Antifungal Therapy of Aspergillosis of the Central Nervous System and Aspergillus Endophthalmitis

Martin      Hoenigl; Robert      Krause

Abstract

Cerebral Aspergillosis is the most lethal manifestation of infection due to Aspergillus species arising most commonly as hematogenous dissemination from a pulmonary focus, direct extension from paranasal sinus infection or direct inoculation through trauma and surgery of the central nervous system (CNS). Voriconazole is currently considered the standard of treatment of CNS aspergillosis with liposomal amphotericin B being the next best alternative. Neurosurgical resection of infected cerebral tissue in addition to antifungal therapy is frequently performed in patients with CNS aspergillosis to prevent neurological deficits and improve outcome.

Aspergillus endophthalmitis may occur endogenously mostly from a pulmonary focus or exogenously following eye surgery or trauma. Although amphotericin B is still described as the primary therapy, voriconazole is increasingly considered the first line treatment of Aspergillus endophthalmitis. Vitrectomy is recommended in most cases of Aspergillus endophthalmitis.

Keywords: Aspergillus, invasive aspergillosis, endophthalmitis, central nervous system, CNS infection, blood brain barrier, CSF levels, tissue levels, voriconazole, posaconazole, amphotericin B, liposomal amphotericin B, echinocandin, itraconazole, epidemiology, surgery, surgical, neurosurgical, vitrectomy, intravitreal.