Poor efficacy of amphotericin B-based therapy in CNS aspergillosis.
Recently, improved response and survival rates in patients treated with voriconazole and neurosurgery for central nervous system (CNS) aspergillosis have been reported. We assessed retrospectively the outcome in 17 patients with definite or probable CNS aspergillosis treated with amphotericin B alone (n = 15) or in combination with 5-fluorocytosine (n = 3) or itraconazole (n = 2). Four patients underwent neurosurgery. The mortality rate was 100% with a median survival of only 10 days (range: 3-60) after onset of first symptoms or first radiological evidence of CNS aspergillosis. In conclusion, treatment with amphotericin B and itraconazole has negligible efficacy in CNS aspergillosis.
Schwartz
Stefan
S
Medizinische Klinik III, Charité Campus Benjamin Franklin, Freie Universität, Berlin, Germany. stefan.schwartz@charite.de
Ruhnke
Markus
M
Ribaud
Patricia
P
Reed
Elizabeth
E
Troke
Peter
P
Thiel
Eckhard
E
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D001231:Aspergillus flavus / Q000302:isolation & purification; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D020314:Central Nervous System Fungal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D016896:Treatment Outcome
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D005437:Flucytosine