Chronic Aspergillus sp. meningitis successfully treated with fluconazole: case report

Mariushi, Wagner Munemori; Arruda, Walter Oleschko; Tsubouchi, Mário Henrique; Ramina, Ricardo

doi:10.1590/s0004-282x1999000200020

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…A culture-based diagnosis of Aspergillus meningitis is hampered by the lack of sensitivity as shown by the 31% of positive results observed in our review of published cases. 3,9,13,22,23,25,26,29,33,35,37,40,45,52e54,56,70 PR It has been previously suggested that a minimum of 5 mL of cerebrospinal fluid should be cultured when a mycosis is suspected or that repeated culture of large volumes of CSF are critical for successful in vitro isolation. However, such large volumes are not easy to obtain in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…80 On the other hand, serial lumbar puncture does indeed seem to have a role since in 9 cases, the fungus could be successfully isolated from cerebrospinal fluid only after several attempts. 3,25,26,29,35,37,40,45 Non-culture based diagnostic methods for the diagnosis of aspergillosis were employed on CSF in fifteen patients and seem to outperform traditional culture, with a overall sensitivity of 87%. 23,25,28,29,34,36,48,49,64,75,76PR Although a cut-off value of the GM index has not yet been formally established for the diagnosis of CNS aspergillosis, it has been proposed that it might be lower than that used for serum samples due to the lower back-ground reactivity of CSF.…”

Section: Discussionmentioning

confidence: 99%

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Aspergillus meningitis: A rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases

Antinori

Corbellino

Meroni

et al. 2013

Journal of Infection

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aspergillus meningitis: A rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases

Antinori

Corbellino

Meroni

et al. 2013

Journal of Infection

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“…A literature review conducted by Antinori et al found a sensitivity of 31% [ 7 ]. Some of the measures that appear to increase the culture yield are to obtain high volumes of CSF or to perform serial lumbar punctures [ 8 , 9 ]. In our patient, CSF culture did not show any growth, despite the numerous samples sent for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Central Nervous System Aspergillosis: An Unexpected Complication following Neurosurgery

2018

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Post-surgical aspergillosis is an uncommon complication that carries a high mortality rate in affected patients. The diagnosis is challenging given the lack of highly sensitive methods to isolate Aspergillus from surgical sites. Here, we present a case of post-surgical aspergillosis that occurred after the resection of acoustic neuroma in an immunocompetent patient. Imaging revealed leptomeningeal enhancement and a cerebellar extra-axial fluid collection adjacent to the right retrosigmoid craniotomy. The patient was taken to the operating room for debridement, where purulent fluid was obtained from subdural space. The diagnosis was achieved by histopathology and polymerase chain reaction (PCR) in brain tissue. Appropriate investigations failed to detect contamination in the operating room. The patient was successfully treated with 3 months of voriconazole. We highlight the importance of recognizing this uncommon complication and advocate for the use of molecular techniques to improve the diagnostic yield in central nervous system aspergillosis.

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“…Nos últimos anos, a aspergilose foi a infecção fúngica sistêmica com segundo índice de mortalidade dentre pacientes imunocomprometidos. Este índice também é freqüente em pacientes que fazem uso por longo prazo de esteróides e de drogas imunossupressoras, antibióticos de grande espectro e quimioterapia(MARIUSHI et al, 1999, WALSH, 2008.Em hospitais, a aspergilose representa uma significante ameaça para pacientes imunocomprometidos, sendo numerosos os casos de aspergilose invasiva descritos. Uma análise realizada utilizando dados de 53 estudos (publicados na base de dados Pubmed) envolvendo 458 pacientes mostrou que 77,7% dos pacientes apresentaram infecção primária por Aspergillus spp.…”

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Microorganismos do solo e de manguezais: fonte de produtos antimicrobianos.

Firoozmand¹

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Systemic fungal infections are responsible for high morbidity and mortality especially in immune-sensitive patients. The treatment with the available antifungal substances is long and causes various collateral effects, which justifies the search for new antifungal agents. In Brazil, endemic diseases, such as Tuberculosis, Leishmaniasis and Chagas Disease, also need new drugs to increase the possibilities of their cure. The biodiversity of microorganisms found in the ecosystems provide excellent perspectives for the discovery of pharmacologically active molecules. In this study, microorganisms extracted from the soil and from the mangrove swamps of the Brazilian coast were analyzed with respect to their antifungal, antimycobacterial, leishmanicidal and trypanocidal actions. Eighty-three actinobacteria from the soil and fungi from the mangrove swamps were isolated and tested antagonistically in relation to the fungi Trichophyton rubrum, Candida albicans, Aspergillus fumigatus e Cryptococcus neoformans. Twenty-three of them inhibited the growth of the pathogens (producing circles ≥ 2mm of inhibition to growth) and were cultivated in a culture medium of Potato Dextrose for seven days. From the supernatant of the culture of the microorganisms, twenty-three organic extracts were obtained and analyzed taking in consideration their antimicrobial action through the determination of their minimum inhibitory concentrations (MICs). Five extracts presented MICs equal or less than 400 µg/mL over the pathogenic fungi and two presented significant action against the trypomastigote of Trypanosoma cruzi. For the promastigote of Leishmania amazonensis and of Mycobacterium tuberculosis H37Rv, the extracts were not effective. The five isolated producers of the extracts with promising antimicrobial action were fungi from the mangrove swamps and were taxonomically identified as to their genus. The purification of these five more effective extracts using high efficiency liquid chromatography for the separation of the active ingredient was not concluded but the chromatography data of the mass spectrometry indicate that the extracts are made of a small number of molecules. The results indicate that fungi from mangrove swamps present better microbial action than the actinobacteria tested and present promising perspectives for the research of new antimicrobial agents.

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Chronic Aspergillus sp. meningitis successfully treated with fluconazole: case report

Abstract: -We a case of chronic Aspergillus sp. meningitis in a healthy 43-year-old woman successfully treated with fluconazole given orally (300 ms/day). The diagnosis was made by detection of anti-aspergillus antibodies and positive culture to Aspergillus sp. in the cerebrospinal fluid.

Cited by 4 publications

References 26 publications

Aspergillus meningitis: A rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases

Aspergillus meningitis: A rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases

Central Nervous System Aspergillosis: An Unexpected Complication following Neurosurgery

Microorganismos do solo e de manguezais: fonte de produtos antimicrobianos.

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