Title:Antifungal Therapy of Aspergillosis of the Central Nervous System and Aspergillus Endophthalmitis
Volume: 19
Issue: 20
Author(s): Martin Hoenigl and Robert Krause
Affiliation:
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.
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.
