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

Abstract

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.

Methods for Rapid Diagnosis of Meningitis Etiology in Adults

“…S. pneumoniae, N. meningitidis and Aspergillus spp. are of particular concern in the HSCT population [27,[42][43][44][45].…”

“…In a study by Antinori, et al, only 56% of patients were diagnosed prior to death [13]. CSF fungal culture is only 31% sensitive among all hosts, and 18% in immunocompromised hosts [13,43,44,168,169]. Multiple, large volume CSF cultures may improve sensitivity [13,167].…”