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[Cerebral aspergillosis in immunocompromised patients]
M P Preckel1, A Mercatello, E Tognet
1Service d'Anesthésie-Réanimation, Hôpital Edouard-Herriot, Lyon.
Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1991
Summary
Central nervous system aspergillosis is a rare but fatal infection in immunocompromised patients. Early diagnosis and prompt antifungal treatment are crucial for survival, though outcomes remain poor.
Area of Science:
- Infectious Diseases
- Neurology
- Radiology
Background:
- Central nervous system (CNS) aspergillosis is a severe opportunistic infection.
- Immunocompromised patients are at high risk for invasive fungal infections.
- Accurate and timely diagnosis is critical for patient management.
Observation:
- Three immunocompromised patients presented with neurological symptoms and normal cerebrospinal fluid (CSF).
- CT scans revealed non-enhancing, poorly defined lesions.
- Pulmonary signs and fever persisted despite antibiotic therapy.
Findings:
- Aspergillus fumigatus was identified in bronchoalveolar lavage fluid.
- Postmortem examination confirmed disseminated aspergillosis affecting multiple organs.
- CT findings differed from typical bacterial ring lesions.
Implications:
- Early empirical antifungal treatment, particularly amphotericin B, is vital for survival in neutropenic patients with unexplained fever and pulmonary signs.
- Differential diagnosis in immunocompromised patients with CNS lesions should include Aspergillus, Nocardia, Cryptococcus, Toxoplasma, and Mycobacterium tuberculosis.
- Multiorgan involvement and CSF analysis aid in diagnosis.