title: Localization of aspergillosis to the central nervous system among patients with acute leukemia: report of 14 cases. Gruppo Italiano Malattie Ematologiche dell'Adulto Infection Program.
abstract: We retrospectively studied a consecutive series of 100 patients with acute leukemia and aspergillosis to evaluate the clinical findings and risk factors for colonization of the central nervous system (CNS) by Aspergillus species. The diagnosis of CNS aspergillosis was made in 14 patients on the basis of the following criteria: neurological signs of CNS involvement (13 of 14 patients); cerebral CT scan findings (9 of 12); microbiological findings (6 of 12); and histological findings at autopsy (11 of 11). The majority of patients had severe neurological complications (i.e., hemiparesis or seizures), due mainly to brain abscesses or mycetomas. Autopsies were performed on 11 of 14 patients and provided evidence that CNS localization was secondary to invasive aspergillosis; in each case, the most likely primary focus of infection was the lung. Although all patients had received oral antimycotic prophylaxis and had received timely empirical antifungal treatment, they all died within a median time of 5 days from the onset of neurological symptoms. Analysis of the characteristics of patients with invasive aspergillosis did not reveal any difference between those with CNS localization and those without CNS localization.
authors.affiliation: Istituto di Semeiotica Medica, Università Cattolica S. Cuore, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pagano
authors.forename: P
authors.initials: P
authors.lastname: Ricci
authors.forename: M
authors.initials: M
authors.lastname: Montillo
authors.forename: A
authors.initials: A
authors.lastname: Cenacchi
authors.forename: A
authors.initials: A
authors.lastname: Nosari
authors.forename: A
authors.initials: A
authors.lastname: Tonso
authors.forename: L
authors.initials: L
authors.lastname: Cudillo
authors.forename: A
authors.initials: A
authors.lastname: Chierichini
authors.forename: C
authors.initials: C
authors.lastname: Savignano
authors.forename: M
authors.initials: M
authors.lastname: Buelli
authors.forename: L
authors.initials: L
authors.lastname: Melillo
authors.forename: E O
authors.initials: EO
authors.lastname: La Barbera
authors.forename: S
authors.initials: S
authors.lastname: Sica
authors.forename: S
authors.initials: S
authors.lastname: Hohaus
authors.forename: A
authors.initials: A
authors.lastname: Bonini
authors.forename: G
authors.initials: G
authors.lastname: Bucaneve
authors.forename: A
authors.initials: A
authors.lastname: Del Favero
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate