Aspergillosis of the CNS in a Pediatric Liver Transplant Recipient: Case Report and Review

Green, Michael; Wald, Ellen R.; Tzakis, Andreas G.; Todo, S; Starzl, Thomas E.

doi:10.1093/clinids/13.4.653

Cited by 54 publications

(24 citation statements)

References 43 publications

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“…Craniotomy with excision and/or drainage [22][23][24][25][26] for diagnostic and therapeutic purposes should play an active role in the treatment of these patients. The role of newer antifungal agents, such as liposomal amphotericin B or itraconazole, is still unclear.…”

Section: Fungal Brain Abscessesmentioning

confidence: 99%

Brain Abscess in Solid Organ Transplant Recipients Receiving Cyclosporine-Based Immunosuppression

Selby

Ramirez²,

Singh³

et al. 1997

Arch Surg

125

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Objective-To determine the incidence, clinical presentation, and outcome and confounding factors associated with the development of a brain abscess in solid organ transplant recipients.Design-A 14-year retrospective survey.Setting-A single, multiorgan, academic transplantation center.Patients-A total of 2380 liver transplant recipients, 1650 kidney transplant recipients, and 598 heart, heart-lung, or lung transplant recipients of all ages (pediatric and adult) were included. All patients were given cyclosporine-based immunosuppression during this period.Main Outcome Measure-A brain abscess was determined to be present if there was histological and/or microbiological confirmation of a brain lesion seen by a computed tomographic scan. A brain abscess was considered suspicious if radiographic findings were seen in the clinical setting of neurologic symptoms and fever without histological or microbiological confirmation.Results-A brain abscess developed in a total of 28 patients (0.61%) of the total study population. The frequency of brain abscess according to organ type was as follows: 0.63%, liver; 0.36%, kidney; and 1.17%, heart and heart-lung. The overall mortality was 86%. Complicating factors associated with fungal (Candida and Aspergillus sp) abscess formation included major subsequent operations, retransplantations, antirejection therapy, associated bacteremia or viremia, and multiorgan failure. The lung was the primary site of dissemination in 18 patients. Low-dose prophylactic amphotericin was ineffective in preventing a fungal brain abscess in 10 high-risk patients. Because of the ineffective therapy and the deadly nature of established fungal abscesses, full-dose antifungal therapy and reduced immunosuppression were warranted on identification of a high-risk clinical setting. Nonfungal abscesses (Nocardia and Toxoplasma sp) occurred in healthy graft recipients long after transplantation. The existing medical therapy is usually effective in these patients, provided that rapid tissue diagnosis is established. Conclusion-The epidemiological features of brain abscess formation after solid organ transplantation suggest 2 populations of patients exist that differ in timing, clinical setting, and response to therapy. For the chronically immunosuppressed outpatient, an established abscess should be empirically treated with sulfonamides until tissue diagnosis is confirmed. On the other hand, the acutely immunosuppressed posttransplant recipient, with defined risk factors, should receive full-dose therapy with amphotericin B and concomitantly lowered immunosuppression.

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Section: Fungal Brain Abscessesmentioning

confidence: 99%

Brain Abscess in Solid Organ Transplant Recipients Receiving Cyclosporine-Based Immunosuppression

Selby

Ramirez²,

Singh³

et al. 1997

Arch Surg

125

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“…About 14 cases of intracranial aspergillosis in infants have been reported till recently[891011] among them only 2 had multiple brain abscess. Four of the 14 cases were operated of whom only 3 survived.…”

Section: Discussionmentioning

confidence: 99%

Multiple intracranial fungal abscesses in an immunocompetent infant treated surgically

2014

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Intracerebral abscess are rare in neonates and infants. We present a rare case of 4-month-old immunocompetent infant with multiple intracranial fungal abscess. Right frontoparietal craniotomy was done with excision of multicystic mass containing 200cc of dirty colored fluid. Biopsy and culture of abscess came as Aspergillus fumigates. Patient received parental amphotericin B. An immunocompetent infant with intracranial aspergillosis is rare. We advocate combination of surgical excision with parental amphotericin B as best way to achieve good result.

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Section: Bacterial and Fungal Infectionsmentioning

confidence: 99%

“…35 Children undergoing LTx for cystic fibrosis are at particular risk of developing infection due to aspergillus. 35 A history of recovery of aspergillus prior to transplant should prompt the use of antifungal prophylaxis in liver recipients with cystic fibrosis. Data defining the precise duration of prophylaxis are not available, and prophylactic treatment has ranged from 1 month of intravenous amphotericin to prolonged use of an oral azole agent (ie, voriconazole).…”

Section: Bacterial and Fungal Infectionsmentioning

confidence: 99%

Immunizations and infectious diseases in pediatric liver transplantation

Halasa

Green

2008

Liver Transpl

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Aspergillosis of the CNS in a Pediatric Liver Transplant Recipient: Case Report and Review

Cited by 54 publications

References 43 publications

Brain Abscess in Solid Organ Transplant Recipients Receiving Cyclosporine-Based Immunosuppression

Brain Abscess in Solid Organ Transplant Recipients Receiving Cyclosporine-Based Immunosuppression

Multiple intracranial fungal abscesses in an immunocompetent infant treated surgically

Immunizations and infectious diseases in pediatric liver transplantation

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