Department of Biomedical and Clinical Sciences Luigi Sacco, Università di Milano, Milano, Italy.
J Infect. 2013 Mar;66(3):218-38. doi: 10.1016/j.jinf.2012.11.003. Epub 2012 Nov 21.
To describe the pathogenesis, clinical presentation, cerebrospinal fluid findings and outcome of Aspergillus meningitis, meningoencephalitis and arachnoiditis.
A case of Aspergillus meningitis is described. A comprehensive review of the English-language literature was conducted to identify all reported cases of Aspergillus meningitis described between January 1973 and December 2011.
Ninety-three cases (including the one described herein) of Aspergillus meningitis were identified. Fifty-two (55.9%) were in individuals without any predisposing factor or known causes of immunosuppression. Acute and chronic meningitis was diagnosed in 65.6% of patients and meningoencephalitis in 24.7% of them with the remaining presenting with spinal arachnoiditis and ventriculitis. Cerebrospinal fluid cultures for Aspergillus spp. were positive in about 31% of cases and the galactomannan antigen test in 87%. Diagnosis during life was achieved in 52 patients (55.9%) with a case fatality rate of 50%. The overall case fatality rate was 72.1%.
Aspergillus meningitis may occur in both immunocompetent and immunocompromised patients and run an acute or chronic course. The findings of this systematic review extend the information on this life-threatening infection and could assist physicians in achieving an improved outcome.
描述曲霉菌脑膜炎、脑膜脑炎和蛛网膜炎的发病机制、临床表现、脑脊液表现和转归。
描述了一例曲霉菌脑膜炎病例。对英文文献进行了全面回顾，以确定 1973 年 1 月至 2011 年 12 月间报告的所有曲霉菌脑膜炎病例。
共发现 93 例（包括本文描述的一例）曲霉菌脑膜炎病例。52 例（55.9%）患者无任何易感因素或已知免疫抑制原因。65.6%的患者诊断为急性和慢性脑膜炎，24.7%的患者诊断为脑膜脑炎，其余患者表现为脊髓蛛网膜炎和脑室炎。约 31%的病例曲霉菌属的脑脊液培养阳性，87%的病例半乳甘露聚糖抗原检测阳性。52 例（55.9%）患者在生前确诊，病死率为 50%。总病死率为 72.1%。
曲霉菌脑膜炎可发生于免疫功能正常和免疫功能低下的患者，呈急性或慢性病程。本系统评价的结果扩展了关于这种危及生命的感染的信息，可帮助医生改善预后。
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