Successful treatment of cerebral aspergillosis by stereotactic operation and antifungal therapy

Abstract

Summary. The following is a case report of a cerebral Aspergillus abscess in a male patient predisposed to this disease on account of many years of alcohol abuse. After timely identification of the pathogenic organism, the patient was cured by stereotactic operation in conjunction with antifungal therapy using amphotericin B and 5‐fluorocytosine. The origin and the starting point of the infection remain obscure. Zusammenfassung. Im folgenden wird ein Fall eines zerebralen Aspergillus‐Abszesses bei einem durch langjährigen Alkoholabusus prädisponierten Patienten beschrieben. Er konnte durch stereotaktische Operation und antimykotische Therapie mit Amphotericin B und 5‐Fluorcytosin nach rechtzeitigem Erregernachweis geheilt werden. Ursprung und Beginn der Infektion blieben unklar.

Fungal encephalitis in human autopsy cases is associated with extensive neuronal damage but only minimal repair

“…Flucytosin readily enters the CNS compartments, but in general it is not active enough for the use as a single agent. It is usually combined with amphotericin B . The triazoles fluconazole and voriconazole readily enter the CNS.…”

Diversity and Surgical Management of Intracranial Fungal Infections

“…The existing literature indicates several mainstream surgical methods: (1) craniotomy is the most conventional surgical method, which can effectively reduce the occupying effect of lesions, reduce intracranial spread of fungi, and improve the efficacy of subsequent anti-fungal drugs; (2) stereotactic procedures: it is suitable for patients with multiple lesions at deep location, poor basic state and inability to tolerate anesthesia. Stereotactic aspiration is usually effective for deep brain abscess; [21][22][23][24] (3) Neuroendoscopic surgery: it is suitable for patients with inflammation in adjacent areas such as the paranasal sinuses. 25 The lesion can be removed under direct vision and the surrounding area can be explored; (4) shunt surgery: postoperative hydrocephalus in patients with fungal infection is relatively common.…”