1
|
Vignals C, Emmerich J, Begueret H, Garcia-Hermoso D, Martin-Blondel G, Angoulvant A, Blez D, Bruneval P, Cassaing S, Catherinot E, Cahen P, Moluçon-Chabrot C, Chevenet C, Delhaes L, Escaut L, Faruch M, Grenouillet F, Larosa F, Limousin L, Longchampt E, Mellot F, Nourrisson C, Bougnoux ME, Lortholary O, Roux A, Rozenblum L, Puges M, Lanternier F, Bronnimann D. Deciphering Unexpected Vascular Locations of Scedosporium spp. and Lomentospora prolificans Fungal Infections, France. Emerg Infect Dis 2024; 30:1077-1087. [PMID: 38781681 PMCID: PMC11138966 DOI: 10.3201/eid3006.231409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Scedosporium spp. and Lomentospora prolificans are emerging non-Aspergillus filamentous fungi. The Scedosporiosis/lomentosporiosis Observational Study we previously conducted reported frequent fungal vascular involvement, including aortitis and peripheral arteritis. For this article, we reviewed 7 cases of Scedosporium spp. and L. prolificans arteritis from the Scedosporiosis/lomentosporiosis Observational Study and 13 cases from published literature. Underlying immunosuppression was reported in 70% (14/20) of case-patients, mainly those who had solid organ transplants (10/14). Osteoarticular localization of infection was observed in 50% (10/20) of cases; infections were frequently (7/10) contiguous with vascular infection sites. Scedosporium spp./Lomentospora prolificans infections were diagnosed in 9 of 20 patients ≈3 months after completing treatment for nonvascular scedosporiosis/lomentosporiosis. Aneurysms were found in 8/11 aortitis and 6/10 peripheral arteritis cases. Invasive fungal disease--related deaths were high (12/18 [67%]). The vascular tropism of Scedosporium spp. and L. prolificans indicates vascular imaging, such as computed tomography angiography, is needed to manage infections, especially for osteoarticular locations.
Collapse
|
2
|
Perillo T, Capasso R, Pinto A. Neuroimaging of the Most Common Meningitis and Encephalitis of Adults: A Narrative Review. Diagnostics (Basel) 2024; 14:1064. [PMID: 38893591 PMCID: PMC11171665 DOI: 10.3390/diagnostics14111064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
Meningitis is the infection of the meninges, which are connective tissue membranes covering the brain, and it most commonly affects the leptomeninges. Clinically, meningitis may present with fever, neck stiffness, altered mental status, headache, vomiting, and neurological deficits. Encephalitis is an infection of the brain, which usually presents with fever, altered mental status, neurological deficits, and seizure. Meningitis and encephalitis are serious conditions which could also coexist, with high morbidity and mortality, thus requiring prompt diagnosis and treatment. Imaging plays an important role in the clinical management of these conditions, especially Magnetic Resonance Imaging. It is indicated to exclude mimics and evaluate the presence of complications. The aim of this review is to depict imaging findings of the most common meningitis and encephalitis.
Collapse
Affiliation(s)
- Teresa Perillo
- Department of Radiology, CTO Hospital, AORN dei Colli, 80141 Naples, Italy; (R.C.); (A.P.)
| | | | | |
Collapse
|
3
|
Hirama R, Kono M, Kobayashi T, Oshima Y, Takeda K, Miyashita K, Miwa H, Tsutsumi A, Miki Y, Hashimoto D, Otsuki Y, Nakamura H. Intra-abdominal Hemorrhage Due to Splenic Vein Aneurysm Rupture Caused by Invasive Aspergillosis during Treatment for Advanced Non-small-cell Lung Cancer. Intern Med 2023; 62:423-429. [PMID: 35732455 PMCID: PMC9970813 DOI: 10.2169/internalmedicine.9714-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 71-year-old man was admitted for left-sided chest pain. He had a history of diabetes, treatment with epidermal growth factor receptor-tyrosine kinase inhibitor for advanced non-small-cell lung cancer, and corticosteroid treatment for underlying lung diseases. Chest computed tomography showed consolidations in the bilateral lower lobes, and Aspergillus fumigatus was detected by bronchoscopy. Invasive pulmonary aspergillosis was suspected, and antifungal therapy with voriconazole was initiated; however, the patient passed away suddenly. Autopsy revealed disseminated Aspergillus infection and intra-abdominal hemorrhage due to the rupture of a splenic vein aneurysm caused by Aspergillus necrotizing vasculitis, which was considered the cause of death.
