title: Poor efficacy of amphotericin B-based therapy in CNS aspergillosis.
abstract: 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.
authors.affiliation: Medizinische Klinik III, Charité Campus Benjamin Franklin, Freie Universität, Berlin, Germany. stefan.schwartz@charite.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwartz
authors.forename: Markus
authors.initials: M
authors.lastname: Ruhnke
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Reed
authors.forename: Peter
authors.initials: P
authors.lastname: Troke
authors.forename: Eckhard
authors.initials: E
authors.lastname: Thiel
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D005437:Flucytosine