title: Preoperative antifungal therapy may improve survival in patients with Aspergillus brain abscess.
abstract: OBJECTIVE
  The objective of this study was to determine if the preoperative use of antifungal therapy positively influences clinical outcome in patients with Aspergillus brain abscess.
  
  
  METHODS
  We studied 25 patients with confirmed diagnosis of cerebral aspergillosis. We compared baseline characteristics and outcomes of patients treated with either amphotericin B or itraconazole either pre-operatively (n=11) or post-operatively (n=14) at a tertiary care hospital in Karachi.
  
  
  RESULTS
  Twenty-five patients were included in the study. Cerebral aspergillosis was largely a disease of immune competent people (80%). Baseline clinical characteristics between the two treatment groups were comparable i.e., age (P>0.896), gender (P>0.999), coma at presentation (P>0.999), immunosuppression (P>0.623), number of abscesses (P>0.999) and interval between presentation and surgery (P>0.447). Overall mortality was 40%. The overall outcome was significantly better (P<0.001) in patients treated with antifungal therapy before surgery. All 11 patients who received antifungal therapy before surgery survived, but only preoperative itraconazole treatment was statistically associated with an improved survival compared to delayed treatment.
  
  
  CONCLUSIONS
  Cerebral aspergillosis was largely a disease of immune competent people (80%). Overall mortality was 40%. The outcome was significantly better in patients treated with antifungal therapy (especially itraconazole) before surgery suggesting a possible beneficial effect of pre-surgical treatment with antifungal therapy.
authors.affiliation: Department of Neurology, Medicine, Infectious Diseases and Community Health, Aga Khan University, Karachi 74800, Pakistan. mohammad.wasay@aku.edu
authors.forename: Mohammad
authors.initials: M
authors.lastname: Wasay
authors.forename: Junaid
authors.initials: J
authors.lastname: Patel
authors.forename: Iqbal
authors.initials: I
authors.lastname: Azam
authors.forename: Muhammad Aslam
authors.initials: MA
authors.lastname: Khan
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Smego