Collapse
Affiliation(s)
- Ryutaro Hirama
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Masato Kono
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Takeshi Kobayashi
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yuiko Oshima
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Kenichiro Takeda
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Koichi Miyashita
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Hideki Miwa
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Akari Tsutsumi
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yoshihiro Miki
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Dai Hashimoto
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Japan
| | - Hidenori Nakamura
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| |
Collapse
|
4
|
Smirnov FY, Korneva YS, Shenderov SV, Sveklov DA. [Micotic aneurysm of the internal carotid artery in a patient with sarcoidosis as a cause of ischemic stroke and profuse epitaxis]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:90-94. [PMID: 37682101 DOI: 10.17116/jnevro202312308290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The article describes the following case: a 63-year-old patient with sarcoidosis, who was on long-term therapy with metipred, developed profuse epistaxis, and upon admission to the hospital, clinical manifestation of stroke. Computer tomography (CT) of the brain at admission revealed destruction of the posterior wall of the sphenoid bone and an area of increased density in the projection of the left optic nerve regarded as a neoplasm of the sphenoid sinus or inflammatory changes. CT angiography revealed the occlusion of the left internal carotid artery (LICA) from the C1 segment throughout. At the time of thrombus extraction, the patient developed profuse bleeding from the nasal cavity. According to staged angiography, the antegrade blood flow through the LICA to the sphenoid segment was restored; against the background of profuse bleeding, the flow of contrast from the LICA into the sphenoid sinus and further into the nasopharynx is visualized; in the projection of the sphenoid sinus, a formation was revealed that required differentiation between a giant aneurysm, an arteriovenous fistula, and a neoplasm of the sphenoid sinus. Destructive embolization of the LICA at the level of the petrosal segment was performed for vital indications, the bleeding was stopped, but the patient died due to acute posthemorrhagic anemia. An autopsy revealed a mycotic aneurysm of the LICA, the rupture of the wall of which caused nasal bleeding, which was spontaneously stopped due to the formation of an extended thrombus, which, in turn, became the cause of stroke.
Collapse
Affiliation(s)
| | - Yu S Korneva
- City Hospital No. 26, St. Petersburg, Russia
- Mechnikov North-Western State Medical University, St Petersburg, Russia
- Smolensk State Medical University, Smolensk, Russia
| | | | - D A Sveklov
- City Hospital No. 26, St. Petersburg, Russia
| |
Collapse
|
5
|
Koiso T, Komatsu Y, Matsumaru Y, Ishikawa E. Difficulty of diagnosing a mucor-induced aneurysm arising in segment P4 of the posterior cerebral artery – A case report. Surg Neurol Int 2022; 13:111. [PMID: 35509575 PMCID: PMC9062925 DOI: 10.25259/sni_1273_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Identification of causative pathogen for fungal aneurysm is frequently difficult. We reported the case of a fungal aneurysm caused by Mucor arising in segment P4 of the posterior cerebral artery (PCA) detected only by histopathological examination. Case Description: A 50-year-old female complained of nausea and vomiting. Computed tomography showed an intracranial hemorrhage in the left occipital lobe and acute hydrocephalus due to intraventricular hemorrhaging. Digital subtraction angiography performed after external drainage showed a cerebral aneurysm in segment P4 of the left PCA. Surgical excision of the aneurysm and end-to-end anastomosis of the PCA were performed. A histopathological examination revealed that the aneurysm had been caused by a Mucor infection. Conclusion: In fungal aneurysm cases, especially those involving Mucor infections, it is difficult to identify the causative fungal infection based on cultures, imaging, and serological tests. Therefore, surgical excision and histopathological diagnosis are important for diagnosing such cases if possible.
