Retrospective analysis of cerebral aspergillosis in mainland China from 2000 to 2019

Abstract

Abstract:

Objective To help early diagnosis and efficacious treatment of central nervous system(CNS) aspergillosis, we reviewed 39 cases in China since 2001. Methods We collected and analyzed retrospectively the information of patients' sex and aged composition, geographical features, clinical manifestations, associated diseases, therapeutic methods and outcomes. Results CNS aspergillosis could involve immunocompromised patients and immunocompetent patients, predominantly in middle aged men. The infection of CNS often resulted from the dissemination of the Aspergillus from lungs and paranasal sinuses. There were no early specific symptoms. The chief complaint was usually the symptoms of increased intracranial pressure, with half fever(51.28%). The combination of antifungal therapy with neurosurgery seems to be the most efficacious approach, and voriconazole was the best one. This disease had a poor prognosis, with high mortality. Conclusions With atypical clinical symptoms, nonspecific laboratory or imaging findings, and difficult diagnosis, CNS aspergillosis was still a disease with high mortality.

Key words: cerebral aspergillosis, CNS infection, voriconazole

CLC Number:

R519.8

XUE Qiang, LEI Yan, ZHANG Chao, LIAO Wan-qing, HOU Li-jun. Retrospective analysis of cerebral aspergillosis in mainland China from 2000 to 2019[J]. Chinese Journal of Mycology, 2019, 14(3): 134-140.

