Case Series: Intracranial Mass Lesion Due to Fungal Infection: A Case Series and Review of Literature (original) (raw)
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Intracranial fungal granuloma: analysis of 40 patients and review of the literature
Objective: To describe the characteristics of patients diagnosed with intracranial fungal granuloma (IFG) in the largest reported series to date (to our knowledge). Methods: A 22-year retrospective, multi-institutional review of 40 patients, aged 16 to 62 years (mean, 40.2 years), was performed in patients with histopathologically confirmed IFG. The variables were symptoms/signs at presentation, predisposing factors, location of granuloma, involvement of paranasal sinuses, diagnostic studies including blood and urine cultures, surgical procedures performed, specific organism identified, treatment, and prognosis. Plain x-rays, computed tomography, and/or magnetic resonance imaging scans were performed. Results: Predominant symptoms included headache (83%), vomiting (65%), proptosis (48%), and visual disturbances (48%). Other symptoms were fever, nasal congestion, and seizures (7 [18%]). Common signs included papilledema (12 [30%]), with cranial neuropathy (I, III/IV/VI, and V in 4, 7, and 2 patients, respectively), hemiparesis (3), and meningismus (3). Predisposing factors were diabetes (16 [40%]), tuberculosis (7 [18%]), and immunocompromise related to renal transplant (2), non-Hodgkin's lymphoma (1), and human immunodeficiency virus (1). Location was primarily frontal (10 [25%]), with anterior cranial fossa involved in 8 (20%) patients; 6 (15%) patients had sellar/parasellar involvement. Eighteen (40%) had paranasal sinus involvement. Twenty-nine patients underwent craniotomy for resection, with 11 undergoing biopsy (of which 3 were transsphenoidally approached). Histopathology revealed aspergilloma (25 [63%]), mucormycosis (7 [18%]), cryptococcoma (3), cladosporidium (3), Bipolaris hawaiiensis (1), and Candida species(1). Microbiological analysis of the specimen was positive in 28 (60%) patients. All patients were treated with amphotericin B, fluconazole, and/or flucytosine. Only 26 patients completed amphotericin B therapy (due to nephrotoxicity). Mortality was 63%, most commonly due to meningoencephalitis (16 [36%]). Conclusions: High index of suspicion of IFG should exist for the following groups: (1) immunocompromised patients with intracranial lesions and (2) diabetic patients with intracranial and rhinocerebral mass lesions. Early diagnosis, surgical decompression, and a complete course of promptly initiated antifungal therapy are associated with better prognosis. D
Outcome of Two Treatment Regimens in the Management of Intracranial Fungal Granuloma
Pakistan Journal Of Neurological Surgery, 2017
Objective: Two treatment regimens means either you have to completely/near total excise the granuloma with sinus clearances (extra-dural) OR don’t touch it, even minimal invasive procedure such as burr hole biopsy can be fatal (intra-dural). Introduction: The diagnosis of intracranial fungal granuloma almost always remained a challenge for neurosurgeons because of their rarity, alter behavior and lack of diagnostic tools. These infections are now easily diagnosed because of increased awareness and understanding regarding this pathology, better diagnostic tools and an increase in immunocompromised/immunocompetent hosts (from any cause). Most often, the fungal granulomas are due to contiguous spread of the infection from the paranasal sinuses and ear. Rarely, they may be due to hematogenous spread from a focus in the lungs. The infection can spread from sinuses to invade the brain parenchyma. Once it involves the brain parenchyma then the course of the disease is fulminant. Contrast e...
World neurosurgery, 2015
Fungal granulomas of the central nervous system are rare, and have high mortality and morbidity irrespective of treatment. The authors report their experience of managing 66 patients over 15 years and discuss the clinical, radiological, surgical and pathological findings. This is among the largest reported series. A retrospective analysis was performed on patients with intracranial fungal granulomas (ICFGs), treated in our institution, between January 1997 and May 2011. Only mass forming histopathologically proven ICFG were included in this study. The age of the patients ranged from 7 years to 67 years (mean= 32.3 yrs) and most patients were in the third and fourth decades of life. The study population had 47 males and 19 females. The most common symptom was headache (41 patients), followed by vomiting (16 patients) and blurring of vision (16 patients). Only 3 patients had fever as a presenting feature. The duration of symptoms was less than 6 months in all cases and less then 3 mon...
