Ma Yubao, Li Wanjun, Ao Ran, Lan Xiaoyang, Li Yang, Zhang Jiatang, Yu Shengyuan
Department of Neurology, The First Medical Center of Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian District, Beijing, China.
Medicine (Baltimore). 2020 Oct 30;99(44):e22911. doi: 10.1097/MD.0000000000022911.
The aim of this study was to investigate the clinical characteristics of central nervous system (CNS) aspergillosis in immunocompetent patients.This study enrolled six immunocompetent patients diagnosed with CNS aspergillosis. Additionally, we reviewed the clinical profiles for 28 cases reported in the literature. The age, gender, etiology of Aspergillus infection, clinical manifestations, location of the lesion, treatment, and prognosis were analyzed.There were 19 men (average age, 54.6 ± 14.3 years) and 15 women (average age, 47.0 ± 19.4 years). The clinical manifestations included headache (55.9%; n = 19), visual impairment (32.4%; n = 11), diplopia (32.4%; n = 11), hemiplegia (20.6%; n = 7), fever (17.6%; n = 6), and epilepsy (8.8%; n = 3). According to the radiological features, CNS aspergillosis lesions were divided into two subtypes: parenchymal lesions in the cerebral lobes (n = 11), and meningeal lesions in the meninges (n = 23). The patients with meningeal lesions are easy to be complicated with more serious cerebrovascular diseases, such as subarachnoid hemorrhage and massive infarction. Most of the lesions in brain parenchyma were abscess formation, and magnetic resonance imaging showed ring enhancement. The clinical diagnosis of Aspergillus infection was mainly based on brain biopsy (n = 14), autopsy (n = 8), pathological examination of adjacent brain tissues (n = 7), cerebrospinal fluid (CSF) or tissue culture (n = 3), and second-generation sequencing analysis of the CSF (n = 3). Clinical improvement was achieved in 23 cases, and 11 patients succumbed to the disease. Voriconazole treatment was effective in 24 (70.6%) cases.Immunocompetent subjects are also at risk for Aspergillus infections. Concomitant cerebrovascular diseases are common in patients with CNS aspergillosis, especially in patients with meningeal aspergillosis. Parenchymal aspergillosis lesions are usually localized and manifest as brain abscesses with annular enhancement on magnetic resonance imaging. Biopsy, CSF culture, and next-generation sequencing are mainstream diagnostic modalities. Voriconazole is an effective treatment for Aspergillus infection, and early diagnosis and treatment should be highlighted.
本研究旨在调查免疫功能正常患者中枢神经系统（CNS）曲霉病的临床特征。本研究纳入了6例诊断为CNS曲霉病的免疫功能正常患者。此外，我们回顾了文献报道的28例病例的临床资料。分析了年龄、性别、曲霉感染病因、临床表现、病变部位、治疗及预后情况。
其中男性19例（平均年龄54.6±14.3岁），女性15例（平均年龄47.0±19.4岁）。临床表现包括头痛（55.9%；n=19）、视力障碍（32.4%；n=11）、复视（32.4%；n=11）、偏瘫（20.6%；n=7）、发热（17.6%；n=6）和癫痫（8.8%；n=3）。根据影像学特征，CNS曲霉病病变分为两个亚型：脑叶实质病变（n=11）和脑膜脑膜病变（n=23）。脑膜病变患者易合并更严重的脑血管疾病，如蛛网膜下腔出血和大面积梗死。脑实质内的病变大多为脓肿形成，磁共振成像显示环状强化。曲霉感染的临床诊断主要基于脑活检（n=14）、尸检（n=8）、相邻脑组织病理检查（n=7）、脑脊液（CSF）或组织培养（n=3）以及CSF二代测序分析（n=3）。23例患者临床症状改善，11例患者死亡。伏立康唑治疗24例（70.6%）有效。
免疫功能正常者也有感染曲霉的风险。CNS曲霉病患者常合并脑血管疾病，尤其是脑膜曲霉病患者。实质型曲霉病病变通常局限，磁共振成像表现为脑脓肿伴环状强化。活检、CSF培养和二代测序是主要的诊断方式。伏立康唑是治疗曲霉感染的有效药物，应强调早期诊断和治疗。
