Aspergillosis

Relatively few species of Aspergillus produce infection in man, Aspergillus fumigatus being the most common. Infection occurs through inhalation of spores that colonize the pulmonary system or para-nasal sinuses. Disseminated aspergillosis is almost uniformly encountered in debilitated or immunocompro-mised patients. Predisposing conditions include AIDS, organ transplant, leukemia, carcino-matosis, intravenous drug use, tuberculosis, hepatic cirrhosis and prolonged antibiotic therapy [23]. CNS involvement occurs in approximately 50% of patients with dissem-intaed aspergillosis through hematogenous dissemination or direct invasion of a granulo-matous lesion through the skull base.

Clinically, CNS aspergillosis may present as an acute necrotizing infection or a chronic gran-ulomatous process. Intraparenchymal granulomas or cerebral abscesses produce findings typical of an intracranial mass. Granulomatous masses involving the meninges can produce cranial nerve deficits and/or brainstem dysfunction. Orbital infection may lead to propto-sis, altered vision, external ophthalmoplegia and orbital apex syndrome. The organism has a propensity to invade cerebral vessels, causing occlusive vasculitis with cerebral infarction and/or hemorrhage. Vascular invasion of larger proximal vessels occasionally results in a mycotic aneurysm. Aspergillus meningitis is rare, except in intravenous drug users.

The diagnosis of CNS aspergillosis is difficult. Since meningitis is rare, CSF findings are nonspecific; moreover, culture of the organism from CSF is almost impossible. Definitive diagnosis is based on identification of the fungus in tissue biopsies. The organism has septated hyphae with dichotomous branching, most readily seen using either periodic acid Schiff (PAS) or Gomori methenamine silver stains [24]. Management of CNS aspergillosis consists of surgical excision of fungal abscesses followed by treatment with amphotericin B. Unfortunately, in spite of aggressive therapy, prognosis is extremely poor and few patients survive.

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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