title: Cerebral aspergillosis in adult critically ill patients: a descriptive report of 10 patients from the AspICU cohort.
abstract: An unexpectedly high incidence of invasive pulmonary aspergillosis (IPA) has been reported in non-neutropenic intensive care unit (ICU) patients. After the respiratory tract, the brain is most often affected by invasive aspergillosis. However, little is known about brain involvement by Aspergillus in critically ill patients. In this study, demographics, risk profile, diagnosis, treatment and outcome of proven cases of invasive cerebral aspergillosis (ICA) taken from a cohort of 563 adult patients with evidenced Aspergillus involvement during their ICU stay were reviewed. Ten patients with central nervous system aspergillosis were identified. All had one or more host factors predisposing for invasive aspergillosis. The clinical and radiological presentation was non-specific and exclusively pulmonary-related. All but one patient had proven or probable/putative IPA. On cerebral computed tomography, lesions appeared as either solitary and hyperdense or were multiple and randomly distributed throughout the brain. One patient presented with sole meningeal infestation. Aspergillus infection was confirmed by brain biopsy in three subjects. Voriconazole was used as primary treatment in only one-half of the patients. Mortality was 90%. ICA is not frequently observed in adult ICU patients. Diagnosis must be considered in patients at risk presenting with proven or probable/putative IPA in association with suggestive neuroradiological findings. The brain is most likely affected through haematogenous dissemination from the lungs. Current treatment recommendations are not always applied and outcome remains dismal.
authors: Intensive Care Department, University Hospital, Vrije Universiteit, Laarbeeklaan 101, B-1090 Brussels, Belgium. Electronic address: herbert.spapen@uzbrussel.be.
authors: Herbert
authors: H
authors: Spapen
authors: General Internal Medicine, Vrije Universiteit, Brussels, Belgium.
authors: Jerrold
authors: J
authors: Spapen
authors: Intensive Care Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors: Fabio S
authors: FS
authors: Taccone
authors: Medical Intensive Care Unit, University Hospital Leuven, Leuven, Belgium.
authors: Wouter
authors: W
authors: Meersseman
authors: Hospital Universitari Vall d'Hebron, Vall D'Hebron Institute of Research, CIBERES, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Jordi
authors: J
authors: Rello
authors: Department of Critical Care Medicine, Attikon University Hospital, University of Athens Medical School, Athens, Greece.
authors: George
authors: G
authors: Dimopoulos
authors: Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. Dijon, Dijon University Hospital, Dijon, France.
authors: Pierre-Emmanuel
authors: PE
authors: Charles
authors: Department of Microbiology-Infection Prevention and Control, Apollo Hospitals, Hyderabad, India.
authors: Ratna
authors: R
authors: Rao
authors: Hospital Universitari Vall d'Hebron, Vall D'Hebron Institute of Research, CIBERES, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Marcos
authors: M
authors: Pérez
authors: Intensive Care Department, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors: Claude
authors: C
authors: Martin
authors: General Internal Medicine and Infectious Diseases, Ghent University, Ghent, Belgium.
authors: Dirk
authors: D
authors: Vogelaers
authors: Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.
authors: Stijn I
authors: SI
authors: Blot
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000302:isolation & purification*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D011743:Pyrimidines / Q000627:therapeutic use; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole
keywords: Aspergillus; Cerebral aspergillosis; Diagnosis; Intensive care unit; Invasive pulmonary aspergillosis; Treatment