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Early diagnosis of cerebral aspergillosis with various methods: a case report
Hafize Sav1, Mustafa Altay Atalay, Gonca Demir
1Department of Clinical Microbiology, Faculty of Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Insights
Early diagnosis of cerebral aspergillosis (CA) in pediatric acute lymphoblastic leukemia (ALL) patients is crucial. This case highlights the importance of combining serological and molecular methods for timely and life-saving detection of invasive fungal infections.
Area of Science:
- Mycology
- Pediatric Oncology
- Infectious Diseases
Background:
- Cerebral aspergillosis (CA) presents diagnostic challenges and high mortality, even with treatment.
- Early and accurate diagnosis is critical for improving patient outcomes in CA.
- Pediatric patients with acute lymphoblastic leukemia (ALL) are particularly vulnerable to invasive fungal infections.
Observation:
- A pediatric ALL patient developed neutropenia and focal seizures during chemotherapy.
- Brain MRI revealed nodular lesions consistent with brain abscess.
- Fungal elements were identified in brain tissue, with positive Aspergillus fumigatus culture.
Findings:
- Serum galactomannan (GM) and (1,3)-beta-D-glucan (BG) levels showed dynamic changes.
- Serum real-time polymerase chain reaction (RtPCR) was negative, but tissue RtPCR was positive.
- Treatment with amphotericin B and voriconazole led to symptom resolution and normalization of biomarkers.
Implications:
- This case underscores the utility of integrated serological and molecular diagnostics for early CA detection.
- Prompt diagnosis and treatment can significantly improve survival rates in immunocompromised pediatric patients.
- Utilizing a combination of diagnostic methods (GM, BG, RtPCR) aids in confirming invasive fungal infections.
Abstract:
The clinical and laboratory diagnosis of cerebral aspergillosis (CA) is problematic and mortality is quite high, even in cases receiving appropriate treatment. Therefore, an early and accurate diagnosis may prove to be life saving in patients with the diagnosis of CA. In this report, a case of CA which developed in a pediatric patient with acute lymphoblastic leukemia (ALL) is presented. Upon development of neutropenia and focal seizures in the left arm during implementation of the ALL treatment protocol, brain MRI was performed in the patient and nodular lesions compliant with brain abscess were detected in the frontal lobe, left cerebellum and the cingulate gyrus on the superior aspect of the left corpus callosum. Direct assessment of brain tissue revealed fungal elements, while consecutive serum galactomannan (GM) values were determined as 3.39 ng/ml and 0.72 ng/ml, and the consecutive serum (1x3)-beta-D-glucan (BG) values were 93 pg/ml and 356 pg/ml. Negative serum real-time polymerase chain reaction (RtPCR) and positive tissue RtPCR were determined, with growth of Aspergillus fumigatus in the culture. Treatment was initiated with amphotericin B and voriconazole; upon disappearance of symptoms and negative control serum BG and GM values, the patient was discharged with recommendations. In conclusion, this case is presented with the objective of indicating the significance of serological and molecular methods used in the early diagnosis of patients with CA.
