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Nosocomial cerebral aspergillosis: a report of 3 cases
C Darras-Joly1, B Veber, J P Bedos
1Clinique de Réanimation des Maladies Infectieuses, Hôpital Bichat-Claude Bernard, Paris, France.
Abstract:
Cerebral aspergillosis carries a mortality rate close to 100%, especially in immunocompromised patients. We describe 3 patients who contracted cerebral aspergillosis after neurosurgery, 2 of whom survived after exhaustive surgical treatment and medical treatment with high doses of amphotericin B (once liposomal), 5-fluorocytosine and itraconazole. We review the few non-fatal cases of cerebral aspergillosis reported. We consider that surgical excision must be complete and repeated if necessary, always in combination with medical treatment.
Insights
Cerebral aspergillosis is often fatal, but aggressive surgical removal and antifungal medication can improve survival rates. This case series highlights successful treatment strategies for this rare post-neurosurgery complication.
Area of Science:
- Medicine
- Infectious Diseases
- Neurosurgery
Background:
- Cerebral aspergillosis is a severe fungal infection of the brain.
- It has a high mortality rate, particularly in immunocompromised individuals.
- Post-neurosurgical infection presents unique challenges.
Observation:
- Three patients developed cerebral aspergillosis following neurosurgery.
- Two patients survived after extensive surgical intervention and combination antifungal therapy.
- Treatment included liposomal amphotericin B, 5-fluorocytosine, and itraconazole.
Findings:
- Complete surgical excision, potentially requiring repeat procedures, is crucial.
- Aggressive medical management with high-dose antifungals is essential.
- Successful outcomes are possible with combined surgical and medical approaches.
Implications:
- This study suggests that a multidisciplinary approach can improve outcomes for cerebral aspergillosis.
- Early and aggressive intervention is key to managing this devastating infection.
- Further research into optimal treatment protocols for post-neurosurgical fungal infections is warranted.