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Cerebral aspergillosis in adult critically ill patients: A descriptive report of 10 patients from the AspICU cohort

par Spapen, Herbert D. M.;Spapen, Jerrold;Taccone, Fabio ;Dimopoulos, George;Rello, Jordi;Blot, Stijn
Référence European Society of Intensive Care Medecine Annual Congress(XXVI: 5-9 October 2013: Paris), 26th ESICM Annual Congress
Publication Publié, 2013-10

Abstract de conférence

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Résumé :

INTRODUCTION. An unexpectedly high incidence of invasive pulmonary aspergillosis has been reported in intensive care unit (ICU) patients without underlying immunosuppression. Next to the respiratory tract, the brain is most often affected by invasive aspergillosis. However, little is known about brain involvement by Aspergillus in critically ill patients.OBJECTIVES. To study demographics, risk profile, diagnosis, treatment, and outcome of central nervous system aspergillosis in ICU patients.METHODS. Retrospective analysis of proven cases of invasive cerebral aspergillosis taken from a cohort of 563 adult patients in whom Aspergillus involvement was evidenced during their ICU stay.RESULTS. Ten patients with central nervous system aspergillosis were identified. All had one or more host factors predisposing for invasive aspergillosis. Clinical presentation was subtle and, apart from unexplained fever, mostly devoid from "classical" neurological manifestations. All but one patient had proven or probable/putative invasive pulmonary aspergillosis. On cerebral CT scanning, lesions appeared to be either solitary and hyperdense or were multiple and randomly distributed throughout the brain. One patient presented with sole meningeal infestation. Aspergillus infection was confirmed by brain biopsy in 3 subjects. Voriconazole was used as primary treatment in only half of the patients. Nine patients died, six of them receiving antifungal treatment for less than 2 weeks.CONCLUSIONS. Central nervous system aspergillosis was not frequently observed in adult ICU patients. Diagnosis should be considered in patients at risk presenting with proven or probable/putative invasive pulmonary aspergillosis in association with suggestive neuroradiological findings. The brain most likely was affected through haematogenous dissemination from the lungs. Current treatment recommendations were not always applied and outcome remains dismal.GRANT ACKNOWLEDGMENT. The AspICU project received an unrestricted educational grant from Pfizer Belgium and a research grant from the Special Research Fund of Ghent University.