References

[1] 廖万清. 曲霉病研究进展[C].第二届全国深部真菌感染学术论文集.第二届杭州:2007.
[2] Kourkoumpetis TK, Desalermos A, Muhammed M,et al. Central nervous system aspergillosis:a series of 14 cases from a general hospital and review of 123 cases from the literature[J]. Medicine (Baltimore), 2012, 91(6):328-336.
[3] 康伟芳. 慢性肺曲霉菌病55例临床分析[J]. 中国真菌学杂志, 2019, 14(1):28-31.
[4] Turgut M, Ozsunar Y, Oncu S,et al. Invasive fungal granuloma of the brain caused by Aspergillus fumigatus:a case report and review of the literature[J]. Surg Neurol, 2008, 69(2):169-174.
[5] Kumar D, Nepal P, Singh S, et al. CNS aspergilloma mimicking tumors:review of CNS Aspergillus infection imaging characteristics in the immunocompetent population[J]. J Neuroradiol, 2018, 45(3):169-176.
[6] 徐媛,陈敏,廖万清. 中国侵袭性曲霉菌病流行病学现状[J]. 中国真菌学杂志, 2018, 13(1):57-60.
[7] 陈敏, 宋维庚, 王根娣, 等. 颅内及肺部侵袭性曲霉菌病一例[J]. 中国现代神经疾病杂志, 2015, 15(6):498-500.
[8] 周学士, 连江山, 粱赣锋,等. 肺曲霉感染致脑脓肿一例[J]. 中华临床感染病杂志, 2018, 11(2):143-145.
[9] 李燕芬. 1例脑曲霉菌病的中西医结合护理[J]. 内蒙古中医药, 2016, 35(9):156.
[10] 朱凤云,赵华真,王睿莹,等. 免疫功能正常的鼻、眼、脑型播散性曲霉病一例[J]. 中华传染病杂志, 2016, 34(10):619-620.
[11] 沈鸣燕, 钱萍. 1例急性重症胰腺炎合并脑曲霉菌脓肿患者的护理[C]. 浙江省神经外科学学术年会暨浙闽江赣四省神经外科学术交流会. 舟山:2015.
[12] 朱文佳,邸海,谭纪萍,等. 免疫功能正常的青年海绵窦-眶尖曲霉菌感染一例报道并文献复习[J]. 中国神经免疫学和神经病学杂志, 2014, 21(2):85-88.
[13] 吴欣宇,韩玉惠,郑德泉,等. 鞘内注射两性霉素B联合静脉滴注伏立康唑成功救治1例脑曲霉菌病患者[J]. 东南国防医药, 2014, 16(5):479-481.
[14] 宫立众,杜亚楠,路平,等. 确诊中枢神经系统曲霉病1例并文献复习[J]. 临床血液学杂志, 2013,26(2):183-186.
[15] 封秀琴,黄科儿,朱祎容. 侵袭性肺部和中枢神经系统曲霉感染一例[J]. 中华急诊医学杂志, 2012, 21(6):657-659.
[16] 李云芳,李宏军. 艾滋病相关性脑内曲霉菌感染一例[J]. 放射学实践, 2012, 27(9):1038-1039.
[17] 黄欢,张柯基,何双军,等. 中枢神经系统曲霉病1例[J]. 中国感染与化疗杂志, 2011, 11(5):386-388.
[18] 刘毅,方彬,戴富林. 侵袭性肺曲霉菌病合并脑脓肿一例[J]. 医学信息(中旬刊), 2011, 24(2):584-585.
[19] 李庆林,李风景,冯胜利,等. 脑内曲霉菌感染1例报告并文献复习[J]. 中国误诊学杂志, 2010, 10(22):5511-5512.
[20] 朱红梅,贾袆鹏,陈敏,等. 黄曲霉致鼻-眼-耳-脑侵袭性曲霉病的抗真菌治疗[J]. 中国真菌学杂志, 2009, 4(2):90-92.
[21] 李国京,陈永汉,张刚,等曲霉菌性脑炎并发脑疝一例[J]. 中华神经外科杂志, 2009,25(7):646.
[22] 张勇,何东初,林慧,等. 肾移植术后并发曲霉菌脑脓肿1例分析[J]. 中国误诊学杂志, 2009,9(9):2252-2253.
[23] 孟强,张蕾,梅茸,等. 曲霉菌性脑脓肿一例[J]. 中华神经科杂志, 2009, 42(4):286-287.
[24] 白洁,程敬亮. 曲霉菌性脑脓肿一例[J]. 临床放射学杂志, 2008, 27(9):1210-1211.
[25] 黄梅,周剑峰,冉丹,等. Ph阳性急性淋巴细胞白血病合并肺、脑曲霉菌病[J]. 中国实验血液学杂志, 2006,14(3):610-613.
[26] 欧陕兴,柏瑞,林伟光,等. 深部烟曲霉菌感染并多发性脑脓肿1例MRI影像[J]. 中国微侵袭神经外科杂志, 2006, 11(4):184.
[27] 洪海味,欧阳辉. 右额叶曲霉菌性脑脓肿1例报告兼文献复习[J]. 中国科技信息, 2005(16):278.
[28] 李正军,刘振文,马维亚,等. 肝移植后曲霉菌性脑脓肿二例[J]. 中华器官移植杂志, 2005, 26(3):174.
[29] 塔娜. 治疗1例Ph⁺急性淋巴细胞白血病合并肺、脑曲霉菌病的体会[J]. 内科急危重症杂志, 2005, 11(1):43.
[30] 马燕,杜英,李晶. 1例肾病综合征合并脑曲霉菌脓肿的护理[J]. 中国实用护理杂志(下旬版), 2005, 21(20):46-47.
[31] 姜敏,刘秀云,王维. 小儿烟曲霉菌肺炎合并脑脓肿一例[J]. 中华儿科杂志, 2005, 43(8):637-638.
[32] 朱利平,翁心华,金嘉琳,等. 伊曲康唑注射液和口服液序贯治疗脑曲霉病二例[J]. 中华内科杂志, 2005, 44(12):938-939.
[33] 黄庆晖,李少明,邵明,等. SARS合并中枢神经系统曲霉菌感染1例[J]. 疑难病杂志, 2004, 3(2):110-111.
[34] 邓锦清,刘泽,黄纪昌. 慢性乙醇中毒治疗中发生肺脑曲霉菌病例报道[J]. 中华医院感染学杂志, 2004, 14(4):476-477.
[35] 李国忠,董齐,钟震宇,等. 肾病综合症合并脑曲霉菌脓肿一例[J]. 中华神经外科杂志, 2003, 19(6):480.
[36] 吴恒义,顾葆春,王伟民,等. 烟曲霉菌致脑肺多发性脓肿1例报告[J]. 中国微侵袭神经外科杂志, 2003, 8(4):185-186.
[37] 卢青虎, 其布热, 侯小平. 烟曲霉菌引起脑炎一例报告[J]. 浙江临床医学, 2002, 4(4):267.
[38] 钟琴,谢其冰,吴燕. 系统性红斑狼疮合并曲霉菌性脑脓肿1例[J]. 华西医学, 2002, 17(3):417.
[39] 许学杰,陈文燕,李子慧,等. 鼻脑曲霉病1例报告[J]. 四川医学, 2002, 23(9):983.
[40] 周青,周敬安,耿琪,等. 脑曲霉菌性肉芽肿误诊为结核瘤1例报告[J]. 第一军医大学学报, 2002, 22(6):511-511.
[41] 周青,周敬安,王利清,等. 难治性脑曲霉菌性肉芽肿1例[J]. 中国误诊学杂志, 2001, 1(6):956.
[42] 俞志勇,陈虎,江岷,等. 化疗后骨髓抑制期发生鼻脑曲霉菌病——一例报告附文献复习[J]. 中华血液学杂志, 2001(7):29-32.
[43] 索耀华,景猛. 颅脑损伤并发迟发曲霉菌性脑脓肿1例[J]. 中国微侵袭神经外科杂志, 2000, 5(4):241-242.
[44] Cherian T, Giakoustidis A, Yokoyama S, et al. Treatment of refractory cerebral aspergillosis in a liver transplant recipient with voriconazole:case report and review of the literature[J]. Exp Clin Transplant, 2012, 10(5):482-486.
[45] 虞军, 赵学群, 周景义. 颅内烟曲霉菌感染一例报道并文献复习[C]. 2011中华医学会神经外科学学术会议论文汇编. 天津:2011.
[46] Alsultan A, Williams MS, Lubner S, et al. Chronic granulomatous disease presenting with disseminated intracranial aspergillosis[J]. Pediatr Blood Cancer, 2006, 47(1):107-110.
[47] Dotis J, Iosifidis E, Roilides E. Central nervous system aspergillosis in children:a systematic review of reported cases[J]. Int J Infect Dis, 2007, 11(5):381-393.
[48] Schwartz S, Thiel E. Cerebral aspergillosis:tissue penetration is the key[J]. Med Mycol, 2009, 47(Suppl 1):S387-S393.
[49] Nadkarni T, Goel A. Aspergilloma of the brain:an overview[J]. J Postgrad Med, 2005, 51(Suppl 1):S37-S41.
[50] Schwartz S, Thiel E. Update on the treatment of cerebral aspergillosis[J]. Ann Hematol, 2004, 83(Suppl 1):S42-S44.