1/3. Long-term survival following treatment of multiple supra- and infratentorial aspergillus brain abscesses.aspergillus brain abscess is a rare but frequently fatal disease. Despite the scarcity of reported survivors, a combination of medication and surgical treatment might be effective. We report a 37-year-old man who developed multiple aspergillus brain abscesses after severe bacterial pneumonia. The following strategy was used to treat the patient: diagnostic puncture of one of the abscesses, long-term treatment with medication, excision of chronic granuloma in the occipital lobe and fourth ventricle, surgical treatment of the hydrocephalus. Following various surgical and antifungal treatments, the patient survived. Nearly three years after discharge, he still is in good physical condition and has a moderate neurologic deficit. Only 36 patients have been reported to have survived longer than three months after receiving treatment for brain aspergillosis. A course of medication in combination with various surgical procedures was required to achieve a successful outcome in this otherwise fatal disease.- - - - - - - - - - ranking = 1keywords = survival (Clic here for more details about this article) |
2/3. Case report: successful interdisciplinary treatment of cerebrally disseminated invasive pulmonal aspergillosis in a child with acute myeloid leukemia.invasive pulmonary aspergillosis (IPA) is a life-threatening infection in immunocompromised patients. mortality rates of cerebrally disseminated IPA approach 100%. We report on a case of a 9-year-old girl with acute myeloid leukemia, who acquired cerebrally disseminated IPA during chemotherapy-induced leukopenia. Longtime survival was achieved by left pneumonectomy and neurosurgical resection of the intracerebral lesion combined with systemic application of itraconazole and liposomal amphotericin b. A review of literature revealed 7 other cases of cerebrally disseminated IPA with survival of more than 12 months.- - - - - - - - - - ranking = 0.5keywords = survival (Clic here for more details about this article) |
3/3. Improved survival in central nervous system aspergillosis: a series of immunocompromised children with leukemia undergoing stereotactic resection of aspergillomas. Report of four cases.central nervous system (CNS) aspergillosis remains a daunting diagnosis. This opportunistic mycosis historically carries a mortality rate approaching 100% in immunocompromised patients, with death ensuing within days after the onset of neurological symptoms. From their literature review, the authors concluded that children contracting CNS aspergillosis while undergoing systemic chemotherapy for leukemias represent a particularly unfortunate prognostic group. Antifungal medications prove ineffective for treating CNS aspergillosis in patients immunocompromised because of their chemotherapy regimens. In contrast, withholding chemotherapy to reverse immunosuppression, thereby improving the efficacy of antifungal medications, allows for progression of the primary leukemic disease. The authors present a series of four immunosuppressed patients whose course of treatment for leukemia was complicated by CNS aspergillus sp. abscesses. Multiple cerebral fungal abscesses developed in two patients and a single cerebral abscess developed in two. All four patients underwent frameless stereotactic resection of the aspergilloma. All children later experienced resolution of their CNS infections and full neurological recovery. At 2- to 4-year follow ups, one patient has died of leukemia and the other three continue to thrive without evidence of recurrent aspergillosis. Given the grave natural history cited in the literature for this disease when medical treatment is instituted alone, the authors stress the crucial role of stereotactic neurosurgery for the intelligent treatment of immunocompromised children suspected of harboring a CNS aspergilloma abscesses. The authors propose that the goal for successful treatment in these patients should be gross-total resection of the abscess, its wall, and its capsule.- - - - - - - - - - ranking = 1keywords = survival (Clic here for more details about this article) |