Aspergilloma of the brain: an overview
Fungal infections of the central nervous system (CNS) are almost always a clinical surprise. Their presentation is subtle, often without any diagnostic characteristics, and they are frequently mistaken for tuberculous meningitis, pyogenic abscess, or brain tumor. Granulocytopenia, cellular and humor...
Main Authors: | , |
---|---|
Format: | Article |
Language: | English |
Published: |
Wolters Kluwer Medknow Publications
2005-01-01
|
Series: | Journal of Postgraduate Medicine |
Subjects: | |
Online Access: | http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2005;volume=51;issue=5;spage=37;epage=41;aulast=Nadkarni |
id |
doaj-6d7663d6366741d986ec9bca03b56017 |
---|---|
record_format |
Article |
spelling |
doaj-6d7663d6366741d986ec9bca03b560172020-11-25T01:43:02ZengWolters Kluwer Medknow PublicationsJournal of Postgraduate Medicine0022-38590972-28232005-01-015153741Aspergilloma of the brain: an overviewNadkarni TGoel AFungal infections of the central nervous system (CNS) are almost always a clinical surprise. Their presentation is subtle, often without any diagnostic characteristics, and they are frequently mistaken for tuberculous meningitis, pyogenic abscess, or brain tumor. Granulocytopenia, cellular and humoral mediated immune dysfunction are predisposing factors to the development of CNS infections in immunosuppressed patients. <i> Aspergillus fumigatus</i> is the most common human pathogen in the genus Aspergillus .Maxillary sinusitis of dental origin or the lungs are the most common sites of primary Aspergillus infection. Infection reaches the brain directly from the nasal sinuses via vascular channels or is blood borne from the lungs and gastrointestinal tract. Single or multiple abscess formation with blood vessel invasion leading to thrombosis is a characteristic feature of Aspergillosis on neuropathologic examination. Aspergillosis should be considered in cases manifesting with acute onset of focal neurologic deficits resulting from a suspected vascular or space-occupying lesion especially in immunocompromised hosts. Aspergillosis is diagnosed on direct examinations and culture, however the diagnosis of aspergillosis of the CNS is difficult. Diagnosis of an intracranial mass lesion is best confirmed with a computed tomography or magnetic resonance imaging of the head with or without intravenous contrast. Aggressive neurosurgical intervention for surgical removal of Aspergillus abscesses, granulomas, and focally infracted brain; correction of underlying risk factors; Amphotericin B combined with flucytosine and treatment of the source of infection should form the mainstay of the management. Off late Liposomal Amphotericin B was found to be more effective and safe than conventional Amphotericin B in the management of Apergillus infections Only with a high index of suspicion, an aggressive approach to diagnosis, and rapid vigorous therapy may we hope to alter the clinical course in this group of patients.http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2005;volume=51;issue=5;spage=37;epage=41;aulast=Nadkarni<i>A0 spergillus fumigatus</i>Liposomal Amphotericin BFungal infections |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nadkarni T Goel A |
spellingShingle |
Nadkarni T Goel A Aspergilloma of the brain: an overview Journal of Postgraduate Medicine <i>A0 spergillus fumigatus</i> Liposomal Amphotericin B Fungal infections |
author_facet |
Nadkarni T Goel A |
author_sort |
Nadkarni T |
title |
Aspergilloma of the brain: an overview |
title_short |
Aspergilloma of the brain: an overview |
title_full |
Aspergilloma of the brain: an overview |
title_fullStr |
Aspergilloma of the brain: an overview |
title_full_unstemmed |
Aspergilloma of the brain: an overview |
title_sort |
aspergilloma of the brain: an overview |
publisher |
Wolters Kluwer Medknow Publications |
series |
Journal of Postgraduate Medicine |
issn |
0022-3859 0972-2823 |
publishDate |
2005-01-01 |
description |
Fungal infections of the central nervous system (CNS) are almost always a clinical surprise. Their presentation is subtle, often without any diagnostic characteristics, and they are frequently mistaken for tuberculous meningitis, pyogenic abscess, or brain tumor. Granulocytopenia, cellular and humoral mediated immune dysfunction are predisposing factors to the development of CNS infections in immunosuppressed patients. <i> Aspergillus fumigatus</i> is the most common human pathogen in the genus Aspergillus .Maxillary sinusitis of dental origin or the lungs are the most common sites of primary Aspergillus infection. Infection reaches the brain directly from the nasal sinuses via vascular channels or is blood borne from the lungs and gastrointestinal tract. Single or multiple abscess formation with blood vessel invasion leading to thrombosis is a characteristic feature of Aspergillosis on neuropathologic examination. Aspergillosis should be considered in cases manifesting with acute onset of focal neurologic deficits resulting from a suspected vascular or space-occupying lesion especially in immunocompromised hosts. Aspergillosis is diagnosed on direct examinations and culture, however the diagnosis of aspergillosis of the CNS is difficult. Diagnosis of an intracranial mass lesion is best confirmed with a computed tomography or magnetic resonance imaging of the head with or without intravenous contrast. Aggressive neurosurgical intervention for surgical removal of Aspergillus abscesses, granulomas, and focally infracted brain; correction of underlying risk factors; Amphotericin B combined with flucytosine and treatment of the source of infection should form the mainstay of the management. Off late Liposomal Amphotericin B was found to be more effective and safe than conventional Amphotericin B in the management of Apergillus infections Only with a high index of suspicion, an aggressive approach to diagnosis, and rapid vigorous therapy may we hope to alter the clinical course in this group of patients. |
topic |
<i>A0 spergillus fumigatus</i> Liposomal Amphotericin B Fungal infections |
url |
http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2005;volume=51;issue=5;spage=37;epage=41;aulast=Nadkarni |
work_keys_str_mv |
AT nadkarnit aspergillomaofthebrainanoverview AT goela aspergillomaofthebrainanoverview |
_version_ |
1725033665203798016 |