Intracranial fungal granuloma: a single-institute study of 90 cases over 18 years
Neurosurgical Focus, 2019
OBJECTIVEIntracranial fungal granuloma (IFG) remains an uncommon entity. The authors report a single-institute study of 90 cases of IFG, which is the largest study until now.METHODSIn this retrospective study, all cases of IFG surgically treated in the years 2001–2018 were included. Data were obtained from the medical records and the pathology, microbiology, and radiology departments. All relevant clinical data, imaging characteristics, surgical procedure performed, perioperative findings, and follow-up data were recorded from the case files. Telephonic follow-up was also performed for a few patients to find out their current status.RESULTSA total of 90 cases consisting of 64 males (71.1%) and 26 (28.9%) females were evaluated. The mean patient age was 40.2 years (range 1–79 years). Headache (54 patients) was the most common presenting complaint, followed by visual symptoms (35 patients), fever (21 patients), and others such as limb weakness (13 patients) or seizure (9 patients). Cr...
2020
Introduction Objective: MRI and outcome based learning experience in the management of intracranial fungal granulomas and atypical brain infections (IFG) considering risk versus benefit before neurosurgical interventions. Methods: We performed a retrospective analysis of all patients with diagnosed IFG or anticipated diagnosis based predominantly on imaging from 2011 to 2019 collected data included clinical history, lab results treatment and review of all imaging studies performed. Among these cases, one case required additional consideration of histopathological confirmation due to refractory response to antifungal medication and subsequent deterioration of neurology of patient hence neurosurgical intervention was done in that individual case. The variables were symptoms and signs at presentation, predisposing factors, location of granuloma, involvement of paranasal sinuses, diagnostic studies including blood and urine cultures, septic profile, surgical procedure performed along wi...
Central nervous system fungal infections; a review article
Jundishapur Journal of Microbiology
Central nervous system (CNS) fungal infections have a high rate of morbidity and mortality that increased during last three decades. CNS fungal infections present a diagnostic and therapeutic challenge. High numbers of organ transplants, chemotherapy patients, intensive care unit hospitalizations, immunocompromised patients and haematological malignancies increase morbidity and mortality. Several fungi including, saprophytic fungi, melanized fungi, dimorphic fungi, yeast and yeasts-likes cause CNS fungal infections. New antifungal, posaconazole, voriconazole and echinocandins as well as traditionally antifungal, amphotericine B, flucytosine and itraconazole were used for CNS fungal infection therapy.
International Journal of Antimicrobial Agents, 2006
Invasive aspergillosis of the central nervous system has a mortality rate exceeding 90%. We describe a 29-year-old woman with a medical history of chronic polyarthritis who developed a proven rhinocerebral Aspergillus fumigatus infection refractory to first-line treatment with liposomal amphotericin B. The patient responded successfully to salvage combination treatment with voriconazole and caspofungin. Furthermore, for the first time, voriconazole levels in an intracerebral abscess were measured in this patient undergoing voriconazole oral therapy.
Asian Journal of Medical Sciences
Background: Mycotic keratitis is a potential sight-threatening infection and a leading cause of ocular morbidity worldwide. It is inherently difficult to treat due to the delayed diagnosis and fungistatic nature of available topical medications. Aims and Objectives: The aim is to compare the safety and efficacy of intrastromal voriconazole alone and in combination with intracameral voriconazole in recalcitrant fungal keratitis cases. Materials and Methods: A prospective, hospital-based, interventional study was conducted in 40 cases of fungal keratitis involving >50% stromal thickness and not showing a good response to conventional antifungal treatment even after 4 weeks. Cases were randomly divided into two groups: group A and group B of 20 each; group A patients received intrastromal voriconazole, while group B patients were given intrastromal+intracameral voriconazole combination in 50 mg/0.1 mL dose. Cases were examined daily for 1 week and then every week for 4 weeks to moni...
Diagnostic Imaging for Fungal Infections of the Central Nervous System
2005
A 31-year-old female heart transplant recipient was admitted to the hospital for a recent history of progressively worsening headaches. Her past medical history included doxorubicin (Adriamycin)-induced cardiomyopathy and cisplatin-induced nephropathy secondary to a nonrecurrent osteosarcoma that occurred in 1982; in 1991, she underwent orthotopic heart transplantation. After transplantation (at age 29), she was admitted on several occasions for organ rejection and for onset of moderate-to-severe headaches after an uneventful pregnancy. In September 1992, a complete neurological evaluation for the headaches was unrevealing, and she was treated symptomatically. The patient was admitted to another hospital for worsening headaches in January 1993; her WBC count was 0, and a lumbar puncture indicated a pressure of 450 mm H20. She was diagnosed with pseudotumor cerebri and given acetazolamide (Diamox). While hospitalized, she developed a low-grade fever, and empiric antibiotic therapy wa...