Treatment Of Cerebral Aspergillosis Research Articles

Need of voriconazole high dosages, with documented cerebrospinal fluid penetration, for treatment of cerebral aspergillosis in a 6-month-old leukaemic girl

This case report indicates the usefulness of voriconazole for the treatment of central nervous system (CNS) aspergillosis, also in paediatrics. However, it also confirms the need for therapeutic drug monitoring (TDM), especially in younger children that may require very high dosages in order to achieve plasma and cerebrospinal fluid (CSF) therapeutic concentrations.

Treatment of Refractory Cerebral Aspergillosis in a Liver Transplant Recipient With Voriconazole: Case Report and Review of the Literature

Extension of invasive aspergillosis to the central nervous system is associated with high mortality, in part because of poor central nervous system penetration of antifungal drugs. Voriconazole yields fungicidal drug concentrations within the central nervous system, but use of this drug is limited in liver transplant recipients because of hepatotoxicity and drug interactions. We reviewed medical records and antifungal treatment for all liver transplant recipients from 2007 to 2009 who had cerebral aspergillosis (Proven [2]; Probable [1]; Possible [1]) at week 3, 4, 6, and 12 after transplant. A 33-year-old white man underwent orthotopic liver transplant for acute liver failure that was caused by acetaminophen overdosage. Risk factors for fungal infection included major blood loss (8 L), prolonged surgery (9 h), and emergency revision transplant that was done because of nonfunctioning of the primary transplant at 48 hours. He developed postoperative aspergillus pneumonia and invasive aspergillosis of the kidneys, brain, and eye. Treatment with voriconazole and amphotericin B was successful, with moderate residual renal impairment. Voriconazole was effective and safe in the treatment of cerebral aspergillosis in this liver transplant recipient.

Cerebral aspergillosis complicated by intracerebral haemorrhage

Aspergillus infection can cause a wide variety of clinical syndromes. We report on an immunocompromised man who had a catastrophic intracerebral haemorrhage secondary to cerebral aspergillosis. This report highlights the need for systemic evaluations of the role of neurosurgery in the treatment of cerebral aspergillosis.

Diffusion‐weighted imaging in brain aspergillosis

Brain aspergillosis is a rare pathology, occurring mainly in immunocompromised patients, responsible for multiple cerebral septic infarctions. Some researchers have described magnetic resonance (MR) findings in cerebral invasive aspergillosis, but diffusion-weighted imaging (DWI) has rarely been reported, especially in typical non-enhancing lesions, while it may be helpful for early differential diagnosis and may allow earlier antifungal treatment. We describe three cases of patients presenting brain aspergillosis, with MR imaging including diffusion-weighted sequences and apparent diffusion coefficient (ADC) cartography. The three patients described in this study presented a total of 23 circular lesions, and one patient presented an infarction area in the territory of the right middle cerebral artery. Lesions were ring-enhancing for one patient, and presented no enhancement for the other two. Eleven lesions were very bright on DWI, with reduced ADC values. Twelve lesions, either enhancing or not enhancing, presented a 'target-like' aspect with central and peripheral hypointense areas on DWI, corresponding to higher ADC value areas, and intermediate marked hypersignal on DWI. This typical aspect of aspergillosis lesions on DWI may allow early diagnosis and treatment of cerebral aspergillosis, and is helpful for differentiating aspergillosis lesions from other infectious or malignant lesions affecting immunocompromised patients.

99 Caspofungin vs. caspofungin combined with liposomal amphotericin B for the treatment of cerebral aspergillosis in a nursing rat model

99 Caspofungin vs. caspofungin combined with liposomal amphotericin B for the treatment of cerebral aspergillosis in a nursing rat model

Intracavitary administration of amphotericin B in the treatment of cerebral aspergillosis in a non immune-compromised patient: case report and review of the literature

A 24-year-old man presented with cerebral aspergillus fungal granuloma involving the left frontal region secondary to pulmonary aspergillosis. He was otherwise healthy with no evidence of immune-suppression. Because of poor penetration of amphotericin B into the brain and cerebrospinal fluid (CSF), this patient was treated by a combination of systemic and local therapy in addition to surgical excision resulting in a cure with follow up for more than three years.This form of treatment produced no untoward long-term side effects or neurological sequel. On review of the literature on aspergillosis of the central nervous system (CNS), we found that six patients, including the present case, have been reported who survived longer than 1 year; their treatment included local administration of antifungal agent in the abscess cavity or into cerebral ventricles in order to control this devastating, treatment-resistant pathological fungal infection.

Treatment of Cerebral Aspergillosis with Itraconazole: Do High Doses Improve the Prognosis?

We describe a 72-year-old woman with chronic asthma who presented with cerebral abscesses due to Aspergillus fumigatus after she received treatment with corticosteroids. Therapy with high-dose itraconazole (800 mg/d for 5 months, followed by 400 mg/d for an additional 4.5 months) resulted in complete resolution of all lesions. Serum concentrations of the drug ranged from 2 micrograms/mL to 30 micrograms/mL. Review of 20 cases of cerebral aspergillosis that were treated with itraconazole revealed that three of the four patients who received high doses (800 mg/d in the adults) of the drug responded favorably, while only two of the 16 patients who received a dose of 400 mg/d were cured. The use of high-dose itraconazole appears to be justified for high-risk patients with cerebral aspergillosis for whom conventional therapy has failed.