Central nervous system Aspergillus fumigatus infection after near drowning

Kowacs, PA; Almeida, Sérgio Monteiro de; Pinheiro, Rosângela Lameira; Fameli, H.; Piovesan, Élcio Juliato; Correia, Alexandre; Werneck, Lineü Cesar

doi:10.1136/jcp.2003.010066

Cited by 25 publications

(14 citation statements)

References 18 publications

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“…On the other hand, the CNS invasion in the immunocompromised patient may occur in the multiple areas of cerebral infarction, hemorrhage, encephalomalacia, a cerebrovascular accident (CVA), or as a multiple or isolated abscess. [16]…”

Section: Discussionmentioning

confidence: 99%

Aspergillosis of the central nervous system in a previously healthy patient that simulated Creutzfeldt-Jakob disease

et al. 2016

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Background:The presence of Aspergillus in the central nervous system (CNS) is rare in immunocompetent patients but not in immunocompromised patients who may have a more common infection. This article describes a case of an adult immunocompetent patient with a diagnosis of cerebral aspergillosis and with a clinical process of rapidly progressive dementia which simulated a Creutzfeldt–Jakob syndrome.Case Description:A 34-year-old adult was previously healthy and had no medical history of any significance. The patient had suffered only facial trauma 8 months before admission. One month prior to admission, he showed rapidly progressing changes in his behavior and higher mental functions. He was admitted to the emergency room with an occipital headache with 2 months of history. By the time he arrived, he suffered from total disability and was prostrate. He was diagnosed with meningeal and demential syndrome in the process of being studied. After starting the diagnostic approach by investigating cerebrospinal fluid, a magnetic resonance of the skull, an electroencephalogram, a brain biopsy was indicated. The histopathological study reported the presence of the hyphae characteristics of Aspergillus. The patient died 7 days after the diagnosis.Conclusion:Cerebral aspergillosis is a common aggressive disease in immunosuppressed patients. However, the disease is rare in individuals with respected immunity and in individuals with neurological impairment and a rapid and progressive deterioration of mental functions. The suspected diagnosis should always be considered given its poor prognosis and the encouraging efficacy of antifungal treatment administered in a timely manner.

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Section: Discussionmentioning

confidence: 99%

Aspergillosis of the central nervous system in a previously healthy patient that simulated Creutzfeldt-Jakob disease

et al. 2016

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“…2 The lungs and maxillary sinusitis are the most common sites of primary aspergillosis. [3][4][5] Intracranial spread of Aspergillus infection occurs more frequently by haematogenous routes, and less frequently through direct or contiguous spread. [2][3][4] Contiguous spread can always be seen in the PPF, which communicates intracranially via channels.…”

Section: Discussionmentioning

confidence: 99%

“…However, amphotericin B alone showed few encouraging results, especially in refractory fungal infections. 5 Voriconazole has proven to be significantly superior to conventional amphotericin B, and has led to a profound survival improvement in patients with CNS aspergillosis. 2,6 Combination therapies with two antifungal compounds are the common treatment protocol.…”

Section: Discussionmentioning

confidence: 99%

Invasive intracranial aspergillosis spread by the pterygopalatine fossa in an immunocompetent patient

