title: Successful treatment of Aspergillus ventriculitis through voriconazole adaptive pharmacotherapy, immunomodulation, and therapeutic monitoring of cerebrospinal fluid (1→3)-β-D-glucan.
abstract: Aspergillus ventriculitis is an uncommon but often fatal form of invasive aspergillosis of the central nervous system (CNS). As little is known about the diagnosis, treatment, and outcome of this potentially lethal infection, we report the strategies used to successfully treat Aspergillus ventriculitis complicating a pineal and pituitary germinoma with emphasis on the critical role of adaptive pharmacotherapy of voriconazole and serial monitoring of (1→3)-β-D-glucan in cerebrospinal fluid. We describe several rationally based therapeutic modalities, including adaptive pharmacotherapy, combination therapy, sargramostim-based immunomodulation, and biomarker-based therapeutic monitoring of the CNS compartment. Through these strategies, our patient remains in remission from both his germinoma and Aspergillus ventriculitis making him one of the few survivors of Aspergillus ventriculitis.
authors.affiliation: Pediatric Infectious Diseases, Department of Pediatrics, Miller Children's and Women's Hospital, Long Beach, CA, USA.|University of California, Irvine, Irvine, CA, USA.
authors.forename: Tempe K
authors.initials: TK
authors.lastname: Chen
authors.affiliation: Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Paula K
authors.initials: PK
authors.lastname: Groncy
authors.affiliation: Neurosurgery, Long Beach Memorial Medical Center, Miller Children's and Women's Hospital, Long Beach, CA, USA.
authors.forename: Ramin
authors.initials: R
authors.lastname: Javahery
authors.affiliation: Radiology, Long Beach Memorial Medical Center, Miller Children's and Women's Hospital, Long Beach, CA, USA.
authors.forename: Richard Y
authors.initials: RY
authors.lastname: Chai
authors.affiliation: Endocrinology, Department of Pediatrics, Miller Children's and Women's Hospital, Long Beach, CA, USA.
authors.forename: Pablito
authors.initials: P
authors.lastname: Nagpala
authors.affiliation: Associates of Cape Cod, Inc., East Falmouth, MA, USA.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Finkelman
authors.affiliation: Transplantation-Oncology Infectious Diseases Program and Infectious Diseases Translational Research Laboratory, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Ruta
authors.initials: R
authors.lastname: Petraitiene
authors.affiliation: Transplantation-Oncology Infectious Diseases Program and Infectious Diseases Translational Research Laboratory, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA thw2003@med.cornell.edu.|Departments of Pediatrics, and Microbiology & Immunology, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy*; D058565:Cerebral Ventriculitis / Q000188:drug therapy*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D016903:Drug Monitoring / Q000379:methods*; D018237:Germinoma / Q000150:complications; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000150:complications; D011509:Proteoglycans; D016896:Treatment Outcome; D065819:Voriconazole / Q000627:therapeutic use*; D047071:beta-Glucans / Q000134:cerebrospinal fluid*
chemical_list: D000935:Antifungal Agents; D007155:Immunologic Factors; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K; D065819:Voriconazole
keywords: (1→3)-β-D-glucan; Aspergillus; central nervous system (CNS); cerebrospinal fluid (CSF); voriconazole