Management of granulomatous cerebral aspergillosis in immunocompetent adult patients: a review

Abstract

Cerebral aspergillosis, is an infrequent, opportunistic infection of the central nervous system that accounts for 5–10% of all intracranial fungal pathology. It is uncommon in immunocompetent patients and has a significant disease burden, with high morbidity and mortality, even with appropriate treatment. Basic principles of abscess management should be employed, including aspiration and targeted anti-fungal therapy for 12–18 months. However, reported outcomes with a purely minimally invasive approach are poor and there should be a low threshold for surgical excision, especially in resource poor settings and in patients with deteriorating neurology harbouring sizeable masses. Evidence favouring gross total excision over subtotal resection is lacking, however. It is notable that these recommendations are largely based on retrospective case series and isolated case reports. There is a need therefore for international collaboration to evaluate management strategies for immunocompetent patients with cerebral aspergillosis.

Keywords:

• Antifungal agents
• Aspergillus
• management
• neuroaspergillosis

Disclosure statement

The authors declare there were no sources of support or intellectual or financial conflicts of interest in the production of this work. The authors declare this work is original and has not been published or submitted for consideration, elsewhere.