Xiao¹,

Jiang²,

Liu³

et al. 2012

Braz J Infect Dis

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Pterygopalatine fossa Magnetic resonance imaging A B S T R A C T Aspergillosis of the central nervous system (CNS) is an uncommon infection, mainly found inimmunocompromised patients but rarely seen among immunocompetent patients. Herein we describe a 57 year-old immunocompetent man who suffered intracranial aspergillosis spread by the pterygopalatine fossa (PPF) following a tooth extraction. Based on magnetic resonance imaging (MRI) characteristics, in this report we focus on the spreading routes of CNS aspergillosis via communicative structures of the PPF, the relationship between clinical manifestations and the locations of the lesion, and propose a therapeutic strategy to improve the prognosis.© 2012 Elsevier Editora Ltda. All rights reserved. Case presentationA 57-year-old male had suffered from persistent headache for 20 months on the left occipitotemporal side after a tooth extraction, followed by a decrease of his left visual acuity and disordered speech. On neurological examinations, his left eye fixed with light reflex disappeared, the ipsilateral palpebral fissure became narrow in response to his eyelid weakness, and the temporalis and masseter muscles were weak with apparent atrophy. Moreover, his left side hearing declined, his left face felt numb, and his memory deteriorated. On magnetic resonance imaging (MRI) of the head, an enlarged mass with hypo-intense signal on T2WI and T1WI in the left pterygopalatine fossa (PPF) was shown, involving the ipsilateral sphenoid sinus, cavernous sinus, inferior orbital fissure, and temporal and frontal lobes. The left pterygopalatine canal was obviously enlarged with abnormal signal intensity. The contrast enhanced T1WI showed strong enhancement at the aforementioned regions (Fig. 1). In order to confirm the nature of the mass, a transnasal biopsy of the PPF was carried out. The histological result revealed the rare finding of Aspergillus. Antifungal therapy was immediately started with vorionazole and amphotericin B. However, his condition was not satisfactorily under control after a long period of antibiotic therapy. A surgical operation was then arranged, and preoperation examinations were completed. The patient underwent a left pterion craniotomy with resection of skull base occupying lesions. The multiple intradural lesions were excised, and Aspergillus was proved again by intraoperative biopsy. The lesion had a light yellowish color and a hard consistency that was tightly adhered to the nearby tissue, especially to the left middle cerebral artery. After incision, the

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“…However, immersion in polluted waters may lead to infection of the CNS by free living amoeba, such as Acanthamoeba spp and Naegleria spp, 16 and exceptionally by Aspergillus spp. 17 Further diagnostic difficulties are the usual lack of appearance of P boydii in CSF stained smears, the lengthy time taken for the fungal colonies to grow in Sabouraud cultures, and the false negative immune reactions on serum and CSF, probably explained by the high genetic variability of this species. 18 19 Furthermore, false positive CSF latex reactions to cryptococcus capsular antigens may occur, confusing the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Infection of the CNS byScedosporium apiospermumafter near drowning. Report of a fatal case and analysis of its confounding factors

Kowacs

2004

J Clin Pathol

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This report describes a fatal case of central nervous system pseudallescheriasis. A 32 year old white man presented with headache and meningismus 15 days after nearly drowning in a swine sewage reservoir. Computerised tomography and magnetic resonance imaging of the head revealed multiple brain granulomata, which vanished when steroid and broad spectrum antimicrobial and antifungal agents, in addition to dexamethasone, were started. Cerebrospinal fluid analysis disclosed a neutrophilic meningitis. Treatment with antibiotics and amphotericin B, together with fluconazole and later itraconazole, was ineffective. Miconazole was added through an Ommaya reservoir, but was insufficient to halt the infection.Pseudallescheria boydiiwas finally isolated and identified in cerebrospinal fluid cultures, a few days before death, three and a half months after the symptoms began. Diagnosis was delayed because of a reduction in the lesions after partial treatment, which prevented a stereotactic biopsy. Physicians should be aware of this condition, and provide prompt stereotactic biopsy. Confirmed cases should perhaps be treated with voriconazole, probably the most effective, currently available treatment for this agent.

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Central nervous system Aspergillus fumigatus infection after near drowning

Cited by 25 publications

References 18 publications

Aspergillosis of the central nervous system in a previously healthy patient that simulated Creutzfeldt-Jakob disease

Aspergillosis of the central nervous system in a previously healthy patient that simulated Creutzfeldt-Jakob disease

Invasive intracranial aspergillosis spread by the pterygopalatine fossa in an immunocompetent patient

Infection of the CNS byScedosporium apiospermumafter near drowning. Report of a fatal case and analysis of its confounding factors

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