Expect the Unexpected: Invasive Central Nervous System (Cns) Aspergillosis in Non-Neutropenic Patients - a Case Series of 15 Patients from India
International Journal of Infectious Diseases
; 130(Supplement 2):S86, 2023.
Article
in English
| EMBASE | ID: covidwho-2325776
ABSTRACT
Intro Invasive aspergillosis of CNS is a severe form of aspergillosis & is associated with high mortality. Most of these cases are suspected & diagnosed in neutropenic patients. We hereby describe a series of 15 patients with CNS aspergillosis in non-neutropenic patients from a tertiary care hospital in India. Method(s) All patients with clinical & radiological features suggestive of CNS aspergillosis were screened for microbiological evidence of invasive aspergillosis, either by demonstration of hyphae by microscopy or histology, culture or galactomannan assay. Patients demographic details, clinical features, risk factors, diagnosis, management & outcome details were documented. Finding(s) A total of 15 patients were found to have CNS aspergillosis, 5 isolated CNS infections & 10 showing concomitant CNS & pulmonary aspergillosis in one between January 2021 to July 2022. The average age was 41.46+/-14.6y, with majority being male. Among the risk factors, most common ones were fungal sinusitis (46.6%), steroid use (40%), COVID-19 (33.3%). One patient had history of endoscopic sinus repair, another had h/o lung abscess. Most common symptoms of CNS aspergillosis were headache (73.3%), fever (60%), altered sensorium (53.3%) & seizures (47.6%). Radiologically, the common findings included ring enhancing lesion, s/o cerebral abscesses were observed in four patients. Direct microscopy s/o fungal hyphae were reported in 5 patients, with 4 culture positives. Average serum galactomannan was 1, while CSF galactomannan showed better sensitivity with mean CSF galactomannan being 2.53. Almost all patients were treated with Voriconazole based on weight, but showed high mortality of 60% even after initiation of therapy. Complete resolution were seen in only two patients, while 4 patients remaining static in improvement during 6 months follow up. Conclusion(s) Invasive CNS aspergillosis must be suspected even with nonneutropenic patients with newer emerging risk factors like steroid use, COVID-19 & h/o fungal sinusitis presenting with clinical & radiological manifestations.Copyright © 2023
adult; brain abscess; case report; case study; central nervous system; central nervous system aspergillosis; central nervous system infection; cerebrospinal fluid; clinical article; clinical feature; conference abstract; coronavirus disease 2019; demography; drug therapy; fever; follow up; fungal sinusitis; fungus hyphae; headache; histology; histopathology; human; human tissue; India; invasive aspergillosis; lung abscess; lung aspergillosis; male; microscopy; mortality; outcome assessment; risk factor; seizure; sensory system; tertiary care center; galactomannan; steroid; voriconazole
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Cohort study
/
Prognostic study
Language:
English
Journal:
International Journal of Infectious Diseases
Year:
2023
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS