Brain aspergillomycosis — the fungal damage to brain fabrics caused by aspergilla. There are mainly at patients with immunosupressivny states against the background of diseases of blood, malignant tumors, organs transplantation, long glucocorticoid treatment. It is shown by weakness, nausea, fever, a headache, focal neurologic symptomatology. Aspergillomycosis by results of neurologic survey, MPT/KT of a brain, the analysis of a likvor, IFA, PTsR-researches is diagnosed. Treatment is based on long reception of system antimycotics.
Brain aspergillomycosis met extremely seldom earlier. In economically developed countries annual incidence made 34 cases on 1 million population. The main forms were damages of easy and okolonosovy bosoms. On aspergillomycosis of other bodies, including a brain, 5% were necessary. Persons with immunodeficiency are subject to a disease. Growth of number of cases of aspergillomycosis in general and aspergillyozny damage of a brain in particular is lately noted that is caused by the increased number of patients with an immune supressiya. Every 5th immunokomprometirovanny patient has fungal diseases. Aspergillomycosis makes up to 70% of such cases. Age and gender distinctions in incidence are not traced.
The causative agent of a disease — mold mushrooms of a sort Aspergillus. Are widespread everywhere: in the soil, grain, dust, ventilating systems, on houseplants, food. Are found in dust of medical institutions. The cases of infection of medical tools for inhalation therapy, conditioners of hospital chambers which provoked developing of an intrahospital infection are described. The fungus gets in mainly airborne way to time of inhalation of air with the parts of dust containing a mycelium into a human body. Infection cases through the damaged integuments and meet food. The sick person is not an infection source. Treat the factors promoting development of cerebral aspergillomycosis:
- Gemoblastoza, followed by the expressed neytropeniya and agranulotsitozy (a sharp leukosis, aplastic anemia). Falling of number of immune blood cells leads to development of a secondary immunodeficiency.
- HIV infection. Virus defeat of immune system is followed by sharp reduction of resilience of an organism.
- Long kortikosteroidny therapy. Application of glucocorticoids negatively affects over 3 weeks immune system.
- Cytostatic treatment. It is appointed to the cancer patients, patients undergoing transplantation of marrow or bodies. Leads to a neytropeniya and an immunodeficiency.
- Chronic diseases which long course is complicated by an immune supressiya. Enter into group: tuberculosis, HOBL, , bronkhoektatichesky disease, diabetes.
- Injuries, burns, surgical interventions – promote infection of a wound surface against the background of the immunity reduced owing to traumatizing.
- Installation of venous catheters. Infection is possible at pollution of skin in the place of a catheter disputes .
The greatest risk represents a combination of several factors. For example, surgeries at sick HIV, bone marrow transplantation at leukemia.
Normal, thanks to adequate work of immunity, at hit fungal a dispute aspergillomycosis does not develop in a human body. In the absence of the due immune answer disputes settle in easy and nasal bosoms, with current of blood are brought in cerebral fabrics. Infection of hypermarket without the previous defeat of easy or other bodies is observed extremely seldom. In brain fabrics fungi form colonies, cause inflammatory changes with formation of abscesses. The obturation of an aspergillama of a gleam of intrakranialny vessels with development of zones of ischemia and hemorrhagic treatment, intracerebral hemorrhages is characteristic. Defeat of covers of a brain with developing of meningitis is noted in rare instances.
Brain aspergillomycosis symptoms
The clinical symptomatology has no specific manifestations. Usually cerebral aspergillomycosis begins with a headache, nausea, weakness, dizziness. Often there is a temperature increase. Fever can arise in the debut of cerebral defeat and several days later from the beginning of clinical manifestations. The sharp demonstration with symptoms of violation of brain blood circulation (an ischemic, hemorrhagic stroke) is possible.
