Why do we urgently need a new treatment for cerebral aspergillosis?

Area of Science:

• Neurology
• Infectious Diseases
• Mycology

Background:

• Cerebral aspergillosis has high mortality due to delayed diagnosis and suboptimal management.
• Challenges include poor disease recognition, slow diagnostics, and limited antifungal drug penetration.
• Lack of standardized molecular diagnosis and effective surgical strategies exacerbate the problem.

Purpose of the Study:

• To highlight novel diagnostic modalities for early detection of cerebral aspergillosis.
• To emphasize optimal management strategies to improve patient outcomes.
• To review current and emerging therapeutic options for this invasive fungal infection.

Main Methods:

• Literature search of PubMed and Embase databases (2015-2025) using keywords: 'cerebral aspergillosis,' 'diagnosis ca,' 'management ca,' 'treatment ca.'
• Review of references from retrieved articles.
• Synthesis of expert opinion on diagnostic and management advancements.

Main Results:

• Early diagnosis can be achieved through clinical suspicion, neuroimaging, stereotactic biopsy, and galactomannan testing.
• Advanced techniques like whole genome sequencing and cell-free nucleic acid detection show promise.
• Surgical debridement and optimized azole therapy (voriconazole, posaconazole, isavuconazole) with therapeutic drug monitoring are recommended.

Conclusions:

• Implementing new diagnostic tools and management strategies is essential for improving outcomes in cerebral aspergillosis.
• Emerging agents like olorofim and fosmanogepix warrant further investigation.
• Multidisciplinary approaches combining early diagnosis, surgical intervention, and targeted antifungal therapy are key.