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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| Published in: | Clinical infection in practice Vol. 7-8; p. 100026 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Elsevier Ltd
01.10.2020
Elsevier |
| Subjects: | |
| ISSN: | 2590-1702, 2590-1702 |
| Online Access: | Get full text |
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| Summary: | 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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| ISSN: | 2590-1702 2590-1702 |
| DOI: | 10.1016/j.clinpr.2020.100026 |