Sinocranial aspergillosis: a form of central nervous system aspergillosis in South India

Abstract

Of the 21 patients with aspergillosis of central nervous system seen during the years 1990-1997, 16 (76%) had aspergillosis of sino-cranial origin. The occupation in patients with sino-cranial aspergillosis was either agricultural or manual work and predisposing risk factors were present in only two (12.5%) patients. Skull-base syndromes were the presenting features in 13 patients and three patients presented with features of intracranial space-occupying lesion. Paranasal sinus mass lesions were seen in all the 16 patients. Computerized tomography showed intracranial extradural-enhancing mass lesions in the anterior, middle or posterior cranial fossa in nine (68%) patients, intracranial and orbital lesions in four and orbital lesions in three. Well-formed granuloma with dense fibrosis was the histological feature. Survival rates were not good even after surgical and antifungal chemotherapy. Surgical treatment was subradical in our series. The majority of cases of sinocranial aspergillosis are reported from countries with temperate climates and the high incidence in these regions is probably related to constant exposure to the high spore content of pathogenic Aspergillus species in the 'mouldy' work environment.

Comparison of Efficacy of Amphotericin B and Itraconazole in Chronic Invasive Fungal Sinusitis

“…In a study by Murthy et al [4], the mean duration of disease at the time of presentation was 9.5 months (range 4 ± 48 months). Clancy and Nguyen [5] reported a mean delay of 24 months while Alrajhi et al [6] reported a mean duration of symptoms of 18 months before diagnosis.…”

Occupation, Lifestyle, Diet, and Invasive Fungal Infections

“…Specifically, in a report from India, 16 immunocompetent patients with no predisposing factors experienced CNS aspergillosis of sinocranial origin [24]. These patients were either agricultural or manual workers in ''moldy'' environments.…”

Fulminant cranio-cerebral invasive aspergillosis in a patient with phytophotodermatitis

“…[5,6] As the patient was a farmer she would have been exposed to furocoumarins as well as fungus through handling of plants while working in the fields and also in present case administration of steroids in a known diabetic resulted in further immnocompromised state and infection with Aspergillus. The temperate climate of our country and constant exposure to the high spore content of pathogenic Aspergillus species in the "mouldy" work environment [7] posed a high risk to the patient. Cerebral infarction associated with skull base aspergillosis can mimic like any other causes of cerebrovascular disease.…”