Table 1 Clinical manifestations, diagnosis, epidemiological and therapeutic features of central nervous system aspergillosis in patients with leukemia and stem cell transplantation (PubMed reported cases until August 2020)
Country, year of publication and references | Sex/age | Pathogen | Leukemia | Clinical presentation and | Treatment | Surgery | Diagnosis | Outcome |
|---|---|---|---|---|---|---|---|---|
Australia, 1995 [45] | M/2 | A fumigatus | ALL | Cough, rhinorrhea, fever, myoclonic jerking of the left side of his body | AMB. LAMB, itraconazole | A right frontal craniotomy, a frontal lobectomy, and a left parietal craniotomy | HE, culture | Alive |
Australia, 2019 [25] | 66/M | A. felis complex | CLL | Confusion and expressive dysphasia | Voriconazole, posaconazole | Craniotomy and excision of the left parietotemporal lesion | HE, culture and PCR | Alive |
Austria, 1999 [46] | 59/M | A. fumigatus | ALL | Headache and aphasia | AMB, LAMB, itraconazole | NR | HE, culture | Died |
Belgium, 1999 [7] | 11/F | NR | ALL | Frontal headache, pyrexia, lethargy and left-sided hemiparesis without meningeal signs | AMB | The entire abscess was removed surgically | HE, negative CSF culture | Died |
China, 2015 [18] | 53/M | NR | APL | Confusion, left lower extremity movement disorder, and dyspnea | Itraconazole, caspofungin | NR | Culture of sputum | Alive |
Czech Republic, 2005 [10] | 16/F | NR | B-ALL | Painful severe peripheral neuropathy, gross, frontal behavior, followed by qualitative and quantitative changes in her consciousness | AMB | Open neurosurgical removal | HE | Alive |
France,2018 [37] | 65/M | A. fumigatus | CLL | Headedness, balance disorder, and right hemiparesis (90Â days after starting treatment with ibrutinib) | Voriconazole, LAMB and reduction of the ibrutinib dose | NR | Culture | Alive |
France, 2001 [47] | 30/F | A. fumigatus | CML | Fever and right sided pleuritic chest pain | AMB, Flucytosine | NR | Culture | Died |
France, 2003 [33] | 57/M | NR | AML and PSCT | Fever then the patient became withdrawn and confused | AMB, caspofungin/voriconazole | NA (Due to the bad condition of the patient) | GM assay | Alive |
France, 2018 [37] | 75/M | A. fumigatus | CLL | Fever, visual impairment and ataxia, generalized seizure | Voriconazole, Prednisone | NR | HE, PCR, negative CSF culture | Alive |
France, 2019 [26] | 39/F | A. fumigatus | CLL | Headache, seizures, and fever | LAMB, voriconazole, caspofungin and | Radical surgery | HE of surgical samples and culture | Not reported |
France, 2019 [48] | 69/M | A. fumigatus | CLL | Neurological signs | Voriconazole, ibrutinib was stopped | NR | Culture of BAL | Alive |
France, 2019 [32] | 52/F | A. fumigatus | CLL | Fever, confusion, behavior disorders and aggression | LAMB, voriconazole, isavuconazole, ibrutinib | NR | Culture of brain biopsy | Alive |
France, 2020 [31] | 69/M | A. fumigatus | CLL | Left miosis and a balance disorder | LAMB, voriconazole, isavuconazole, ibrutinib was discontinued | NR | Culture of BAL | Alive |
Germany, 1997 [49] | F/62 | NR | AML | Fever, Speech was slow and non-fluent, the patient was disoriented, alexic and had homonymous hemianopsia to the right | LAMB and itraconazole | Stereotactic fine-needle aspiration | HE | Alive |
Germany, 1997 [23] | 18/m | NR | ALL | Fever, sudden onset of pleural chest pain and a pulmonary infiltrate (30Â days) | AMB, LAMB, itraconazole, voriconazole | NR | HE, negative culture | Died |
Germany, 2017 [24] | 22Â month/M | A. fumigatus | T-ALL | Fever and lymphadenitis, left sided hemiparesis | LAMB, caspofungin, Voriconazole | Neurosurgery with postoperative external ventricular drains | HE, negative culture | Alive |
Germany, 2017 [50] | 52/M | NR | T-LGL | Acute strong nausea, vomiting, fever, relapsing focal seizures of his right arm, paresthesia and motoric weakness | Voriconazole, LAMB | NR | HE, negative culture and PCR | Alive |
Greece, 2013 [51] | 32/M | A. fumigatus | AML | Weight‑loss, frequent rhinorrhagia, gum swelling, cephalalgia, fatigue, fever, and somnolence, motor nor sensory deficits | AMB | NR | HE, culture | Died |
India, 2012 [14] | 14/M | NR | B-ALL | Unconsciousness with anisocoria, papilledema and a fixed right-sided gaze | AMB | NR | GM assay | Died |
Iran, 2020 [4] | 18Â month/M | A. fumigatus/ A. niger | B cell-ALL | Fever, abnormal focal movement in his right upper limb, loss of consciousness, and seizure | LAMB, voriconazole, Caspofungin | External drainage and hemorrhage drained | HE, culture, PCR | Died |
Italy, 2003 [11] | 53/F | A. flavus | CLL | Left hemiparesis | AMB, voriconazole | NR | Culture | Died |
Italy, 2011 [42] | 65/M | A. fumigatus | CLL, | Fever, headache, pontocerebellar angle syndrome | Caspofungin | A left suboccipital retro sigmoidal craniotomy | HE | Alive |
Italy, 2018 [40] | 57/ | A. fumigatus | CLL | Fever and dyspnea | Voriconazole, ibrutinib was stopped | NR | HE | Alive |
Italy, 2019 [3] | 3/F | NR | B-ALL | Fever and pancytopenia, seizure | Voriconazole then LAMB and isavuconazole | NR | MRI,CT and GM assay | Alive |
Japan, 2004 [21] | 15/F | NR | PSCT | High fever, headache and weakness in the left hand and leg, and a neurologic examination revealed hemiparesis (1Â month after transplantation) | Fluconazole | NR | Panfungal PCR | Alive |
Japan, 2007 [20] | 33/M | NR | AML | A sudden fever, severe headache, decreased consciousness level and a stiff neck | AMB, voriconazole | NR | GM assay, PCR | Alive |
Japan, 2008 [52] | 18/M | NR | PSCT | Tachypnea and hypoxemic 30Â days after BMT and 1Â day after SCT | Micafungin, AMB, flucytosine | NR | PCR, culture, autopsy | Died |
Japan, 2008 [44] | 15/M | NR | BMT | Left ear pain, and left facial nerve palsy 21Â days after BMT, declining level of consciousness as well as right hemiplegia on day 196 after BMT | AMB, itraconazole, micafungin and Voriconazole | NA but catheter coil embolization performed | HE | Alive |
Japan, 2020 [19] | 90/M | NR | CLL | Headache, fever with altered mental status | Voriconazole | NR | GM assay | Alive |
Japan, 2020 [29] | 15/M | NR | AML | Dry cough, high fever, right-sided weakness and impaired consciousness | Voriconazole, LAMB and itraconazole | NR | GM assay | Died |
Netherlands, 2008 [34] | 16/F | A. fumigatus | B-ALL | Fever and febrile neutropenia | Voriconazole, caspofungin | NR | Culture | Alive |
Portugal, 2005 [12] | 52/F | NR | HSCT | Fever, declining level of consciousness 11Â month after transplantation | LAMB, fluconazole | Surgery | HE | Died |
Spain, 1997 [53] | 43/M | NR | ALL | Fever, dyspnea and pleuritic chest pain, then lost consciousness | AMB | NR | HE | Died |
Sweden, 2012 [54] | 59/M | A. fumigatus | B-ALL, | Fever, dysphasia and weakness of his right hand, seizures (12Â days) | Voriconazole, LAMB, caspofungin, posaconazole | NR | Culture of BAL and GM assay | Alive |
Turkey, 1997 [55] | 18/F | A. fumigatus | BMT | Fever, headache and hemiparesis | LAMB, itraconazole | Aspiration | Culture | Alive |
Turkey, 2002 [43] | 45/F | A. fumigatus | PSCT | Ataxia and gait disturbance | AMB, itraconazole | Surgical removal of the cerebellar abscess with suboccipital craniectomy | HE | Alive |
Turkey, 2012 [2] | 4/F | A. niger | B-ALL | Right focal seizures | LAMB, voriconazole | Not feasible because of the critical localizations of the lesion | HE and culture | Alive |
