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Management of cerebral azole-resistant A. fumigatus infection. A role for intraventricular liposomal-amphotericin B?

In the pre-azole era, central nervous system (CNS) infections with Aspergillus had a dismal outcome. Survival improved with voriconazole but CNS infections caused by azole-resistant A. fumigatus is precluding its use. Intravenous liposomal-amphotericin B (L-AmB) is the preferred treatment option for...

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Bibliographic Details
Published in:Journal of global antimicrobial resistance. 2020-04
Main Authors: Schauwvlieghe, A F A D, Bredius, R G M, Verdijk, Rob M, Smiers, Frans J W, van der Beek, Martha T, Goemans, Bianca F, Zwaan, C Michel, Brüggemann, Roger J, Rijnders, Bart J A
Format: Article
Language:English
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Summary:In the pre-azole era, central nervous system (CNS) infections with Aspergillus had a dismal outcome. Survival improved with voriconazole but CNS infections caused by azole-resistant A. fumigatus is precluding its use. Intravenous liposomal-amphotericin B (L-AmB) is the preferred treatment option for azole-resistant CNS infections but has suboptimal brain concentrations. We describe three patients with biopsy proven CNS aspergillosis where intraventricular L-AmB is added to systemic therapy. 2 patients with azole-resistant and 1 patient with azole-susceptible CNS aspergillosis were treated with intraventricular L-AmB at a dose of 1 mg weekly. We describe 3 patients successfully treated with a combination of intravenous and intraventricular L-AmB. All three patients survived but one patient has serious headache, most likely not related to this treatment. Intraventricular L-AmB may have a role in the treatment of therapy-refractory CNS aspergillosis when added to systemic therapy.
ISSN:2213-7173