title: Aspergillus meningitis: a rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases.
abstract: OBJECTIVE
  To describe the pathogenesis, clinical presentation, cerebrospinal fluid findings and outcome of Aspergillus meningitis, meningoencephalitis and arachnoiditis.
  
  
  METHODS
  A case of Aspergillus meningitis is described. A comprehensive review of the English-language literature was conducted to identify all reported cases of Aspergillus meningitis described between January 1973 and December 2011.
  
  
  RESULTS
  Ninety-three cases (including the one described herein) of Aspergillus meningitis were identified. Fifty-two (55.9%) were in individuals without any predisposing factor or known causes of immunosuppression. Acute and chronic meningitis was diagnosed in 65.6% of patients and meningoencephalitis in 24.7% of them with the remaining presenting with spinal arachnoiditis and ventriculitis. Cerebrospinal fluid cultures for Aspergillus spp. were positive in about 31% of cases and the galactomannan antigen test in 87%. Diagnosis during life was achieved in 52 patients (55.9%) with a case fatality rate of 50%. The overall case fatality rate was 72.1%.
  
  
  CONCLUSIONS
  Aspergillus meningitis may occur in both immunocompetent and immunocompromised patients and run an acute or chronic course. The findings of this systematic review extend the information on this life-threatening infection and could assist physicians in achieving an improved outcome.
authors.affiliation: Department of Biomedical and Clinical Sciences Luigi Sacco, Università di Milano, Milano, Italy. spinello.antinori@unimi.it
authors.forename: Spinello
authors.initials: S
authors.lastname: Antinori
authors.forename: Mario
authors.initials: M
authors.lastname: Corbellino
authors.forename: Luca
authors.initials: L
authors.lastname: Meroni
authors.forename: Federico
authors.initials: F
authors.lastname: Resta
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sollima
authors.forename: Massimo
authors.initials: M
authors.lastname: Tonolini
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Tortorano
authors.forename: Laura
authors.initials: L
authors.lastname: Milazzo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bello
authors.forename: Elisa
authors.initials: E
authors.lastname: Furfaro
authors.forename: Massimo
authors.initials: M
authors.lastname: Galli
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
mesh_terms: D000328:Adult; D001228:Aspergillosis / Q000382:microbiology / Q000473:pathology*; D001231:Aspergillus flavus / Q000302:isolation & purification*; D002490:Central Nervous System / Q000382:microbiology / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D016921:Meningitis, Fungal / Q000382:microbiology / Q000473:pathology*