Fungal infections of the CNS - Treatment strategies for the immunocompromised patient

被引:58
作者
Black, Katharine E.
Baden, Lindsey R.
机构
[1] Brigham & Womens Hosp, Dana Farber Canc Inst, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Boston, MA 02115 USA
关键词
D O I
10.2165/00023210-200721040-00004
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Infections with fungi cause significant morbidity in the immunocompromised host and invasion of the CNS may lead to devastating consequences. Vulnerable individuals include those with haematological malignancies, transplant recipients, and those infected with HIV. Potential pathogens include yeasts, Aspergillus spp., other moulds of an increasing variety, and a range of dimorphic fungi, often associated with particular geographical locations. Antifungal treatments include polyenes such as amphotericin B and its lipid formulations, azoles such as fluconazole and itraconazole, and the more recent voriconazole and posaconazole. The new antifungal class of echinocandins, such as caspofungin, micafungin and anidulafungin, typically lack CNS penetration. Amphotericin B and flucytosine are used to initiate treatment for CNS yeast infections caused by Candida and Cryptococcus neoformans. Voriconazole is preferred for aspergillus, although amphotericin B, particularly in lipid formulation, is also useful. Reliable treatment data are lacking for CNS infections with most of the non-aspergillus moulds; posaconazole holds promise for the zygomycetes and perhaps some of the rarer pigmented fungi, but amphotericin B preparations are still recommended. Oral fluconazole is effective for the CNS manifestations of coccidioides, while histoplasmosis and blastomycoses typically require amphotericin B therapy. Effective treatment requires a definitive diagnosis, which is often challenging in the population at risk of CNS fungal infections.
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页码:293 / 318
页数:26
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共 156 条
  • [1] Successful therapy of cerebral phaeohyphomycosis due to Ramichloridium mackenziei with the new triazole posaconazole
    Al-Abdely, HM
    Alkhunaizi, AM
    Al-Tawfiq, JA
    Hassounah, M
    Rinaldi, MG
    Sutton, DA
    [J]. MEDICAL MYCOLOGY, 2005, 43 (01) : 91 - 95
  • [2] Study of renal safety in amphotericin B lipid complex-treated patients
    Alexander, BD
    Wingard, JR
    [J]. CLINICAL INFECTIOUS DISEASES, 2005, 40 : S414 - S421
  • [3] Neuroimaging as a guide to predict outcomes for patients with coccidioidal meningitis
    Arsura, EL
    Johnson, R
    Penrose, J
    Stewart, K
    Kilgore, W
    Reddy, CM
    Bobba, RK
    [J]. CLINICAL INFECTIOUS DISEASES, 2005, 40 (04) : 624 - 627
  • [4] Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: An international consensus
    Ascioglu, S
    Rex, JH
    de Pauw, B
    Bennett, JE
    Bille, J
    Crokaert, F
    Denning, DW
    Donnelly, JP
    Edwards, JE
    Erjavec, Z
    Fiere, D
    Lortholary, O
    Maertens, J
    Meis, JF
    Patterson, TF
    Ritter, J
    Selleslag, D
    Shah, PM
    Stevens, DA
    Walsh, TJ
    [J]. CLINICAL INFECTIOUS DISEASES, 2002, 34 (01) : 7 - 14
  • [5] Outbreak of histoplasmosis among cavers attending the National Speleological Society Annual Convention, Texas, 1994
    Ashford, DA
    Hajjeh, RA
    Kelley, MF
    Kaufman, L
    Hutwagner, L
    McNeil, MM
    [J]. AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, 1999, 60 (06) : 899 - 903
  • [6] Salvage therapy with voriconazole for invasive fungal infections in patients failing or intolerant to standard antifungal therapy
    Baden, LR
    Katz, JT
    Fishman, JA
    Koziol, C
    DelVecchio, A
    Doran, M
    Rubin, RH
    [J]. TRANSPLANTATION, 2003, 76 (11) : 1632 - 1637
  • [7] Successful treatment of cerebral blastomycosis with voriconazole
    Bakleh, M
    Aksamit, AJ
    Tleyjeh, IM
    Marshall, WF
    [J]. CLINICAL INFECTIOUS DISEASES, 2005, 40 (09) : E69 - E71
  • [8] Nonvalue of culturing cerebrospinal fluid for fungi
    Barenfanger, J
    Lawhorn, J
    Drake, C
    [J]. JOURNAL OF CLINICAL MICROBIOLOGY, 2004, 42 (01) : 236 - 238
  • [9] COMPARISON OF AMPHOTERICIN-B ALONE AND COMBINED WITH FLUCYTOSINE IN THE TREATMENT OF CRYPTOCCAL MENINGITIS
    BENNETT, JE
    DISMUKES, WE
    DUMA, RJ
    MEDOFF, G
    SANDE, MA
    GALLIS, H
    LEONARD, J
    FIELDS, BT
    BRADSHAW, M
    HAYWOOD, H
    MCGEE, ZA
    CATE, TR
    COBBS, CG
    WARNER, JF
    ALLING, DW
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1979, 301 (03) : 126 - 131
  • [10] Efficacy of caspofungin against invasive Candida or invasive Aspergillus infections in neutropenic patients
    Betts, R
    Glasmacher, A
    Maertens, J
    Maschmeyer, G
    Vazquez, JA
    Teppler, H
    Taylor, A
    Lupinacci, R
    Sable, C
    Kartsonis, N
    [J]. CANCER, 2006, 106 (02) : 466 - 473