Aspergillosis of central nervous system in patients with leukemia and stem cell transplantation: a systematic review of case reports

作者：Aref Shariati, Mojtaba Didehdar, Shahin Rajaeih, Alireza Moradabadi, Mohammad Ghorbani, Vahid Falahati, Zahra Chegini · 发表于：Annals of Clinical Microbiology and Antimicrobials · 年份：2021 · DOI：10.1186/s12941-021-00452-9 · 被引用次数：16 · 研究领域：Antifungal resistance and susceptibility、Fungal Infections and Studies、Infectious Diseases and Mycology

BACKGROUND: Aspergillosis of Central Nervous System (CNS) is a highly lethal infection in patients with leukemia and Stem Cell Transplantation (SCT). METHODS: Case reports of CNS aspergillosis in patients with leukemia and SCT published between 1990 and August 2020 were gathered using a structured search through PubMed/Medline. RESULTS: Sixty-seven cases were identified over the searches of the PubMed bibliographic database and then, 59 cases were included in the final analysis. Europe had the largest share of cases at 57.6% (34 reports), followed by Americas and Asia. Affected patients were predominantly males (58.6%) and the mean age of the patients was 36.1 years, while 62.7% of the patients were under the age of 50 years. The most common leukemia types include Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), and Acute Myeloid Leukemia (AML) at 43.4%, 27.4%, and 23.5%, respectively. Furthermore, stem cell transplantation was reported in 11 cases. The overall mortality was 33%; however, the attributable mortality rate of CNS aspergillosis was 24.5%. Altered mental status, hemiparesis, cranial nerve palsies, and seizures were the clearest manifestations of infection and lung involvement reported in 57% of the patients. Histopathologic examination led to the diagnosis of infection in 57% of the patients followed by culture (23.7%), galactomannan assay (8.5%), and molecular method (3.3%). Amphotericin B and voriconazole were the most frequently used drug...