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Role of Voriconazole in the Management of Invasive Central Nervous System Aspergillosis: A Case Series from a Tertiary Care Centre in India

Invasive central nervous system (CNS) aspergillosis is acquired by either hematogenous dissemination or direct spread from a sinus infection. We describe a series of nine patients with CNS aspergillosis from a tertiary care teaching institute in North India who were treated with voriconazole alone o...

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Autores principales: Gupta, Nitin, Kodan, Parul, Mittal, Ankit, Singh, Gagandeep, Netto, George, Ramteke, Prashant, Malla, Sundeep, Kumar, Rohit, Kumar, Tirlangi Praveen, Singh, Komal, Aggarwal, Anivita, Desai, Devashish, Soneja, Manish, Xess, Immaculata, Wig, Naveet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558272/
https://www.ncbi.nlm.nih.gov/pubmed/32824829
http://dx.doi.org/10.3390/jof6030139
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author Gupta, Nitin
Kodan, Parul
Mittal, Ankit
Singh, Gagandeep
Netto, George
Ramteke, Prashant
Malla, Sundeep
Kumar, Rohit
Kumar, Tirlangi Praveen
Singh, Komal
Aggarwal, Anivita
Desai, Devashish
Soneja, Manish
Xess, Immaculata
Wig, Naveet
author_facet Gupta, Nitin
Kodan, Parul
Mittal, Ankit
Singh, Gagandeep
Netto, George
Ramteke, Prashant
Malla, Sundeep
Kumar, Rohit
Kumar, Tirlangi Praveen
Singh, Komal
Aggarwal, Anivita
Desai, Devashish
Soneja, Manish
Xess, Immaculata
Wig, Naveet
author_sort Gupta, Nitin
collection PubMed
description Invasive central nervous system (CNS) aspergillosis is acquired by either hematogenous dissemination or direct spread from a sinus infection. We describe a series of nine patients with CNS aspergillosis from a tertiary care teaching institute in North India who were treated with voriconazole alone or in combination with surgery. All patients who had clinical and radiological features consistent with fungal CNS infection, showed the presence of septate hyphae on histopathology/microscopy and were either culture positive for Aspergillus spp. or had serum galactomannan positivity were diagnosed as CNS aspergillosis. Clinical features, risk factors, diagnostic modalities, treatment details and outcome at last follow-up were recorded for all patients diagnosed with CNS aspergillosis. A total of nine patients were diagnosed with CNS aspergillosis. The median duration of presentation at our hospital was six months (IQR-2-9 months). Six patients had concomitant sinus involvement, while two patients had skull-base involvement as well. All patients were treated with voriconazole therapy, and three of these patients underwent surgery. All but one patient survived at the last follow-up (median duration was 14 months (IQR- 8-21.5). Two patients had complete resolution, and voriconazole was stopped at the last follow-up, and the rest of the patients were continued on voriconazole. Of the six patients who were continued on voriconazole, all but one had more than 50% radiological resolution on follow-up imaging. Invasive CNS aspergillosis is an important cause of CNS fungal infection that is often diagnosed late and requires long-term voriconazole-based therapy.
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spelling pubmed-75582722020-10-22 Role of Voriconazole in the Management of Invasive Central Nervous System Aspergillosis: A Case Series from a Tertiary Care Centre in India Gupta, Nitin Kodan, Parul Mittal, Ankit Singh, Gagandeep Netto, George Ramteke, Prashant Malla, Sundeep Kumar, Rohit Kumar, Tirlangi Praveen Singh, Komal Aggarwal, Anivita Desai, Devashish Soneja, Manish Xess, Immaculata Wig, Naveet J Fungi (Basel) Brief Report Invasive central nervous system (CNS) aspergillosis is acquired by either hematogenous dissemination or direct spread from a sinus infection. We describe a series of nine patients with CNS aspergillosis from a tertiary care teaching institute in North India who were treated with voriconazole alone or in combination with surgery. All patients who had clinical and radiological features consistent with fungal CNS infection, showed the presence of septate hyphae on histopathology/microscopy and were either culture positive for Aspergillus spp. or had serum galactomannan positivity were diagnosed as CNS aspergillosis. Clinical features, risk factors, diagnostic modalities, treatment details and outcome at last follow-up were recorded for all patients diagnosed with CNS aspergillosis. A total of nine patients were diagnosed with CNS aspergillosis. The median duration of presentation at our hospital was six months (IQR-2-9 months). Six patients had concomitant sinus involvement, while two patients had skull-base involvement as well. All patients were treated with voriconazole therapy, and three of these patients underwent surgery. All but one patient survived at the last follow-up (median duration was 14 months (IQR- 8-21.5). Two patients had complete resolution, and voriconazole was stopped at the last follow-up, and the rest of the patients were continued on voriconazole. Of the six patients who were continued on voriconazole, all but one had more than 50% radiological resolution on follow-up imaging. Invasive CNS aspergillosis is an important cause of CNS fungal infection that is often diagnosed late and requires long-term voriconazole-based therapy. MDPI 2020-08-18 /pmc/articles/PMC7558272/ /pubmed/32824829 http://dx.doi.org/10.3390/jof6030139 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Brief Report
Gupta, Nitin
Kodan, Parul
Mittal, Ankit
Singh, Gagandeep
Netto, George
Ramteke, Prashant
Malla, Sundeep
Kumar, Rohit
Kumar, Tirlangi Praveen
Singh, Komal
Aggarwal, Anivita
Desai, Devashish
Soneja, Manish
Xess, Immaculata
Wig, Naveet
Role of Voriconazole in the Management of Invasive Central Nervous System Aspergillosis: A Case Series from a Tertiary Care Centre in India
title Role of Voriconazole in the Management of Invasive Central Nervous System Aspergillosis: A Case Series from a Tertiary Care Centre in India
title_full Role of Voriconazole in the Management of Invasive Central Nervous System Aspergillosis: A Case Series from a Tertiary Care Centre in India
title_fullStr Role of Voriconazole in the Management of Invasive Central Nervous System Aspergillosis: A Case Series from a Tertiary Care Centre in India
title_full_unstemmed Role of Voriconazole in the Management of Invasive Central Nervous System Aspergillosis: A Case Series from a Tertiary Care Centre in India
title_short Role of Voriconazole in the Management of Invasive Central Nervous System Aspergillosis: A Case Series from a Tertiary Care Centre in India
title_sort role of voriconazole in the management of invasive central nervous system aspergillosis: a case series from a tertiary care centre in india
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558272/
https://www.ncbi.nlm.nih.gov/pubmed/32824829
http://dx.doi.org/10.3390/jof6030139
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