title: [Clinical and radiological findings in two cases of aspergillosis of the central nervous system in children].
abstract: BACKGROUND
  Aspergillosis is the second fungemia after candidiasis that affects the central nervous system of immunodeppresed and immunocompetent humans. The literature reports nearly always compromised adults.
  
  
  METHODS
  Two pediatric cases of central nervous system aspergillosis with different clinical course are presented. The first of them, is a immunocompetent person in whom a granulomatous disease of the central nervous system was suspected. The cultivation of stereotaxic biopsy reported thin septated hyphae. After 42 days of treatment with itraconazol the patient recovered completely. The second patient, had an acute lymphoblastic leukemia and developed a widespread aspergillosis including the central nervous system. In spite of antifungic treatment for 63 days, he died of heart failure.
  
  
  CONCLUSIONS
  Diagnosis of aspergillosis is difficult because of the poor specificity of the neuroimages, cerebrospinal fluid and complementary labs. The images are indistinguishable from acute ischemia infarcts and later those images change to abscesses. Direct KOH staining and the cultivation of biopsed samples confirmed the diagnosis of aspergillosis. An aggressive treatment with amphotericin B and itraconazol is recommended, but high mortality is suspected. Diagnosis, neuroimaging, clinical evolution and treatment are discussed.
authors.affiliation: Hospital Universitario San Vicente de Paul., Medellín, Antioquia, Colombia. anabot@epm.net.co
authors.forename: L
authors.initials: L
authors.lastname: Blazicevich-Carrillo
authors.forename: L M
authors.initials: LM
authors.lastname: Cabrales- Camacho
authors.forename: J
authors.initials: J
authors.lastname: Carrizosa
authors.forename: W
authors.initials: W
authors.lastname: Cornejo
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000378:metabolism; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002675:Child, Preschool; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D020953:Neuroaspergillosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D011379:Prognosis; D011859:Radiography
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B