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Poor efficacy of amphotericin B-based therapy in CNS aspergillosis

Stefan Schwartz1, Markus Ruhnke, Patricia Ribaud

  • 1Medizinische Klinik III, Charité Campus Benjamin Franklin, Freie Universität, Berlin, Germany. stefan.schwartz@charite.de

Mycoses
|May 3, 2007
PubMed

Insights

Amphotericin B and itraconazole treatment for central nervous system (CNS) aspergillosis showed 100% mortality. This combination therapy for fungal CNS infections has negligible efficacy, highlighting the need for alternative treatments.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Neurosurgery

Background:

  • Central nervous system (CNS) aspergillosis is a rare but severe fungal infection.
  • Previous reports suggested improved outcomes with voriconazole and neurosurgery.
  • Limited data exists on the efficacy of other antifungal agents in CNS aspergillosis.

Purpose of the Study:

  • To retrospectively assess the outcome of patients with CNS aspergillosis treated with amphotericin B, alone or in combination with other antifungals.
  • To evaluate the efficacy of amphotericin B-based regimens in treating CNS aspergillosis.

Main Methods:

  • Retrospective analysis of 17 patients with definite or probable CNS aspergillosis.
  • Treatment regimens included amphotericin B alone, or in combination with 5-fluorocytosine or itraconazole.
  • Four patients underwent neurosurgery.

Main Results:

  • A 100% mortality rate was observed in the studied patient cohort.
  • The median survival time was only 10 days after the onset of symptoms or radiological evidence.
  • Treatment with amphotericin B and itraconazole demonstrated negligible efficacy.

Conclusions:

  • Amphotericin B, particularly in combination with itraconazole, is ineffective for treating CNS aspergillosis.
  • The high mortality rate underscores the critical nature of CNS aspergillosis and the urgent need for more effective therapeutic strategies.

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