Collapse
Affiliation(s)
- Takao Koiso
- Department of Neurosurgery, Hitachi General Hospital, Hitachi, Ibaraki, Japan,
| | - Yoji Komatsu
- Department of Neurosurgery, Hitachi General Hospital, Hitachi, Ibaraki, Japan,
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| |
Collapse
|
6
|
|
7
|
Meena DS, Kumar D, Bohra GK, Kumar G. Clinical manifestations, diagnosis, and treatment outcome of CNS aspergillosis: A systematic review of 235 cases. Infect Dis Now 2021; 51:654-660. [PMID: 33964485 DOI: 10.1016/j.idnow.2021.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
Aspergillus is a ubiquitous ascomycete that can cause a variety of clinical presentations depending on immune status. Central nervous system aspergillosis is a fatal disease with non-specific clinical features. The aim of this systematic review was to evaluate the epidemiology, clinical features, diagnosis and therapeutic interventions in CNS aspergillosis patients. We also aimed to examine the possible predictors of mortality in neuroaspergillosis. Literature search was performed in Medline, PubMed, and Google scholar and all patients≥18 years with proven CNS aspergillosis were included. A total of 175 articles (235 patients) were included in the final analysis. Their mean age was 51 years and the majority were male (57.4%). Overall case-fatality was 45.1%. Aspergillus fumigatus was the most common species (70.8%) followed by A. flavus (18.6%). Corticosteroids (22.6%), malignancy (19.1%) and diabetes mellitus (14%) were the most common risk factors. Neuroimaging findings included cerebral abscess (70.2%), meningitis (14%), infarction (13.2%) and mycotic aneurysm (8.9%). Disseminated disease (29.2% vs 17.8%, p 0.03), CSF hypoglycorrhachia (48.1% vs 22.2%, P: 0.001) and heightened CSF galactomannan (3.62 vs 2.0ng/ml, p 0.05), were the factors associated with poor outcome in neuroaspergillosis. Persons infected with Aspergillus flavus (13.1% vs 3.1%, P: 0.01), and having been treated with Voriconazole (51.9% vs 29.2%, P: 0.004) were more likely to survive. Our review will provide insight into the different spectrums of CNS aspergillosis. Notwithstanding the promising role of Voriconazole, future work is required to ascertain the role of combination antifungal therapy.
Collapse
Affiliation(s)
- Durga Shankar Meena
- Department of Internal Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, Rajasthan, India.
| | - Deepak Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, Rajasthan, India.
| | - Gopal Krishana Bohra
- Department of Internal Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, Rajasthan, India.
| | - Gaurav Kumar
- Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| |
Collapse
|
8
|
Veiga IB, Hahn K, Wenker C, Wyss F, Mühlethaler K, Posthaus H, Jan Janzen. Pulmonary Artery Aneurysm in a Greater Flamingo (Phoenicopterus roseus) Associated with Aspergillus fumigatus Infection. J Comp Pathol 2021; 184:19-23. [PMID: 33894873 DOI: 10.1016/j.jcpa.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/13/2020] [Accepted: 01/16/2021] [Indexed: 12/01/2022]
Abstract
We report necropsy findings in a captive 60-year-old female greater flamingo (Phoenicopterus roseus) that died suddenly following rupture of a pulmonary artery aneurysm. Histologically, there was focally extensive, intramural granulomatous inflammation with intralesional fungal hyphae, and adjacent severe mixed-cell inflammation and acute haemorrhage at the rupture site. Aspergillus fumigatus was identified as the aetiological agent following DNA PCR amplification and sequencing from paraffin-embedded pulmonary artery tissue sections. The most likely explanation is that this lesion was a consequence of haematogenous spread, secondary to mycotic pneumonia or aerosacculitis, following aspiration of A. fumigatus conidiospores. However, no further fungal-related lesions were observed on gross or histopathological examination.
Collapse
Affiliation(s)
- Inês B Veiga
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
| | - Kerstin Hahn
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | | | - Konrad Mühlethaler
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Horst Posthaus
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | |
Collapse
|
9
|
A Case Report. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
Katano T, Sakamoto Y, Kunugi S, Nishiyama Y, Shimizu A, Kimura K. [A fungus in a thrombus by mechanical thrombectomy in acute cerebral infarction: a case report]. Rinsho Shinkeigaku 2020; 60:340-345. [PMID: 32307396 DOI: 10.5692/clinicalneurol.cn-001400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 88-year-old man suddenly presented with aphasia and right hemiparesis. The diffusion-weighted image of MRI showed ischemic lesions on the left middle cerebral artery area, and MRA showed the left intracranial artery (ICA) occlusion. Therefore, we diagnosed him as having acute ischemic stroke and treated with mechanical thrombectomy (MT). The DWI of MRI showed ischemic lesions on the left middle cerebral artery area, and MRA showed the left ICA occlusion. Therefore, we performed MT and continued best medical treatment, but ICA was reoccluded. Six day later, aspergillus was found in the thrombus from ICA. Then, we considered that ICA occlusion was caused by aspergillus. We experienced a patient specified the cause by thrombus pathology. The pathological diagnosis of the thrombus getting by MT is usefulness for stroke etiology.
