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Cerebral infection complicating systemic aspergillosis in acute leukemia: clinical and radiographic presentation
J A Sparano1, R Gucalp, J F Llena
1Department of Oncology, Albert Einstein Cancer Center, Bronx, New York.
Abstract:
Cerebral fungal infection is becoming an increasingly recognized entity in immunocompromised patients on post-mortem examination. In order to determine the frequency of clinically significant cerebral fungal infection and define its clinical characteristics in a cohort of immunocompromised patients at high risk of fungal infection, the records of 118 patients with acute leukemia were examined for 57 clinical and laboratory features. The characteristics of 26 patients with systemic aspergillosis and acute leukemia were compared to 92 patients with acute leukemia in a control group. Eight of 118 patients (7%) had cerebral infection (seven Aspergillus, on Candida). Patients with systemic aspergillosis were more likely than patients in the control group to have focal neurologic findings (p = 0.02), confusion (p = 0.04), and abnormal computerized tomography (CT) of the brain characterized by single or multiple, enhancing or non-enhancing hypodense lesions (p = 0.02). Patients with systemic aspergillosis were more likely to die in complete remission than patients in the control group (p = 0.003); three of six patients with aspergillosis who died in remission expired as a consequence of cerebral infection. Cerebral infection complicated systemic Aspergillus infection in seven of 26 patients (27%), versus one of 16 patients with systemic Candida infection (6%) (p = NS). The authors conclude, therefore, that systemic aspergillosis complicating acute leukemia is more likely to be associated with confusion, focal neurologic findings, and abnormal CT scan of the brain, and that these findings suggest the presence of cerebral infection. In addition, cerebral infection commonly complicates the course of systemic aspergillosis, and is a significant cause of morbidity and mortality in patients with acute leukemia. A high index of suspicion is needed to insure early diagnosis and appropriate therapy, particularly in those who achieve remission of their leukemia.
Insights
Cerebral fungal infections, particularly Aspergillus, are increasingly seen in acute leukemia patients. These infections often present with neurological symptoms and abnormal brain scans, significantly increasing mortality risk.
Area of Science:
- Medical Mycology
- Neurology
- Hematology
Background:
- Cerebral fungal infections are a growing concern in immunocompromised individuals.
- Post-mortem examinations reveal an increasing incidence of these infections.
Purpose of the Study:
- To determine the frequency of clinically significant cerebral fungal infections in acute leukemia patients.
- To define the clinical characteristics of cerebral fungal infections in this high-risk cohort.
Main Methods:
- Retrospective analysis of 118 acute leukemia patients.
- Examination of 57 clinical and laboratory features.
- Comparison of patients with systemic aspergillosis to a control group.
Main Results:
- Seven percent (8/118) of patients had cerebral fungal infections (7 Aspergillus, 1 Candida).
- Systemic aspergillosis patients showed higher rates of focal neurologic findings, confusion, and abnormal brain CT scans.
- Cerebral infection complicated systemic aspergillosis in 27% of cases and was a cause of death in remission.
Conclusions:
- Systemic aspergillosis in acute leukemia is associated with specific neurological signs and CT findings suggestive of cerebral infection.
- Cerebral fungal infections are a significant cause of morbidity and mortality in acute leukemia patients.
- Early diagnosis and prompt treatment are crucial, especially for patients achieving leukemia remission.