoles is seen in the successful outcomes with azoles following failure of amphotericin therapy. 7,28 Liposomal amphotericin B, which has less toxicity, has been recommended as alternative primary therapy only in patients with hepatic impairment or where drug interactions necessitate alternatives to azoles.…”

Post-Flood Impacts on Occurrence and Distribution of Mycotoxin-Producing Aspergilli from the Sections Circumdati, Flavi, and Nigri in Indoor Environment

“…This species is the second leading cause of invasive aspergillosis and is associated with approximately 10% of bronchopulmonary aspergillosis [ 64 ]. It may cause various diseases, including keratomycosis [ 65 ] and endophthalmitis [ 66 ].…”

Abses Otak Aspergilus Pada Pasien Imunokompeten : Sebuah Laporan Kasus Jarang

“…[7] Vorikonazol mempunyai daya penetrasi yang baik terhadap sawar darah otak sehingga vorikonazol menjadi terapi pilihan untuk aspergilosis intrakranial. [19,20] Literatur menunjukkan mayoritas pasien yang mendapatkan vorikonazol sebagai pilihan pertama pengobatan mengalami perbaikan. [7] Pada sebuah penelitian dari 123 kasus dengan aspergilosis SSP, didapatkan mortalitas pada kelompok monoterapi amfoterisin B lebih tinggi dibandingkan monoterapi vorikonazol (63 vs 35%).…”

“…[7] Pada sebuah penelitian dari 123 kasus dengan aspergilosis SSP, didapatkan mortalitas pada kelompok monoterapi amfoterisin B lebih tinggi dibandingkan monoterapi vorikonazol (63 vs 35%). [20] Vorikonazol menghambat biosintesis ergosterol yang merupakan komponen penting membran sel jamur sehingga mengganggu pertumbuhannya. [21] Vorikonazol dapat diberikan secara intravena maupun per oral.…”