Table 3.
Case Reports of CNS Aspergillosis with Evidence of Meningeal and/or CSF Involvement
| Authors | Summary | Clinical Presentation | Predisposing Conditions | Diagnostic Methodology | Antifungal Therapy * | Outcome | Organism |
|---|---|---|---|---|---|---|---|
| Van de Wygaert et al. (1986) | Case report | Skin abscess, headache, and meningeal signs | Healthy | (−) CSF cx (+) laminectomy bx, morphology of gelatinous leptomeninges (+) immunostaining (+) precipitins in CSF but not blood |
AmphoB 5-FC |
Survival (229 day post-onset follow-up) | A. fumigatus (immunostaining) |
| Breneman and Colford (1992) | Case report | Fever, dyspnea, headache, meningeal signs, progressive mental status changes | History of drug abuse, COPD, steroids | (+) sputum cx (+) brain bx and cx (−) CSF cx (+) CSF pleocytosis (4,100/mm3; 95% PMNs) |
AmphoB | Deceased | A. fumigatus |
| Nenoff et al. (2001) | Case report | Exophthalmos, ptosis, diplopia | Diabetes mellitus | (+) morphology and cx from prior extranasal ethmoidectomy and orbitotomy, direct extension into intracranium (+) CSF Aspergillus latex agglutination assay |
AmphoB Itraconazole 5-FC |
Deceased | A. fumigatus |
| Moling et al. (2002) | Case reports (x2) | Fever, headache, mental status changes Fever, mental status changes, nuchal rigidity |
Chronic alcohol abuse Complement 4 deficiency, glomerulonephritis, renal transplant, steroids |
(+) CSF Aspergillus latex agglutination assay (+) CSF cx with multiple prior (−) CSF cxs (+) CSF PCR (+) CSF sediment cx |
AmphoB Voriconazole Itraconazole Fluconazole L-AmphoB IT- L-AmphoB Itraconazole |
Survival (>1 yr follow-up) Survival (>11 mo follow-up) |
A. candidus A. fumigatus |
| Rodrigo et al. (2007); Gunaratne et al. (2007) | Case reports (x5) | Fever, headache, nuchal rigidity; progression to cranial nerve deficits, cerebral infarction, and hemorrhage | Spinal analgesia for cesarian secion | (−) CSF cx (x4) (+) CSF cx (x1) (+) cx post-mortem brain specimens (x3); (+) spores by cytology (x1) |
AmphoB (IV and/or IT) Voriconazole Fluconazole |
Deceased (x3) Survival (x2) (1 yr follow-up) |
A. fumigatus |
| Larson Kolbe et al. (2007) | Case report | Lower extremity weakness, urinary incontinence, low back pain | Discography and multiple epidural steroid injections | (+) cx disc aspiration and abscess | Caspofungin Voriconazole |
Deceased | A. fumigatus |
| Saitoh et al. (2007) | Case report | Fever, headache, nuchal rigidity | AML with granulocytic sarcoma, chemotherapy | (−) CSF cx (+) CSF galactomannan ELISA (+) CSF PCR |
AmphoB Voriconazole |
Survival (>1 yr follow-up) | Not isolated |
| Kagawa et al. (2008) | Case Report | Low grade fever, headache, hydrocephalus | Healthy | (+) morphology in fibrous tissue from VP shunt (−) CSF cultures |
AmphoB Fluconazole Shunt revisions and reconstruction | Survival (15 yrs post onset; 3 yrs post shunt reconstruction) | Aspergillus species |
*
List of antifungal agents does not imply concurrent therapy. Many patients were also administered prolonged broad spectrum antimicrobial therapy and/or anti-tubercular agents. Please consult the original manuscripts for detailed information regarding individual cases as well as dosing.
ABBREVIATIONS
bx = biopy
cx = culture
mo = month
yr = year
AmphoB = Amphotericin B
5-FC = 5-Fluorocytosine
IT = intrathecal
IV = intravenous
CSF = cerebrospinal fluid
ELISA = enzyme linked immunosorbent assay
PCR = polymerase chain reaction
PMN = polymorphonuclear cell