Lu Weina, Ji Ran, Li Wen
1Surgical Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou City, Zhejiang Province, 310000, China.
2Department of Respiratory Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou City, Zhejiang Province, 310000, China.
Acta Microbiol Immunol Hung. 2025 Mar 25;72(1):9-15. doi: 10.1556/030.2025.02528. Print 2025 Mar 27.
Invasive aspergillosis primarily affects individuals with compromised immune systems. This study endeavors to suggest the importance of early diagnosis and treatment related to central nervous system (CNS) aspergillosis. Recognizing the typical and atypical imaging characteristics of CNS aspergillosis enables the early and aggressive treatment of an otherwise rapidly fatal infection. We reported a case of an elderly patient with a history of non-Hodgkin lymphoma and prostate cancer who underwent repeated chemotherapy and subsequently experienced a sudden disturbance of consciousness. The diagnosis was affirmed through metagenomic next-generation sequencing (mNGS) of sputum and cerebrospinal fluid. The treatment encompassed systemic antifungal agents and intrathecal injection of amphotericin B. Metagenomic sequencing of sputum and cerebrospinal fluid detected Aspergillus fumigatus and Aspergillus flavus, leading to a diagnosis of invasive pulmonary and CNS aspergillosis. Although the patient actively received combined systemic antifungal drugs (voriconazole and amphoteric B liposome) and intrathecal injection of amphotericin B, he ultimately succumbed to the infection. A review of similar cases from PubMed and Medline from 2014 to 2024, encompassing 64 patients, showed that while early diagnosis and combination therapy have improved survival rates, outcomes remain suboptimal. Invasive aspergillosis has a high mortality rate and requires early diagnosis and treatment. Metagenomic sequencing of pathogenic microorganisms constitutes a convenient approach to facilitate the early diagnosis of aspergillosis. Voriconazole is the preferred treatment for invasive aspergillosis. When CNS aspergillosis emerges, it might be necessary to combine other systemic antifungal agents with intrathecal injection of amphotericin B.
侵袭性曲霉病主要影响免疫系统受损的个体。本研究旨在表明中枢神经系统（CNS）曲霉病早期诊断和治疗的重要性。认识到CNS曲霉病的典型和非典型影像学特征有助于对这种否则会迅速致命的感染进行早期积极治疗。我们报告了一例老年患者，有非霍奇金淋巴瘤和前列腺癌病史，接受了多次化疗，随后突然出现意识障碍。通过痰液和脑脊液的宏基因组下一代测序（mNGS）确诊。治疗包括全身抗真菌药物和鞘内注射两性霉素B。痰液和脑脊液的宏基因组测序检测到烟曲霉和黄曲霉，从而诊断为侵袭性肺和CNS曲霉病。尽管患者积极接受联合全身抗真菌药物（伏立康唑和两性霉素B脂质体）和鞘内注射两性霉素B治疗，但最终仍死于感染。对2014年至2024年来自PubMed和Medline的64例类似病例的回顾表明，虽然早期诊断和联合治疗提高了生存率，但结果仍不尽人意。侵袭性曲霉病死亡率高，需要早期诊断和治疗。病原微生物的宏基因组测序是促进曲霉病早期诊断的便捷方法。伏立康唑是侵袭性曲霉病的首选治疗药物。当出现CNS曲霉病时，可能需要将其他全身抗真菌药物与鞘内注射两性霉素B联合使用。
