Aspergillosis of central nervous system in patients with leukemia and stem cell transplantation: a systematic review of case reports

Annals of Clinical Microbiology and Antimicrobials

Alireza Moradabadi¹  Mojtaba Didehdar²  Aref Shariati³  Zahra Chegini³  Vahid Falahati⁴  Mohammad Ghorbani⁵  Shahin Rajaeih⁶ 

[1] Department of Medical Laboratory Sciences, Khomein University of Medical Sciences;Department of Medical Parasitology and Mycology, Arak University of Medical Sciences;Department of Microbiology, School of Medicine, Iran University of Medical Sciences;Department of Pediatrics, School of Medicine, Amirkabir Hospital, Arak University of Medical Sciences;Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital;ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, Firoozgar Hospital, Iran University of Medical Sciences;

关键词: Central nervous system aspergillosis;    Leukemia;    Stem cell transplantation;    Fungal infections;    Voriconazole;   

DOI  :  10.1186/s12941-021-00452-9

来源: DOAJ

【 摘 要 】

Abstract Background Aspergillosis of Central Nervous System (CNS) is a highly lethal infection in patients with leukemia and Stem Cell Transplantation (SCT). Methods Case reports of CNS aspergillosis in patients with leukemia and SCT published between 1990 and August 2020 were gathered using a structured search through PubMed/Medline. Results Sixty-seven cases were identified over the searches of the PubMed bibliographic database and then, 59 cases were included in the final analysis. Europe had the largest share of cases at 57.6% (34 reports), followed by Americas and Asia. Affected patients were predominantly males (58.6%) and the mean age of the patients was 36.1 years, while 62.7% of the patients were under the age of 50 years. The most common leukemia types include Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), and Acute Myeloid Leukemia (AML) at 43.4%, 27.4%, and 23.5%, respectively. Furthermore, stem cell transplantation was reported in 11 cases. The overall mortality was 33%; however, the attributable mortality rate of CNS aspergillosis was 24.5%. Altered mental status, hemiparesis, cranial nerve palsies, and seizures were the clearest manifestations of infection and lung involvement reported in 57% of the patients. Histopathologic examination led to the diagnosis of infection in 57% of the patients followed by culture (23.7%), galactomannan assay (8.5%), and molecular method (3.3%). Amphotericin B and voriconazole were the most frequently used drugs for infection treatment. Good results were not obtained in one-third of the patients treated by voriconazole. Finally, neurosurgical intervention was used for 23 patients (39%). Conclusion CNS aspergillosis is a rapidly progressive infection in leukemic patients. Thus, these patients should be followed up more carefully. Furthermore, management of induction chemotherapy, use of different diagnostic methods, and use of appropriate antifungal can lead to infection control.

【 授权许可】

Unknown