Collapse
Affiliation(s)
| | - Yuki Sakamoto
- Department of Neurology, Nippon Medical School Hospital
| | | | | | - Akira Shimizu
- Department of Pathology, Nippon Medical School Hospital
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School Hospital
| |
Collapse
|
11
|
Challa S. Invasive Fungal Infections of the Central Nervous System in Immune-Competent Hosts. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00384-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
12
|
Basilar Occlusion and Rupture Secondary to Rare Fungal Sinusitis. World Neurosurg 2019; 125:217-221. [PMID: 30772526 DOI: 10.1016/j.wneu.2019.01.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intracranial vascular infections of fungal etiology are extremely rare. Most cases occur in immunocompromised patients with invasive fungal disease, most commonly originating in the paranasal sinuses or the lungs. Granulomatous invasive rhinosinusitis, which is extremely rare in North America, has been reported to affect immunocompetent patients in most cases, and its causative strain has potential to invade the intracranial arteries. We present a rare case of basilar artery rupture and infarction secondary to granulomatous invasive rhinosinusitis. CASE DESCRIPTION A 50-year-old man in Florida presented with ischemic symptoms and a 6-month history of headache, dizziness, and falls. After biopsy, the patient developed subarachnoid hemorrhage and thrombosis. Several thrombectomy attempts were performed, resulting in persistent occlusion of the basilar artery and subsequent comatous state. After discussion with the patient's family, compassionate weaning and autopsy were authorized. CONCLUSIONS Invasive fungal rhinosinusitis is more frequent nowadays owing to increased use of immunosuppressive therapies. However, it is still a disease that mostly affects immunocompromised patients. The development of new microbiologic investigation techniques has enabled the discovery of fungal diseases that can also affect immunocompetent hosts, such as granulomatous invasive rhinosinusitis. This is an extremely rare condition in North America, with very few cases documented in the last few decades.
Collapse
|
13
|
Varghese B, Ting K, Lopez-Mattei J, Iliescu C, Kim J, Kim P. Aspergillus endocarditis of the mitral valve with ventricular myocardial invasion, cerebral vasculitis, and intracranial mycotic aneurysm formation in a patient with hemophagocytic lymphohistiocytosis. Med Mycol Case Rep 2018; 21:49-51. [PMID: 29755935 PMCID: PMC5944398 DOI: 10.1016/j.mmcr.2018.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/24/2018] [Accepted: 05/02/2018] [Indexed: 11/20/2022] Open
Abstract
Aspergillus endocarditis is a rare infection and reported mainly in immunocompromised hosts. We report a case of mitral valve aspergillus endocarditis with ventricular myocardial invasion, cerebral vasculitis and intracranial fungal aneurysm formation in a patient with hemophagocytic lymphohistiocytosis (HLH). This case illustrates the importance of prompt investigation and treatment of masses seen on an echocardiogram for rare infections such as Aspergillus endocarditis in immunocompromised patients.
