CNS aspergillosis in organ transplantation: a clinicopathological study.

Abstract

The clinical characteristics and neuropathological findings of 22 organ transplant recipients with CNS aspergillosis were reviewed. Thirteen patients had liver, six kidney, two heart and one had cluster transplants. The most frequent neurological symptoms were alteration of mental status (86%), seizures (41%) and focal neurological deficits (32%). Meningeal signs were less common (19%). Aspergillus spp invasion of the blood vessels with subsequent ischaemic or haemorrhagic infarcts, and solitary or multiple abscesses were the predominant neuropathological findings. The lungs were the probable portal of entry; however, isolated CNS aspergillosis was seen in two patients. Antemortem diagnosis of the infection was made in half of the patients. Concomitant diabetes mellitus was noted in 590/o of the patients and bacterial or other severe infections in 86%. No specific clinical or pathological pattern could be identified among patients with different types of organ transplants. In addition CNS aspergillosis was preceded by organ rejection and the need for intense immunosuppression and retransplantation in the majority of the patients.

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

“…Meningitis as the predominant clinicopathological process has been reported in only a few cases 9,12,15,17 . In autopsy series the meninges were focally involved in areas adjacent to local infection in cerebral hemispheres 19 .…”

“…Positive CSF cultures to Aspergillus are rare 5,7,20 . Aspergillus rarely invades the meninges, and the lack of diffuse meningeal involvement might be the reason of relative paucity of CSF findings 19 .…”

Rare Case of Meningoencephalitis Due to Aspergillus and Acanthamoeba Coinfection

“…12 Aspergillus rarely invades the meninges, and the absence of diffuse meningeal involvement might be the reason for relative paucity of CSF findings. 13 Diagnosis of CNS aspergillosis is challenging. Positive CSF culture gives a direct diagnosis; however, they are generally negative.…”

Neonatal brain infections

“…Invasive systemic aspergillosis is rare with only 35 neonatal cases published [42]. However, the brain is a common site of infection via haematogenous dissemination from an extra cranial focus, commonly the lung [46]. Brain aspergillosis in immunocompromised patients has poor prognosis with a mortality rate approaching 85-100%, and death usually within 1 week of onset of neurological symptoms [47].…”