Cerebral aspergillosis in the era of new antifungals: the CEREALS national cohort study Nationwide CEREbral Aspergillosis Lesional study (CEREALS) - Université de Lyon Access content directly
Journal Articles Journal of Infection Year : 2022

Cerebral aspergillosis in the era of new antifungals: the CEREALS national cohort study Nationwide CEREbral Aspergillosis Lesional study (CEREALS)

V Letscher-Bru
  • Function : Author
G Hekimian
  • Function : Author

Abstract

Background - Cerebral aspergillosis (CA) is a life-threatening disease for which diagnosis and management remain challenging. Detailed analyses from large cohorts are lacking. Methods - We included 119 cases of proven (n = 54) or probable (n = 65) CA diagnosed between 2006 and 2018 at 20 French hospitals. Data were collected at baseline and during follow-up. Cerebral imaging was reviewed centrally by two neuroradiologists. Results - The most frequent underlying conditions were hematological malignancy (40%) and solid organ transplantation (29%). Galactomannan was detected in the serum of 64% of patients. In 75% of cases, at least one of galactomannan, Aspergillus PCR, and β-d-glucan was positive in the cerebrospinal fluid. Six-week mortality was 45%. Two distinct patterns of disease were identified according to presumed route of dissemination. Presumed haematogenous dissemination (n = 88) was associated with a higher frequency of impaired consciousness (64%), shorter time to diagnosis, the presence of multiple abscesses (70%), microangiopathy (52%), detection of serum galactomannan (69%) and Aspergillus PCR (68%), and higher six-week mortality (54%). By contrast, contiguous dissemination from the paranasal sinuses (n = 31) was associated with a higher frequency of cranial nerve palsy (65%), evidence of meningitis on cerebral imaging (83%), macrovascular lesions (61%), delayed diagnosis, and lower six-week mortality (30%). In multivariate analysis and in a risk prediction model, haematogenous dissemination, hematological malignancy and the detection of serum galactomannan were associated with higher six-week mortality. Conclusion - Distinguishing between hematogenous and contiguous dissemination patterns appears to be critical in the workup for CA, as they are associated with significant differences in clinical presentation and outcome.
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hal-03468425 , version 1 (07-01-2022)

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A Serris, J Benzakoun, F Danion, R Porcher, R Sonneville, et al.. Cerebral aspergillosis in the era of new antifungals: the CEREALS national cohort study Nationwide CEREbral Aspergillosis Lesional study (CEREALS). Journal of Infection, 2022, 84 (2), pp.227-236. ⟨10.1016/j.jinf.2021.11.014⟩. ⟨hal-03468425⟩
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