Primary aspergilloma and subacute invasive aspergillosis in two AIDS patients

Martínez, Roberto; Castro, Gabriela Salim de; Machado, Alcyone Artioli; Moya, Maria Janete

doi:10.1590/s0036-46652009000100009

Cited by 16 publications

(7 citation statements)

References 27 publications

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“…Atypically, the patient had slight neutrophil leukocytosis and not neutropenia (Cornet et al, 2002). Elevated neutrophil counts were previously reported in a 33-year-old woman with AIDS who had disseminated aspergillosis affecting the brain and spine (Martinez et al, 2009). Furthermore, HIV-infected patients have defects in neutrophil function as well as activation of neutrophils, contributing to this dysfunction, which may manifest at all stages of HIV disease (Kuritzkes, 2000).…”

Section: Discussionmentioning

confidence: 79%

A rare, fatal case of invasive spinal aspergillosis in an antiretroviral-naïve, HIV-infected man with pre-existing lung colonization

Rossouw

Goedhals

Merwe

et al. 2011

Journal of Medical Microbiology

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Infection of the central nervous system (CNS) is a rare but devastating complication of invasive aspergillosis. We report a case of invasive aspergillosis with spinal involvement in a human immunodeficiency virus (HIV)-infected patient without neutropenia. A 42-year-old, antiretroviralnaïve, HIV-infected man presented with progressive weakness in the lower limbs and urinary and faecal incontinence for 2 weeks. The patient had been prescribed broad-spectrum antibiotics and prednisone. He had upper motor neuron signs and a sensory level at T1, with accompanying neck stiffness on flexion. Magnetic resonance imaging revealed diffuse abnormal signals of the vertebral bodies in the lower cervical and thoracic areas, with cord compression in the C2 and C3 region and signal distortions of the T2 and T3 vertebral bodies. Chest X-ray and computerized tomography demonstrated post-tuberculous apical cavities with suspected fungal colonization. Histopathology of an extradural spinal lesion at T1/T2 suggested invasive aspergillosis. The patient was started on fluconazole in response to the histopathological evidence of Aspergillus infection, but died within 3 weeks. Post-mortem analysis of the biopsy sample by PCR identified the infectious agent as Aspergillus fumigatus. Atypically, his CD4 + T-cell count was 239 cells mm "3 and he had no evidence of neutropenia. Invasive aspergillosis should be considered as part of the differential diagnosis among HIV-infected patients with non-specific, focal CNS symptoms, even among those without classical risk factors such as neutropenia, and aggressive antifungal therapy should be instituted as early as possible. IntroductionAspergillus species are the most frequently isolated moulds among human immunodeficiency virus (HIV)-infected patients (Enoch et al., 2006), but invasive aspergillosis is very uncommon in this population (,1 %) (Cornet et al., 2002). Despite this low incidence, it is of particular importance because the case-fatality rate associated with disseminated infection or central nervous system (CNS) involvement is reported to be 88 % (Lin et al., 2001). Among HIV-infected persons, invasive aspergillosis usually occurs in patients with a CD4 + T-cell count of ,50 cells mm 23 and in those with neutropenia or on corticosteroids (Mylonakis et al., 1998). However, CNS aspergillosis has also been described in immunocompetent patients and following epidural steroid injections (Haran & Chandy, 1993; Larson Kolbe et al., 2007;Saigal et al., 2004;Sundaram et al., 2006). Aspergillosis generally affects the lungs, but can also spread to other organs, including the CNS. Based on a large, randomized-controlled trial, the drug of choice for invasive aspergillosis is voriconazole (Herbrecht et al., 2002). However, a diagnosis of invasive aspergillosis is often only made post-mortem, and a definitive diagnosis requires both microscopic analysis of tissue and identification of the organism by culture (Walsh et al., 2008).Aspergillus infection in the CNS is rare, but appears to be becoming mo...

