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    Home > Active Ingredient News > Infection > Cerebrospinal fluid culture of Aspergillus fumigatus, is it a contaminant or a pathogen

    Cerebrospinal fluid culture of Aspergillus fumigatus, is it a contaminant or a pathogen

    • Last Update: 2022-04-18
    • Source: Internet
    • Author: User
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    foreword

    Foreword Foreword

    Aspergillus fumigatus is the most common isolate of invasive aspergillosis and can cause lung, nose, eye, brain, and bone infections in humans, especially in immunocompromised patients, and in severe cases can lead to sepsis
    .


    In invasive aspergillosis caused by Aspergillus fumigatus, respiratory system infections are the most common, while central nervous system infections are less common


    case after

    case by case by case

    The patient, male, 55 years old, was admitted non-emergently in December 2021 due to "extremity convulsions for 4 days"
    .

    History of present illness: The patient and family members complained that there was no obvious incentive for limb convulsions 4 days ago, the seizure time was about 3 minutes, the seizure process was unclear, foaming at the mouth, high limb muscle tension, the symptoms relieved spontaneously, and the seizure process could not be recalled.
    After the attack, he felt general weakness, no nausea and vomiting, no chills and fever
    .


    To the local hospital for treatment, to symptomatic treatment


    Past history: He was healthy and had no history of chronic diseases.
    In 2011, he underwent resection of intracranial Lacker's cyst.
    He underwent surgical treatment for gastric perforation more than 20 years ago.
    Repeated throat discharge was suspected for one year
    .

    Physical examination: T: 36.
    9℃, P: 75 times/min, R: 19 times/min, BP: 122/66mmHg; Specialist physical examination: clear consciousness, good spirit, physical examination coordination, bilateral pupils are the same size as the circle, Diameter 3.
    0mm, sensitive to light reflex, soft neck, negative Klinefelter sign, left upper limb muscle strength grade 5, left lower limb muscle strength grade 5, right upper limb muscle strength grade 5, right lower limb muscle strength grade 5, muscle tension is not high, Physiological reflexes exist, but pathological reflexes are not elicited
    .


    Surgical scars about 10cm long can be seen on the forehead


    Laboratory tests:

    Laboratory tests:

    *Blood routine: WBC 5.
    33×109/L, N% 59.
    3%, LYM 1.
    48×109/L
    .

    *No abnormality was found in blood coagulation routine, liver and kidney function and electrolytes
    .

    *Hepatitis B surface antigen and the first three items of blood transfusion were all negative
    .

    Initial diagnosis : (1) symptomatic epilepsy, (2) personal history of craniocerebral surgery, (3) cerebrospinal fluid rhinorrhea?

    initial diagnosis

    After admission, brain MRI examination was performed.
    The results showed subdural hematoma in the forehead (non-acute stage), multiple intracranial gas accumulation, discontinuous bone on both sides of the frontal bones, bilateral frontal lobes, sellar area, and bilateral lateral ventricles.
    There are multiple abnormal signals in the anterior horn and temporal horn, which is considered to be anterior skull base disease and multiple intracranial fat deposits, and the recurrence of teratoma may be possible
    .

    5 days after admission, anterior skull base lesion resection was performed.
    During the operation, a tumor of about 3cm×3cm×4cm was seen.
    The tumor had cystic fluid.
    The cystic fluid was milky white oily liquid.
    After culture, large deposits were seen at the bottom of the tumor, which were all taken out for routine pathological examination
    .


    The puncture fluid routinely showed WBC3+; the cerebrospinal fluid was cultured for five days, and Aspergillus fumigatus was detected; the fungal components were found in the pathological section, and the morphology was compared with Aspergillus fumigatus


    ▲A large number of hyphae can be seen under the pathological section of brain tissue (HE staining)

    ▲A large number of hyphae can be seen in the pathological section of brain tissue (HE staining) ▲A large number of hyphae can be seen in the pathological section of brain tissue (HE staining)

    Treatment process: After admission, anti-infection, expectorant, acid suppression, stomach protection, intravenous nutrition, reduction of brain swelling, etc.
    , were transferred to the intensive care unit after surgery to continue ventilator-assisted breathing, and anti-infection, expectorant, and brain stimulation Circulation, maintenance of circulation and appropriate intravenous support therapy
    .


    After treatment, the patient's hemodynamics is stable, and he has been successfully stopped and extubated, and his condition is relatively stable


    case analysis

    case study case study

    Aspergillus fumigatus was detected in cerebrospinal fluid culture, the first reaction of most people is that it may be a contaminating bacteria
    .


    However, in this case, the cerebrospinal fluid specimen is very abnormal, and it is a lump of pus.


    In this case, the cerebrospinal fluid specimen is very abnormal, and it is a lump of pus.


    According to the fungal culture and pathological results, the patient's medication was adjusted.
    After one week of antifungal treatment with voriconazole, the peak body temperature of the patient gradually decreased to the normal level
    .

    Summary

    case summary case summary

    Aspergillosis of the central nervous system is a relatively rare fungal infection of the central nervous system, and its high-risk factors include hematopoietic stem cell transplantation, hematological tumor chemotherapy, primary immunodeficiency, bone marrow failure syndrome, and long-term high-dose hormone therapy
    .

    In this patient, an intracranial tumor was diagnosed in 2011 and underwent surgical resection.
    The patient's low immunity after surgery is a susceptibility factor for Aspergillus infection.
    Aspergillus can infect the brain through surgical and traumatic wounds
    .

    The clinical manifestations of aspergillosis in the central nervous system are mostly non-specific, including fever, local nervous system symptoms, changes in consciousness, convulsions, etc.
    These manifestations can also appear in cases of bacterial infection or other fungal infections
    .

    The common pathological manifestation of Aspergillus fumigatus encephalitis is brain abscess.
    The pathological results of the brain tissue of this patient showed more neutrophil infiltration, chronic suppurative inflammation of epidural scar tissue, and fibrous tissue hyperplasia with degeneration, which is consistent with brain abscess.
    pathological manifestations
    .

    On the imaging, MRI of most patients showed multifocal and polymorphic lesions in the brain parenchyma, manifested as solitary masses, cavernous sinus thrombosis, multiple intracranial abscess formation, acute or chronic skull base meningitis, vasculitis, myelitis,
    etc.

    In laboratory tests, the detection of G or GM in the cerebrospinal fluid is beneficial for the diagnosis of aspergillosis in the central nervous system.
    Studies have shown that the 1,3-β-D-glucan in the cerebrospinal fluid of fungal infection of the central nervous system is significantly higher than that of the control group.
    There are also studies showing that the level of cerebrospinal fluid galactomannan in Aspergillus cases in the central nervous system is significantly higher than that in the control group
    .

    Diagnosis of CNS aspergillosis requires positive culture or evidence of histological findings for Aspergillus
    .


    Among the confirmed cases in the systematic review, more than half of the cases were confirmed by autopsy of dead cases, and the diagnosis method of surviving cases mainly depended on lesion biopsy (40%), and the positive rate of cerebrospinal fluid and blood culture was extremely low (3.


    Drug treatment: The 2016 IDSA guideline on aspergillosis in the United States proposes that voriconazole is the preferred treatment for aspergillosis in the central nervous system


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