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Infection Post Transplant

Central nervous system aspergillosis in allogeneic stem cell transplant recipients

Bone Marrow Transplantation volume 31, pages 191–196 (2003)Cite this article

Summary:

Invasive aspergillosis (IA) is relatively common in allogeneic stem cell transplant (SCT) recipients. Although lungs are the most common site, central nervous system (CNS) involvement is also observed in this setting. We have retrospectively studied 14 cases of CNS aspergillosis found in a cohort of 455 allogeneic SCT recipients (incidence 3%). All patients, except one, had experienced acute graft-versus-host disease treated with high-dose methylprednisolone, and eight patients (57%) had also received ATG. The median time to the diagnosis of CNS aspergillosis was 124 days (range 49–347 days) from SCT. Pulmonary aspergillosis had been diagnosed earlier in four patients (29%). The most common initial symptoms of CNS aspergillosis were convulsions, hemiparesis, and mental alteration. Neuroradiological studies revealed single (two patients) or multiple (seven patients) focal lesions of 0.2–9 cm in diameter. Despite clinical suspicion in many patients, a confirmed diagnosis of CNS aspergillosis was made during life in only one patient. A total of 12 patients (86%) received amphotericin B. Despite therapy, all patients died 0–27 days (median seven days) after the initial CNS symptoms. CNS aspergillosis is not uncommon in allogeneic SCT recipients. Clinical manifestations are usually dramatic and progress quickly. Earlier and more effective treatment of IA is needed to prevent dissemination of infection into the CNS.

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Acknowledgements

This study was financially supported by Blood Disease Research Foundation of Finland.

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Authors and Affiliations

  1. Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland

    E Jantunen, L Volin, T Parkkali, V-J Anttila & T Ruutu

  2. Department of Medicine, Kuopio University Hospital, Kuopio, Finland

    E Jantunen

  3. Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland

    O Salonen & A Piilonen

  4. Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland

    A Paetau

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Jantunen, E., Volin, L., Salonen, O. et al. Central nervous system aspergillosis in allogeneic stem cell transplant recipients. Bone Marrow Transplant 31, 191–196 (2003). https://doi.org/10.1038/sj.bmt.1703812

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