Collapse
Affiliation(s)
- Bibin Varghese
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Kevin Ting
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Juan Lopez-Mattei
- MD Anderson Cancer Center, 1400 Pressler Street, Box 1451, Houston, TX 77030, USA
| | - Cezar Iliescu
- MD Anderson Cancer Center, 1400 Pressler Street, Box 1451, Houston, TX 77030, USA
| | - Joseph Kim
- University of Texas at Austin, 2401 Whitis Ave, Austin, TX 78705, USA
| | - Peter Kim
- MD Anderson Cancer Center, 1400 Pressler Street, Box 1451, Houston, TX 77030, USA
| |
Collapse
|
14
|
|
15
|
Bates DDB, Gallagher K, Yu H, Uyeda J, Murakami AM, Setty BN, Anderson SW, Clement MO. Acute Radiologic Manifestations of America’s Opioid Epidemic. Radiographics 2018; 38:109-123. [DOI: 10.1148/rg.2018170114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David D. B. Bates
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Katherine Gallagher
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - HeiShun Yu
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Jennifer Uyeda
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Akira M. Murakami
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Bindu N. Setty
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Stephan W. Anderson
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Mariza O. Clement
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| |
Collapse
|
16
|
Initial Treatment Strategy for Intracranial Mycotic Aneurysms: 2 Case Reports and Literature Review. World Neurosurg 2017; 106:1051.e9-1051.e16. [DOI: 10.1016/j.wneu.2017.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 11/19/2022]
|
17
|
Baeesa SS, Bakhaidar M, Ahamed NAB, Madani TA. Invasive Orbital Apex Aspergillosis with Mycotic Aneurysm Formation and Subarachnoid Hemorrhage in Immunocompetent Patients. World Neurosurg 2017; 102:42-48. [PMID: 28254599 DOI: 10.1016/j.wneu.2017.02.096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Invasive orbital apex aspergillosis (IOAA) is an aggressive form of aspergillus infection that usually affects immunocompromised patients. It can cause orbital apex syndrome and, if not treated promptly, may progress rapidly causing fatal complications. Subarachnoid hemorrhage (SAH) secondary to ruptured mycotic aneurysms is a very rare complication of invasive aspergillosis. We aim to describe our management and the outcome of six immunocompetent patients with IOAA with subsequent SAH secondary to ruptured mycotic aneurysms. PATIENTS AND METHODS A retrospective review was undertaken of charts of patients treated for orbital involvement with aspergillosis between January 2003 and December 2015 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. We identified all immunocompetent patients with IOAA who developed vascular complications. RESULTS Six immunocompetent patients with IOAA complicated by SAH secondary to ruptured mycotic aneurysms were identified in the study period. Four patients were female, and patients' age ranged between 14 and 53 years (mean, 33.7 ± 13.4 years). All patients presented with progressive retro-orbital headache, visual impairment, and ophthalmoplegia; four had proptosis. Two patients had vasospasm and brain infarction. Antifungal therapy was used in all patients, and 4 underwent emergency craniotomy and clipping of an aneurysm. Five patients died as a consequence of SAH and infarction. CONCLUSIONS IOAA is a serious disease that commonly causes catastrophic and fatal vascular complications.
Collapse
Affiliation(s)
- Saleh S Baeesa
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mohamad Bakhaidar
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Naushad A B Ahamed
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tariq A Madani
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
18
|
Palacios E, Rojas R, Rodulfa J, González-Toledo E. Magnetic resonance imaging in fungal infections of the brain. Top Magn Reson Imaging 2014; 23:199-212. [PMID: 24887690 DOI: 10.1097/rmr.0000000000000025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An invasive fungal infection is a rare disease that can occur in otherwise healthy individuals. Fungi themselves are universal, and they are overall harmless organisms that cause at most a self-limiting disease in the general population. Immunocompromised individuals, whether iatrogenically, genetically, or acquired, present a group who are especially susceptible to a life-threatening disease from a normally innocuous pathogen. Fungi are normally inhaled and are cleared by pulmonary defense mechanisms in immunocompetent hosts. Invasion begins when these mechanisms fail in depressed immunity. Through bypassing of the pulmonary immune system, fungi can spread hematogenously. Fungal infections of the central nervous system are the most common extrapulmonary manifestation after fungal inhalation. Other risk factors of fungemia include prolonged indwelling catheters, maxillofacial infections, uncontrolled diabetes mellitus, systemic antibiotics, implanted neurosurgical devices, and intravenous drug abuse. Thus, other than direct inoculation via surgical complications or open trauma, central nervous system fungal infections are almost never primary.
Collapse
Affiliation(s)
- Enrique Palacios
- From the *Department of Radiology, Section of Neuroradiology, Tulane University School of Medicine, New Orleans, LA; †Department of Radiology, Section of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and ‡Department of Radiology, Section of Neuroradiology, Louisiana State University Medical Center, Shreveport, LA
| | | | | | | |
Collapse
|
19
|
Abstract
The epidemiology of invasive fungal infections in immunocompromised patients is rapidly changing. Several of the fungi have worldwide distribution. However, some have specific geographical distribution. Sinocranial aspergillosis, mostly described from countries with temperate climates, occurs mostly in otherwise immunocompetent individuals Most of the systemic fungal pathogens have been associated with central nervous system (CNS) involvement. The major advances in CNS fungal infections are in the pathobiology, new diagnostic tools, and new therapies. In spite of these developments, there is still considerable delay in the diagnosis of CNS fungal infection. CNS fungal infections are associated with considerable morbidity and mortality. To achieve good outcomes early diagnosis and early institution of appropriate therapies are the key issues.
