Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole

• Published in: Antimicrobial agents and chemotherapy 2015-12, Vol.59 (12), p.7857-7861
• Main Authors: Morgand, Marjolaine, Rammaert, Blandine, Poirée, Sylvain, Bougnoux, Marie-Elisabeth, Tran, Hugo, Kania, Romain, Chrétien, Fabrice, Jouvion, Gregory, Lortholary, Olivier
• Format: Article
• Language: English
• Subjects: Aged; Antifungal Agents; Antifungal Agents - therapeutic use; Aspergillus; Aspergillus flavus - drug effects; Aspergillus flavus - growth & development; Aspergillus flavus - pathogenicity; Aspergillus fumigatus - drug effects; Aspergillus fumigatus - growth & development; Aspergillus fumigatus - pathogenicity; beta-Glucans - blood; beta-Glucans - cerebrospinal fluid; Candida albicans - drug effects; Candida albicans - growth & development; Candida albicans - pathogenicity; Chronic Disease; Clinical Therapeutics; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - microbiology; Female; Humans; Meningitis, Fungal; Meningitis, Fungal - complications; Meningitis, Fungal - diagnosis; Meningitis, Fungal - drug therapy; Meningitis, Fungal - microbiology; Neuroaspergillosis; Neuroaspergillosis - complications; Neuroaspergillosis - diagnosis; Neuroaspergillosis - drug therapy; Neuroaspergillosis - microbiology; Otitis; Otitis - complications; Otitis - diagnosis; Otitis - drug therapy; Otitis - microbiology; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - microbiology; Sinusitis; Sinusitis - complications; Sinusitis - diagnosis; Sinusitis - drug therapy; Sinusitis - microbiology; Treatment Outcome; Voriconazole; Voriconazole - therapeutic use
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/AAC.01506-15

Invasive aspergillosis (IA) is a severe disseminated fungal disease that occurs mostly in immunocompromised patients. However, central nervous system IA, combining meningitis and skull base involvement, does not occur only in groups with classic risk factors for IA; patients with chronic renal failure and diabetes mellitus are also at risk for more chronic forms. In both of our proven IA cases, voriconazole monotherapy was effective without surgery, and cerebrospinal fluid and serum 1,3-β-d-glucan test results were initially positive, in contrast to galactomannan antigen results.