Abstract
The aim of this case series was to provide a modern cohort of patients with cerebral aspergillosis and show the effectiveness of modern treatment concepts. In a 10-year period from January 2009 to January 2019, we identified 10 patients (6 male, 4 female) who received surgery or frameless stereotactic drainage of a cerebral aspergilloma at our center. Patients’ and disease characteristics were recorded. The median age was 65 (range 45 to 83). We conducted 133 cranial surgeries in 100 patients due to cerebral brain abscess (BA) during that time, which leads to a percentage of 10% of aspergilloma within BAs in our patient sample. We performed 3.1 surgeries per patient followed by antifungal treatment for 6 months (= median) according to the microbiological findings. Regarding comorbidities, the mean Charlson comorbidity index (CCI) at the time of admission was 5, representing an estimated 10-year survival of 21%. Six (60%) of 10 patients showed conditions of immunosuppression, one suffered endocarditis after replacement of aortic valves. Four patients showed associated frontobasal bone destruction, mycotic aneurysms, or thromboses. The mean duration of hospital stay was 37 days. Mortality was much lower than in literature. Sixty percent of the patients died during the follow-up period. The outcome of the two immunocompetent patients was more favorable. Cerebral aspergillosis is a rare, but still life-threatening, condition, which predominantly occurs in immunosuppressive conditions. Due to radical surgical and antifungal therapy for several months, mortality can be reduced dramatically.
Highlights
Aspergillosis is a rare type of infection caused by Aspergillus fumigatus, an ubiquitous mold of which spores are an inherent component of breathing air [3]
We aimed to show the effectiveness of our treatment by analyzing our patients’ clinical outcomes and to identify some risk factors for a poor outcome of cerebral aspergillosis
In a 10-year period from January 2009 to January 2019, we identified 10 patients (6 male, 4 female) who received surgery or frameless stereotactic drainage of a cerebral aspergilloma at our center
Summary
Aspergillosis is a rare type of infection caused by Aspergillus fumigatus, an ubiquitous mold (a fungal organism) of which spores are an inherent component of breathing air [3]. It primarily leads to infection in patients with underlying immunosuppression, such as autoimmune diseases, hematopoietic stem cell or solid organ transplantations, or tumor diseases. It is typically found in water and is an emerging opportunistic pathogen. It is the second most common fungus after Aspergillus fumigatus found in patients with cystic fibrosis. Infection can occur in the lung, skin, bones, and CNS. CNS infection is a very rare incident, and the prognosis is poor [27]
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