A F A D Schauwvlieghe1, R G M Bredius2, R M Verdijk3, F J W Smiers2, M T van der Beek4, B F Goemans5, C M Zwaan6, R J Brüggemann7, B J A Rijnders8. 1. Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands. Electronic address: a.schauwvlieghe@erasmusmc.nl. 2. Department of Paediatric Immunology, Section of Infections, Haematology, and Stem Cell Transplantation, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands. 3. Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands. 4. Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands. 5. Department of Haemato-oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, Netherlands. 6. Department of Haemato-oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, Netherlands; Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands. 7. Department of Pharmacy, Radboud Institute of Health Science, Radboud University Medical Center, Nijmegen, Netherlands; Center of Expertise in Mycology, Radboudumc, Nijmegen, Netherlands. 8. Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands.
Abstract
OBJECTIVES: In the pre-azole era, central nervous system (CNS) infections with Aspergillus had a dismal outcome. Survival improved with voriconazole but CNS infections caused by azole-resistant Aspergillus fumigatus preclude its use. Intravenous liposomal-amphotericin B (L-AmB) is the preferred treatment option for azole-resistant CNS infections but has suboptimal brain concentrations. METHODS: We describe three patients with biopsy-proven CNS aspergillosis where intraventricular L-AmB was added to systemic therapy. Two patients with azole-resistant aspergillosis and one patient with azole-susceptible CNS aspergillosis were treated with intraventricular L-AmB at a dose of 1mg weekly. RESULTS: We describe three patients successfully treated with a combination of intravenous and intraventricular L-AmB. All three patients survived but one patient developed serious headaches, most likely not related to this treatment. CONCLUSIONS: Intraventricular L-AmB may have a role in the treatment of therapy-refractory CNS aspergillosis when added to systemic therapy.
OBJECTIVES: In the pre-azole era, central nervous system (CNS) infections with Aspergillus had a dismal outcome. Survival improved with voriconazole but CNS infections caused by azole-resistant Aspergillus fumigatus preclude its use. Intravenous liposomal-amphotericin B (L-AmB) is the preferred treatment option for azole-resistant CNS infections but has suboptimal brain concentrations. METHODS: We describe three patients with biopsy-proven CNS aspergillosis where intraventricular L-AmB was added to systemic therapy. Two patients with azole-resistant aspergillosis and one patient with azole-susceptible CNS aspergillosis were treated with intraventricular L-AmB at a dose of 1mg weekly. RESULTS: We describe three patients successfully treated with a combination of intravenous and intraventricular L-AmB. All three patients survived but one patient developed serious headaches, most likely not related to this treatment. CONCLUSIONS: Intraventricular L-AmB may have a role in the treatment of therapy-refractory CNS aspergillosis when added to systemic therapy.