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Section: Discussionmentioning

confidence: 79%

A rare, fatal case of invasive spinal aspergillosis in an antiretroviral-naïve, HIV-infected man with pre-existing lung colonization

Rossouw

Goedhals

Merwe

et al. 2011

Journal of Medical Microbiology

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“…[10] Risk factors for developing this rare CNS infection are recipients of immunosuppressive disorders such as HIV/AIDS, solid organ transplants, patients on chemotherapy, diabetes, heroin abuse, long-term steroid or broad-spectrum antibiotics use, neutropenia, history of opportunistic infection, and use of ganciclovir/valacyclovir. [12345678]…”

Section: Discussionmentioning

confidence: 99%

“…[1234] Here, we report a case of cerebrospinal fluid (CSF) culture-proven CNS aspergillosis in a middle-aged male with human immunodeficiency virus (HIV) positive illness who presented with febrile encephalopathy, seizures, and pancytopenia with normal contrast-enhanced computerized tomography (CECT) scan brain and normal initial CSF studies. High index of suspicion is necessary in considering fungal infections as a cause of meningoencephalitis; early diagnosis and initiation of potent antifungal may reduce the morbidity and mortality associated with this condition.…”

Section: Introductionmentioning

confidence: 99%

Aspergillus meningoencephalitis in a patient with human immunodeficiency virus infection: Normal cerebrospinal fluid does not mean absence of meningitis

Desai

Seth

Shah

et al. 2016

Indian J Sex Transm Dis

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A male with human immunodeficiency virus infection presented with febrile encephalopathy followed by seizures and left hemiparesis. Initial imaging with contrast computerized tomography (CT) scan brain and cerebrospinal fluid (CSF) examination were normal. Subsequent magnetic resonance imaging brain revealed bilateral parieto-occipital infarcts with bleed. He did not improve on treatment with broad-spectrum antibiotics, anti-tubercular drugs, and antifungals. He finally succumbed to the disease. His CSF culture grew Aspergillus after 2 weeks. Central nervous system (CNS) aspergillosis can present with variable presentations, and initial CT scan and CSF examination can be normal, especially in the immunosuppressed. High index of suspicion is required for the diagnosis of invasive CNS Aspergillus in the immunosuppressed.

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“…Las serologías para toxoplasmosis y enfermedad de Chagas fueron no reactivas. El recuento de linfocitos T CD4 era de 8 céls/mm 3 .…”

Section: Caso Clínicounclassified

“…Su incidencia varía entre distintos centros y según el tipo de inmunosupresión. En pacientes con síndrome de inmunodeficiencia adquirida (SIDA) su frecuencia es baja, variando entre 0 y 12% según diversos autores [1][2][3] . El órgano principalmente comprometido es el pulmón.…”

unclassified

Aspergilosis cerebral como causa de lesión cerebral focal asociada SIDA. A propósito de un caso y revisión de la literatura

Vazquez¹,

Messina²,

Santiso³

et al. 2017

Rev. chil. infectol.

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Cerebral aspergillosis is a rare disease with high mortality rates in AIDS patients. It is important to take this into account in the differential diagnosis of a brain expansive lesion. A high level of suspicion is required to make an early diagnosis. We present a case of an HIV-infected patient with progresive neurological disease caused by Aspergillus flavi. We review 40 previously published cases of central nervous system aspergillosis in patients with AIDS.

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Primary aspergilloma and subacute invasive aspergillosis in two AIDS patients

Cited by 16 publications

References 27 publications

A rare, fatal case of invasive spinal aspergillosis in an antiretroviral-naïve, HIV-infected man with pre-existing lung colonization

A rare, fatal case of invasive spinal aspergillosis in an antiretroviral-naïve, HIV-infected man with pre-existing lung colonization

Aspergillus meningoencephalitis in a patient with human immunodeficiency virus infection: Normal cerebrospinal fluid does not mean absence of meningitis

Aspergilosis cerebral como causa de lesión cerebral focal asociada SIDA. A propósito de un caso y revisión de la literatura

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