Collapse
Affiliation(s)
- J M K Murthy
- Continental Institute of Neurosciences & Rehabilitation, Continental Hospitals, IT & Financial District, Gachibowli, Hyderabad, India.
| | - C Sundaram
- Department of Pathology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, India
| |
Collapse
|
20
|
Baeesa SS, Bokhari RF, Alghamdi KB, Alem HB, Al-Maghrabi JA, Madani TA. Invasive aspergillus sinusitis with orbitocranial extension. Asian J Neurosurg 2014; 12:172-179. [PMID: 28484525 PMCID: PMC5409361 DOI: 10.4103/1793-5482.144188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Context: Invasive sinonasal aspergillosis is a silently progressive disease that, left untreated, may invade the adjacent intracranial and intra-orbital compartments incurring serious morbidity. Aim: To evaluate our results of a collaborative surgical management plans for patients with invasive sinonasal aspergillosis with orbitocranial extension. Setting and Design: Retrospective study. Materials and Methods: Between the years 2000 and 2012, 12 patients with Aspergillus sinusitis with orbitocranial extension were treated at our institution. Preoperative CT and MRI scans were done in all cases and cerebral angiography in two patients with subarachnoid hemorrhage (SAH). Surgical combined transcranial and endonasal approaches to the skull base were considered in all patients. Adjuvant antifungals were administered postoperatively with regular clinical and radiologic follow up. Results: All cases had a long history of headache and nasal obstruction (n = 12). Five presented with unilateral proptosis, one with meningitis, one with epilepsy, two with SAH, and one patient presented with trigeminal neuralgia. Craniotomy alone was chosen for the patients with isolated sphenoiditis (n = 2) while a combined cranial and endonasal approach was elected for the other patients (n = 10). Adjuvant antifungal therapy was used for 3-12 months. Patients were followed up clinically and radiologically for an average 36-month period (range = 12-50 months) with disease eradication achieved in eight patients (67%). Two died as consequence to SAH. Follow up also showed that three patients (25%) had sinunasal recurrence requiring evacuation through an endonasal approach. Conclusions: Surgical intervention, with adjuvant antifungal therapy, aiming for safe total removal of the fungal burden, whenever feasible, has a major role in the management of invasive sinonasal aspergillosis with orbitocranial extension with minimal morbidity and good outcomes.
Collapse
Affiliation(s)
- Saleh S Baeesa
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rakan F Bokhari
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid B Alghamdi
- Department of Otorhinolaryngology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hisham B Alem
- Department of Otorhinolaryngology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jaudah A Al-Maghrabi
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tariq A Madani
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
21
|
Antinori S, Corbellino M, Meroni L, Resta F, Sollima S, Tonolini M, Tortorano AM, Milazzo L, Bello L, Furfaro E, Galli M, Viscoli C. Aspergillus meningitis: a rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases. J Infect 2013; 66:218-38. [PMID: 23178421 PMCID: PMC7112586 DOI: 10.1016/j.jinf.2012.11.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/17/2012] [Accepted: 11/05/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the pathogenesis, clinical presentation, cerebrospinal fluid findings and outcome of Aspergillus meningitis, meningoencephalitis and arachnoiditis. METHODS A case of Aspergillus meningitis is described. A comprehensive review of the English-language literature was conducted to identify all reported cases of Aspergillus meningitis described between January 1973 and December 2011. RESULTS Ninety-three cases (including the one described herein) of Aspergillus meningitis were identified. Fifty-two (55.9%) were in individuals without any predisposing factor or known causes of immunosuppression. Acute and chronic meningitis was diagnosed in 65.6% of patients and meningoencephalitis in 24.7% of them with the remaining presenting with spinal arachnoiditis and ventriculitis. Cerebrospinal fluid cultures for Aspergillus spp. were positive in about 31% of cases and the galactomannan antigen test in 87%. Diagnosis during life was achieved in 52 patients (55.9%) with a case fatality rate of 50%. The overall case fatality rate was 72.1%. CONCLUSIONS Aspergillus meningitis may occur in both immunocompetent and immunocompromised patients and run an acute or chronic course. The findings of this systematic review extend the information on this life-threatening infection and could assist physicians in achieving an improved outcome.
