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Intracranial aspergillosis

Fungal infections of central nervous system (CNS) commonly affect immunocompromised patients, however, recently such cases have been reported even amongst immunocompetent patients.

In a study, Bora et al. retrospectively analyzed outcome of 18 immunocompetent patients with histopathologically proven intracranial aspergillosis undergoing combined surgical and medical management.

The age of patients ranged from 5-65 years. Fourteen out of 18 patients had well defined lesions while 4 had diffuse disease. Paranasal sinuses were involved in 8 & cavernous sinus in 3 patients. Six patients had hydrocephalus. Four patients developed infarcts during their clinical course. Surgical interventions included gross (n = 4) or subtotal excision (n = 8), decompressive craniectomy & biopsy of lesion (n = 4), biopsy only (n = 2) and ventriculoperitoneal shunt placement (n = 6). All patients received postoperative antifungal therapy. The duration of follow up ranged from 10-60 months. Overall mortality was 44.4%. Mortality amongst patients undergoing gross total and subtotal excision was 25% & 50% respectively. Patients undergoing DC had a mortality of 25%. Both patients undergoing only biopsy died. Hydrocephalus was associated with a very high mortality (83.3%). Amongst surviving patients (n = 10), 6 patients became disease free & rest 4 had stable disease at last follow up.

Intracranial aspergillosis is associated with high morbidity & mortality even amongst immunocompetent patients. An aggressive multidisciplinary management is thus needed to improve outcome. Our study shows that a combination of surgical excision or decompressive craniectomy and antifungal therapy can be helpful in improving prognosis of these patients 1).

Nowak et al., present an immunocompetent 64-year-old patient presenting with an orbitofrontal invasive aspergillosis treated successfully with voriconazole monotherapy following biopsy and orbital decompression 2).

Bora S, Kumar A, Mishra S, Satyarthee GD, Singh PK, Sawarkar D, Verma S, Borkar S, Sharma R, Chandra SP, Kale SS. Intracranial aspergillosis amongst immunocompetent patients: An experience with combined surgical and medical management of 18 patients. Clin Neurol Neurosurg. 2019 Sep 3;186:105511. doi: 10.1016/j.clineuro.2019.105511. [Epub ahead of print] PubMed PMID: 31505434.
Nowak S, Bollmann T, Rosenstengel C, Rathmann E, Ribback S, Ewert R, Schroeder HWS. Voriconazole as mono-therapy in orbitofrontal erosive aspergillosis without gross total resection: A case report and review of literature. Clin Neurol Neurosurg. 2018 Jul 2;172:93-95. doi: 10.1016/j.clineuro.2018.06.043. [Epub ahead of print] PubMed PMID: 29986203.
intracranial_aspergillosis.txt · Last modified: 2019/09/11 15:59 by administrador