Post-influenza aspergillus ventriculitis
Invasive aspergillosis is a complication of influenza infection, usually in the form of invasive pulmonary aspergillosis and more often seen in the context of immunosuppression. Post-influenza central nervous system invasion by aspergillus is very rarely described in the literature. We report a 63-y...
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| Vydané v: | Clinical infection in practice Ročník 7-8; s. 100026 |
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Elsevier Ltd
01.10.2020
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| Abstract | Invasive aspergillosis is a complication of influenza infection, usually in the form of invasive pulmonary aspergillosis and more often seen in the context of immunosuppression. Post-influenza central nervous system invasion by aspergillus is very rarely described in the literature.
We report a 63-year old male, with a background of rheumatoid arthritis managed with methotrexate, who initially presented with a respiratory infection. He was positive for Influenza A H1N1 by a reverse-transcriptase polymerase chain reaction assay from a throat swab. He subsequently developed a progressive neurological impairment, had cranial imaging consistent with ventriculitis and hydrocephalus, and a lymphocytic cerebrospinal was obtained by lumbar puncture. Imaging of his chest revealed cavitatory lung disease and a possible aspergilloma.
Following an endoscopic third ventriculostomy, cerebrospinal fluid microscopy revealed fungal hyphae and aspergillus DNA was detected by a polymerase chain reaction assay. Despite appropriate anti-fungal treatment the patient died of complications from an aspergillus ventriculitis.
Clinicians should remain vigilant for post-influenza aspergillosis, even in patients only minimally immunocompromised. Post-influenza aspergillus infection of the central nervous system, presumably by a haematogenous route, is rarely described but does occur as demonstrated by this case.
•Invasive aspergillus infection is a recognised complication of influenza•Aspergillosis of the central nervous system is a rare complication of influenza•Aspergillus infection has characteristic radiological findings•The mainstay of treatment is with an azole but evidence is poor |
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| AbstractList | Background: Invasive aspergillosis is a complication of influenza infection, usually in the form of invasive pulmonary aspergillosis and more often seen in the context of immunosuppression. Post-influenza central nervous system invasion by aspergillus is very rarely described in the literature. Case report: We report a 63-year old male, with a background of rheumatoid arthritis managed with methotrexate, who initially presented with a respiratory infection. He was positive for Influenza A H1N1 by a reverse-transcriptase polymerase chain reaction assay from a throat swab. He subsequently developed a progressive neurological impairment, had cranial imaging consistent with ventriculitis and hydrocephalus, and a lymphocytic cerebrospinal was obtained by lumbar puncture. Imaging of his chest revealed cavitatory lung disease and a possible aspergilloma. Results: Following an endoscopic third ventriculostomy, cerebrospinal fluid microscopy revealed fungal hyphae and aspergillus DNA was detected by a polymerase chain reaction assay. Despite appropriate anti-fungal treatment the patient died of complications from an aspergillus ventriculitis. Conclusion: Clinicians should remain vigilant for post-influenza aspergillosis, even in patients only minimally immunocompromised. Post-influenza aspergillus infection of the central nervous system, presumably by a haematogenous route, is rarely described but does occur as demonstrated by this case. Invasive aspergillosis is a complication of influenza infection, usually in the form of invasive pulmonary aspergillosis and more often seen in the context of immunosuppression. Post-influenza central nervous system invasion by aspergillus is very rarely described in the literature. We report a 63-year old male, with a background of rheumatoid arthritis managed with methotrexate, who initially presented with a respiratory infection. He was positive for Influenza A H1N1 by a reverse-transcriptase polymerase chain reaction assay from a throat swab. He subsequently developed a progressive neurological impairment, had cranial imaging consistent with ventriculitis and hydrocephalus, and a lymphocytic cerebrospinal was obtained by lumbar puncture. Imaging of his chest revealed cavitatory lung disease and a possible aspergilloma. Following an endoscopic third ventriculostomy, cerebrospinal fluid microscopy revealed fungal hyphae and aspergillus DNA was detected by a polymerase chain reaction assay. Despite appropriate anti-fungal treatment the patient died of complications from an aspergillus ventriculitis. Clinicians should remain vigilant for post-influenza aspergillosis, even in patients only minimally immunocompromised. Post-influenza aspergillus infection of the central nervous system, presumably by a haematogenous route, is rarely described but does occur as demonstrated by this case. •Invasive aspergillus infection is a recognised complication of influenza•Aspergillosis of the central nervous system is a rare complication of influenza•Aspergillus infection has characteristic radiological findings•The mainstay of treatment is with an azole but evidence is poor |
| ArticleNumber | 100026 |
| Author | Moran, Edward Senanayake, Varuni Dedicoat, Martin Burns, Daniel Canning, Benjamin |
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| CitedBy_id | crossref_primary_10_1016_j_cmi_2020_06_025 crossref_primary_10_2147_IDR_S272605 crossref_primary_10_1007_s40278_020_82452_2 crossref_primary_10_1038_s41598_021_95772_3 |
| Cites_doi | 10.1016/S2213-2600(14)70041-4 10.1016/S2213-2600(18)30274-1 10.1093/cid/ciz314 10.1007/s00062-014-0305-7 10.3947/ic.2013.45.2.225 10.1097/RTI.0b013e31805f6a42 10.1093/cid/ciw326 10.1080/03009742.2016.1209553 10.1002/14651858.CD008965.pub4 10.1182/blood-2005-02-0733 |
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| Keywords | Aspergillus Meningitis Central nervous system infection Ventriculitis Influenza |
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