Collapse
Affiliation(s)
- Spinello Antinori
- Department of Biomedical and Clinical Sciences Luigi Sacco, Università di Milano, Milano, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
|
23
|
Radwan W, Sawaya R. Intracranial haemorrhage associated with cerebral infections: A review. ACTA ACUST UNITED AC 2011; 43:675-82. [DOI: 10.3109/00365548.2011.581304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
24
|
Fatal mycotic aneurysms due to Scedosporium and Pseudallescheria infection. J Clin Microbiol 2011; 49:2067-71. [PMID: 21430108 DOI: 10.1128/jcm.02615-10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Angioinvasive complications of Scedosporium infections are rare. We report two cases of mycotic aneurysm, following apparent localized infection, due to Scedosporium apiospermum and Pseudallescheria boydii. The thoracoabdominal aorta was affected in one patient, and cerebral vessels were affected in the other. Despite voriconazole therapy and surgical resection, the patients died. Previously reported cases are reviewed.
Collapse
|
25
|
Chakrabarti A, Chatterjee SS, Das A, Shivaprakash MR. Invasive aspergillosis in developing countries. Med Mycol 2010; 49 Suppl 1:S35-47. [PMID: 20718613 DOI: 10.3109/13693786.2010.505206] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To review invasive aspergillosis (IA) in developing countries, we included those countries, which are mentioned in the document of the International Monetary Fund (IMF), called the Emerging and Developing Economies List, 2009. A PubMed/Medline literature search was performed for studies concerning IA reported during 1970 through March 2010 from these countries. IA is an important cause of morbidity and mortality of hospitalized patients of developing countries, though the exact frequency of the disease is not known due to inadequate reporting and facilities to diagnose. Only a handful of centers from India, China, Thailand, Pakistan, Bangladesh, Sri Lanka, Malaysia, Iran, Iraq, Saudi Arabia, Egypt, Sudan, South Africa, Turkey, Hungary, Brazil, Chile, Colombia, and Argentina had reported case series of IA. As sub-optimum hospital care practice, hospital renovation work in the vicinity of immunocompromised patients, overuse or misuse of steroids and broad-spectrum antibiotics, use of contaminated infusion sets/fluid, and increase in intravenous drug abusers have been reported from those countries, it is expected to find a high rate of IA among patients with high risk, though hard data is missing in most situations. Besides classical risk factors for IA, liver failure, chronic obstructive pulmonary disease, diabetes, and tuberculosis are the newly recognized underlying diseases associated with IA. In Asia, Africa and Middle East sino-orbital or cerebral aspergillosis, and Aspergillus endophthalmitis are emerging diseases and Aspergillus flavus is the predominant species isolated from these infections. The high frequency of A. flavus isolation from these patients may be due to higher prevalence of the fungus in the environment. Cerebral aspergillosis cases are largely due to an extension of the lesion from invasive Aspergillus sinusitis. The majority of the centers rely on conventional techniques including direct microscopy, histopathology, and culture to diagnose IA. Galactomannan, β-D glucan test, and DNA detection in IA are available only in a few centers. Mortality of the patients with IA is very high due to delays in diagnosis and therapy. Antifungal use is largely restricted to amphotericin B deoxycholate and itraconazole, though other anti-Aspergillus antifungal agents are available in those countries. Clinicians are aware of good outcome after use of voriconazole/liposomal amphotericin B/caspofungin, but they are forced to use amphotericin B deoxycholate or itraconazole in public-sector hospitals due to economic reasons.
Collapse
Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
| | | | | | | |
Collapse
|
26
|
Lee MY, Whang WJ, Lee WK. Cerebral Basilar Artery Mycotic Aneurysm Associated With Aspergillus Endogenous Endophthalmitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.12.1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mee Yon Lee
- Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Woong Joo Whang
- Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Won Ki Lee
- Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine, Seoul, Korea
| |
Collapse
|