Treatment of Refractory Cerebral Aspergillosis in a Liver Transplant Recipient With Voriconazole: Case Report and Review of the Literature

Cherian, Thomas; Giakoustidis, Alexandros; Yokoyama, Shinji; Heneghan, Michael A.; O’Grady, John; Rela, Mohamed; Wendon, Julia; Heaton, Daniel; Verma, Anita

doi:10.6002/ect.2012.0028

Cited by 9 publications

(7 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, the outcome was not reported for 141 cases, whereas in 174 cases, more than 50% of the characteristics required for the analysis were lacking. Therefore, 116 individual cases in all were analyzed …”

Section: Resultsmentioning

confidence: 99%

Invasive aspergillosis in liver transplant recipients: Epidemiology, clinical characteristics, treatment, and outcomes in 116 cases

et al. 2015

View full text Add to dashboard Cite

Invasive aspergillosis (IA) in liver transplant recipients is associated with grave outcomes. We reviewed 116 individual cases reported in the literature from 1985 to 2013. IA was diagnosed after a median of 25 days after transplantation and involved a single organ in 51% of the cases, whereas in the remaining cases, multiple sites were involved. The most common infecting Aspergillus species were Aspergillus fumigatus (73%), Aspergillus flavus (14%), and Aspergillus terreus (8%). Amphotericin B was the drug most frequently used, and it was followed by voriconazole and itraconazole. Combination regimens were used in 51% of the cases. The overall 1-year cumulative survival probability was 35% [95% confidence interval (CI) 5 24.6%-49.6%]. Survival was significantly higher for patients reported from the year 2000 and thereafter (P < 0.001), for those diagnosed with IA more than 30 days after transplantation versus those diagnosed earlier (P 5 0.019), and for patients without renal failure (P 5 0.020). Additionally, the use of voriconazole was significantly associated with a higher probability of survival (P < 0.001). Cox regression analysis showed that subjects with the involvement of multiple sites had a 2.52 times higher risk of a negative outcome (95% CI 5 1.08-5.87) than those with the involvement of a single site. Thus, IA causes life-threatening infections in liver transplant recipients. Predictors associated with poor outcomes may help clinicians to optimize the management of this infection.

show abstract

Section: Resultsmentioning

confidence: 99%

Invasive aspergillosis in liver transplant recipients: Epidemiology, clinical characteristics, treatment, and outcomes in 116 cases

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Upon performing a PubMed-based literature review dating from 2005 to present, we identified19 previously reported cases of CNS IA in patients with liver disease of any kind (Table 1). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Most patients were male with a median age of 38 (range 12 to 68). Four of the 19 patients never received a transplant, and had severe liver with CSF PCR, while in two cases, diagnosis was inferred from cultures from other sites.…”

Section: Liter Ature Re Vie Wmentioning

confidence: 99%

Diagnosis of central nervous system invasive aspergillosis in a liver transplant recipient using microbial cell‐free next generation DNA sequencing

Shishido

Vostal

Mayer

et al. 2021

Transplant Infectious Dis

View full text Add to dashboard Cite

Invasive aspergillosis (IA) is in an important opportunistic infection affecting transplant patients. 1,2 While all solid organ transplant recipients are at risk for invasive aspergillosis, liver transplant patients appear to be at particularly high risk for disseminated disease and have poor outcomes, with mortality ranging from 64% to 100%. 1,3 For liver transplant recipients, time to onset of IA after transplant is decreased when compared to other organ transplant recipients. 1,3,4 Additionally, liver disease itself, in the absence of a transplant, portends an increased risk for IA. [1][2][3]5,6 Typically, IA is caused by Aspergillus fumigatus and the most frequent manifestation of infection is invasive pulmonary disease. 1 However, disseminated aspergillosis including, intraabdominal, intravascular and neurological involvement is not uncommon. [1][2][3][4]6 While pulmonary IA can be relatively simple to diagnose with use of respiratory samples, serum antigens and imaging, central nervous system (CNS) IA can pose diagnostic challenges which are associated with delayed diagnosis and poor outcomes. 1,3,[5][6][7] Microbial cell-free DNA sequencing (mcfDNA) is a diagnostic modality that has recently shown value as an adjunctive test for the diagnosis of fungal pneumonia in stem-cell transplant patients. 8 When compared to standard diagnostic methods, use of mcfDNA had a 51% sensitivity and 100% specificity. Herein, we present a case demonstrating the utility of this novel diagnostic technique in the diagnosis of fungal brain abscesses in a patient who had recently undergone liver transplantation.

show abstract

“…On the other hand, high concentrations of liposomal Amphotericin B have been measured in post-mortem brain tissue analyses despite low liquor concentrations [ 23 ]. Other cases reported successful treatment with voriconazole in immunocompromised patients [ 24 , 25 ]. Voriconazole effectively penetrates the blood-brain barrier.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL)

Turki

Rashidi-Alavijeh

Dürig³

et al. 2017

BMC Infect Dis

View full text Add to dashboard Cite

BackgroundInvasive aspergillosis involving patients with neutropenia or severe immunosuppression, such as patients with hematologic malignancies is associated with high mortality. Patients with T-cell large granular lymphocytic leukemia (T-LGL) on the other hand are considered to be less vulnerable for severe opportunistic fungal infection as their course of disease is chronic and marked by less violent cytopenia then in e.g. Aplastic Anemia. Only neutropenia is regarded as independent risk factor for severe opportunistic infection in T-LGL patients.Case presentationWe report a case of a 53 year old patient with T-LGL, Immune-Thrombocytopenia (ITP) and combined antibody deficiency, who presented with fever and reduced general condition. The patient revealed a complicated infection involving the lungs and later the brain, with the presentation of vomiting and seizures. Broad microbiological testing of blood-, lung- and cerebrospinal fluid samples was inconclusive. In the absence of mycological proof, Aspergillus infection was confirmed by pathological examination of a brain specimen and finally successfully treated with liposomal amphotericin B and voriconazole, adopting a long-term treatment scheme.ConclusionsBeyond typical problems in the clinical practice involving fungal infections and hematologic malignancies, this case of invasive aspergillosis in a patient with T-LGL illustrates caveats in diagnosis, therapy and follow-up. Our data support careful ambulatory monitoring for patients with T-LGL, even in the absence of neutropenia. Especially those patients with combined hematologic malignancies and immune defects are at risk. Long-term treatment adhesion for 12 months with sufficient drug levels was necessary for sustained clearance from infection.

show abstract

Treatment of Refractory Cerebral Aspergillosis in a Liver Transplant Recipient With Voriconazole: Case Report and Review of the Literature

Cited by 9 publications

References 39 publications

Invasive aspergillosis in liver transplant recipients: Epidemiology, clinical characteristics, treatment, and outcomes in 116 cases

Invasive aspergillosis in liver transplant recipients: Epidemiology, clinical characteristics, treatment, and outcomes in 116 cases

Diagnosis of central nervous system invasive aspergillosis in a liver transplant recipient using microbial cell‐free next generation DNA sequencing

Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL)

Contact Info

Product

Resources

About