Intracavitary amphotericin B in the treatment of intracranial aspergillosis

Kural, Cahit; Özer, Mehmet İlker; Ezgü, Mehmet Can; Mehtiyev, Royal; Yaşar, Soner; Kutlay, Ahmet Murat; Daneyemez, Mehmet; Öngürü, Önder; Erdoğan, Ersin; İzci, Yusuf

doi:10.1016/j.jocn.2018.02.018

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…This prompted us to start intralesional liposomal amphotericin B administration via an Ommaya reservoir, in conjunction with continued systemic therapy with isavuconazole. A small number of cases have reported intralesional amphotericin B administration for cerebral aspergillosis, administering liposomal amphotericin B at a dose of 1 to 3 mg once weekly [ 5 , 16 , 17 ]. We chose to administer the antifungal twice weekly and at a dose of 5 mg (a scheme that has been proposed by Schauwvlieghe et al but had never been tested in practice) [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Multimodal Therapy with Intracerebral Liposomal Amphotericin B and Systemic High-Dose Isavuconazole in Proven Disseminated Aspergillosis

Feys

Dedeurwaerdere

Lagrou

et al. 2023

JoF

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We report the case of a 32-year-old man receiving chemotherapeutics for an acute B-lymphoblastic leukemia who developed proven cerebral and pulmonary aspergillosis with Aspergillus flavus. Because of progressive fungal disease with neurological deterioration despite adequate systemic antifungal therapy and surgical debridement, intracerebral administration of liposomal amphotericin B was initiated at 5 mg twice weekly. This led to improvement of the cerebral infection. Surgical debridement of a pleural Aspergillus empyema was necessary, and pleural trough level of isavuconazole was found to be subtherapeutic despite adequate blood trough levels, which led us to increase the dose of isavuconazole. We conclude that intralesional amphotericin B might be beneficial at 5 mg twice weekly in cerebral aspergillosis if systemic antifungals and surgical debridement fail. In Aspergillus empyema, measurement of pleural isavuconazole trough levels should be considered.

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Section: Discussionmentioning

confidence: 99%

Successful Multimodal Therapy with Intracerebral Liposomal Amphotericin B and Systemic High-Dose Isavuconazole in Proven Disseminated Aspergillosis

Feys

Dedeurwaerdere

Lagrou

et al. 2023

JoF

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“…4,22,25 Fungal infections, Toxoplasma, Staphylococcus species, Streptococcus species, and Pseudomonas are frequently observed in immunocompromised patients and after organ transplantation, chemotherapy, and steroid usage. 4,20,25 Streptococcus anginosus is a commensal microbe of the mucosae of the oral cavity, gastrointestinal tract, and urogenital tract and is rarely found in brain abscess materials or immunocompetent patients. 12 We identified this etiological agent in an immunocompetent patient with a left frontal intracerebral abscess that was treated successfully with craniotomy and drainage.…”

Section: Discussionmentioning

confidence: 99%

“…This technique was previously reported in the literature with satisfactory clinical results. 20 Surgical options for the treatment of brain infections are well known and defined in the literature. 3,7,10,15,17 Craniotomy is the gold standard for superficial, large, or multiloculated abscess or empyemas while stereotactic methods or endoscopic approaches are preferred for deep-seated or small infections.…”

Section: Discussionmentioning

confidence: 99%

Intracranial infections: lessons learned from 52 surgically treated cases

Kural¹,

Kırmızıgöz²,

Ezgü³

et al. 2019

Neurosurgical Focus

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OBJECTIVEIntracranial infections are serious and life-threatening health problems. They may present as subdural empyemas or intracerebral abscesses. Surgical drainage and subsequent antibiotic treatment is the main technique for a satisfactory clinical outcome. The aims of this study were to present a 10-year intracranial infection series and discuss the surgical characteristics in the light of literature.METHODSFifty-two patients with intracranial infection underwent surgical treatment between 2008 and 2018. Eleven patients were female and 41 patients were male. The mean age was 40.46 years (range 10–75 years). Eighteen patients had intracerebral abscesses, and 34 had subdural empyemas. All patients underwent surgical treatment as well as an antibiotic regimen.RESULTSNo etiological agent was isolated in 29 (56%) cases. Bacterial agents were detected in 20 cases, while fungi were observed in 3 cases. Staphylococci species were the most common agents and were isolated in 8 (15%) cases. Endoscopic aspiration was performed in 3 cases, while surgical drainage and capsule resection via craniotomy was performed in 49 cases. An associated intracranial tumor was diagnosed in 2 patients with brain abscesses. Four (8%) patients died despite surgical and medical treatments.CONCLUSIONSSurgical treatment via craniotomy is an older method, but it is still the best to treat the intracranial infections not only for decompression of the brain but also to attain an accurate diagnosis. The abscess wall should always be histologically examined after surgery to rule out any intracranial tumor.

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“…Fungal infections such as Aspergillus, Candida and Cryptococcus should be treated with amphotericin B. Intracavitary amphotericin B following removal of the central infection material was reported to be effective. 66 Voriconazole can be considered in Pseudallescheria boydii cases. Pyrimethamine and sulfadiazine can be used in Toxoplasma gondii cases, with HAART combination therapy in HIV positive cases.…”

Section: Case Reportmentioning

confidence: 99%

Scalp, epidural, subdural and brain abscesses caused by Streptococcus intermedius secondary to sinusitis: A case report

Cheng¹,

Yeow

Chan

et al. 2020

Indonesian Journal of Neurosurgery

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Introduction: Brain abscess and subdural empyema are the most common surgically treated intracranial infections. Involvement of all layers from scalp, epidural and subdural region in brain abscess has not been reported. The clinical significance of the anatomy of emissary veins, sinuses and brain parenchyma is illustrated. Case presentation: A 25-year-old man with a history of sinusitis presented with headache, confusion, fever and a left frontal scalp swelling. Computed tomography (CT) scan of brain revealed sinusitis and abscesses involving scalp, epidural, subdural regions and brain parenchyma. The patient underwent surgical drainage and antibiotic treatment. No complication occurred and the patient recovered with no neurological deficit. Conclusion: Brain abscess is a potentially fatal complication of sinusitis. The presentation of scalp abscess could be a sign of deep infection. Clinicians should have a high degree of awareness in order to prevent neurological complications. Prompt diagnosis and treatment is emphasized.

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Intracavitary amphotericin B in the treatment of intracranial aspergillosis

Cited by 7 publications

References 16 publications

Successful Multimodal Therapy with Intracerebral Liposomal Amphotericin B and Systemic High-Dose Isavuconazole in Proven Disseminated Aspergillosis

Successful Multimodal Therapy with Intracerebral Liposomal Amphotericin B and Systemic High-Dose Isavuconazole in Proven Disseminated Aspergillosis

Intracranial infections: lessons learned from 52 surgically treated cases

Scalp, epidural, subdural and brain abscesses caused by Streptococcus intermedius secondary to sinusitis: A case report

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