Open AccessCerebral Aspergillosis: Literature Review
Author(s) -
Loise Maria de Souza Freijanes,
Elisa Yuki Kurosawa Ueda,
Paola Restum Antonio Lemaitre,
Isabela Pierotti Prado
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.161
Subject(s) - aspergillosis , medicine , voriconazole , etiology , amphotericin b , clinical practice , opportunistic infection , dermatology , meningitis , intensive care medicine , antifungal , pediatrics , pathology , human immunodeficiency virus (hiv) , immunology , family medicine , viral disease
Background: Cerebral Aspergillosis is an opportunistic fungal infection. It reaches by a hematogenous pathway or by paranasal sinuses. Furthermore, the diagnosis is delayed due to the nonspecific clinical signs. Objectives: This study aims to highlight cerebral invasive aspergillosis as a diagnostic hypothesis in a difficult-to-diagnose and nonspecific neurological clinical scenario. Design and setting: This is a literature review from the Escola de Medicina Souza Marques‘s students, Brazil. Methods: The used articles were published between 2016 to 2021, from UpToDate, Journal of Oncology Pharmacy Practice, Elsevier, and Google Academic databases. Results: In immunosuppressed individuals, it manifests as single or multiple brain abscesses with vascular invasion, posing as a life-threatening factor. Immunocompetent patients may respond differently, presenting with meningitis or granulomatous mass, associated with seizures, headache, and visual acuity impairment. MRI or PCR in cerebrospinal fluid is the most used for diagnosis. T2 hypodensity, irregular margins with intracavitary projections on MRI, and absence of the choline peak suggest a fungal etiology. The histopathological study is not common in clinical practice. The recommended treatment is voriconazole in association with echinocandins, for 6 to 12 weeks. Notably, the mortality rate of cerebral aspergillosis in patients who are taking Ibrutinib for other conditions is close to 90%. Conclusion: Therefore it is essential to recognize the complication to avoid morbidity and mortality in immunosuppressed and immunocompetent individuals.