Turkey, 2013 [35] | 4/F | A. fumigatus | ALL | Fever, sore throat and headache and focal seizures in the left arm | AMB and voriconazole | NR | HE, culture, PCR of tissue sample | Alive |
Turkey, 2018 [56] | 21/M | NR | SCT | Vocal cord paralysis and swallowing difficulty (one week after transplantation) | AMB | Abscesses in the brain stem and occipital lobes were totally removed | HE | Died |
Turkey, 2018 [56] | 18/M | NR | ALL | Clouding of consciousness and tendency toward sleepiness | AMB | Lesion was surgically excised | HE | Alive |
Turkey, 2018 [56] | 45/F | NR | PBST | Ataxia (two months after transplantation) | AMB | Cerebellar abscess was surgically removed | HE | Alive |
UK, 2000 [57] | 2/F | A. fumigatus | B-ALL | Seizure | AMB and Flucytosine | NR | HE, culture | Died |
UK, 2006 [58] | 34/M | A. fumigatus | AML | Fever, pleuritic pain, left upper motor neuron facial nerve palsy | AMB, LAM, Voriconazole | NR | Culture | Died |
UK, 2015 [36] | 3/M | A. nidulans | B-All | Fever, leg pain, spontaneous bruising, and a petechial rash, right hemiparesis and aphasia | Voriconazole, LAMB then caspofungin and G-CSF | NR | HE, PCR from CSF | Alive |
USA, 1991 [5] | M/46 | NR | APL | Hemoptysis, lower lobe pneumonic infiltrate, left peripheral facial palsy | AMB | Resection of the inferior temporal lobe abscesses | HE, culture | Alive |
USA, 1998 [6] | 15/f | NR | ALL | Right lower quadrant pain, fever and neutropenia, and right leg weakness, flaccid paraplegia bilaterally with a sensory level at T8 | AMB | NR | Postmortem examination | Died |
USA, 2005 [41] | 6/F | NR | AML | The patient febrile and showed signs of septicemia | LAMB, voriconazole | Lobectomy and Image-guided stereotactic resection of the lesion | HE | Died |
USA, 2005 [41] | 6/M | NR | AML | Mouth sores, neurological deficits | LAMB, voriconazole | Lobectomy and Image-guided stereotactic resection of the lesion | HE | Alive |
USA, 2005 [41] | 16/F | NR | ALL | Seizure | Voriconazole | Image-guided stereotactic resection of the lesion | HE | Alive |
USA, 2012 [22] | 55/F | A. terreus | AML | Mild headache, nonproductive cough and fever, lethargic and Confused | Voriconazole, intrathecal AMB | Stereotactic aspiration and drainage | GMS stains, culture | Died |
USA, 2014 [27] | 24/F | NR | AML | Fever, chills, diarrhea, and malaise | LAMB, voriconazole, caspofungin | Neurosurgical evacuation of brain abscesses | HE | Alive (Multiple brain abscesses) |
USA, 2014 [59] | 32/F | NR | T-ALL | Septic shock, febrile neutropenia, acute hypoxic respiratory failure, a right facial droop, severe aphasia, with right upper and right lower extremity paresis | Voriconazole | NR | GM assay | Alive |
USA, 2014 [28] | 19/F | NR | ALL | Extremity weakness and fevers | Voriconazole | T11–L1 laminectomy | Culture, GM assay | Died |
USA, 2018 [38] | 48/M | A. fumigatus | B cell-ALL | Left eye progressive vision loss, tearing, and redness then declining mental status | Voriconazole and AMB | NR | HE, culture | Alive |
USA, 2018 [39] | 76/M | A. fumigatus | CLL/SLL | Encephalopathy and weakness in his left arm, frontal headache and changes in vision in left eye | voriconazole and micafungin, ibrutinib discontinuation | NR | Culture | Alive |
USA, 2019 [60] | 62/m | A. fumigatus | CLL | Fevers, aphasia, confusion and profound expressive aphasia | Voriconazole, micafungin, isavuconazole Ibrutinib was discontinued | NR | HE, culture | Alive |
USA, 2019 [30] | 79/M | A. fumigatus | B-cell lymphoma/leukemia | Confusion, anorexia, and failure to thrive | Voriconazole, caspofungin | NR | HE, culture | NR |
USA, 2020 [61] | 74/M | NR | CLL | Fluctuating, slowly progressive imbalance, unsteady gait, left occipital headache and intermittent confusion | Voriconazole | Emergent craniotomy | HE, culture | Alive |