Focal neurologic deficiency develops in the first days of a disease, sometimes sharply, with bystry progressing, consciousness violation. The symptomatology depends on an arrangement of the aspergillyozny centers. Weakness in half of body is observed (hemiparesis), a sleep of the person, a unilateral smoothness of a nasolabial fold, a dizartriya. Emergence of the specified manifestations at patients with the diagnosed aspergillomycosis of other localization, against the background of cytostatic chemotherapy, a gemoblastoz is characteristic.
The brain sdavleniye which is followed by violation of the TsNS vital functions acts as a terrible complication of cerebral aspergillomycosis. The compression is caused by the intracerebral abscesses growing in volume, izlitiy blood in brain substance at massive intra cranial bleeding. Also leads treatment of tissues of brain to a sdavleniye blood at the constant diapedezny hemorrhages caused by defeat of an aspergillama of cerebral vessels.
Aspergillomycosis of a brain represents a complex diagnostic challenge. Rare occurrence in practical neurology, not specificity of symptomatology, difficulty of identification of the activator in blood and a likvor complicate diagnosis. Enter an algorithm of diagnosis of a disease:
- Collecting anamnesis. Allows to establish existence of HIV, blood diseases, the aspergillomycosis of lungs revealed earlier; to obtain data on treatment by cytostatics/glucocorticosteroids.
- Survey of the neurologist. On the nature of changes of the neurologic status it is possible to judge existence of organic defeat of brain structures, localization of pathological process.
- Neurovisualization. Apply brain KT or MPT, sometimes – their combination. Tomograms confirm existence of abscesses, ischemic sites with gemorragiya, intracerebral hemorrhages.
- Lyumbalny puncture. It is made for a likvor fence. Aspergilla seldom are found at a research of the received tserebrospinalny liquid. The analysis helps to exclude other cerebral diseases, to diagnose the fact of intra cranial hemorrhage.
- Laboratory diagnostics. Use IFA of blood, cerebrospinal fluid, urine on identification of an aspergillyozny anti-gene. Carry out PTsR-diagnostics. Reliability of the last makes 67%, specificity – 95%.
- Research of respiratory organs. It is necessary for a diagnostics/exception of defeats of respiratory system. The X-ray analysis of a thorax, KT of lungs, a bronkhoskopiya with a fence of a phlegm and its subsequent research is carried out.
Cerebral aspergillomycosis is differentiated from tuberculosis, cysticercosis, toxoplasmosis, bacterial abscess of hypermarket, lymphoma of cerebral localization, intracerebral tumors. The leading role in a difdiagnostika is played by results of laboratory researches, identification of damage of respiratory organs.
Treatment of aspergillomycosis of a brain
Therapy is performed by system antimikotichesky medicines. Complexity of treatment of defeats of hypermarket is connected with bad penetration of the majority of antifungal means through a hematoencephalic barrier (GEB). Besides, intake of medicines in brain fabrics is interfered by occlusion of cerebral vessels of an aspergillama. Now act as choice medicines in treatment of cerebral aspergillomycosis:
- Amfoteritsin In – highly effective medicine, but hardly passes GEB. It is used in the combined therapy with vorikonazoly.
- Intrakonazol can be appointed as monotherapy. Well collects brain fabrics. Concentration in tserebrospinalny liquid low.
- Vorikonazol – gives good concentration in a likvor, accumulates brain substance. It is applied independently, at inefficiency of monotherapy – together with amfoteritsiny.
Antifungal therapy is performed on an extent of half a year up to several years. As criterion of efficiency permanent stabilization of neurologic symptomatology, lack of increase in number and the sizes of the cerebral centers according to a magnetic and resonant tomography acts.
Forecast and prevention
Aspergillomycosis of brain localization always has the serious forecast connected also with the main disease which became the reason of an immune supressiya (gemoblastozy, malignant new growths, AIDS). In due time begun and adequately picked up therapy by antimycotics allows to achieve remission, to prolong life of patients. Aspergillomycosis at patients with an immunodeficiency an exception of agricultural works, contacts with the soil, communication with animals, stay in dusty places helps to warn. Indoors, where there is a patient (at home, in medical institution), it is not recommended to hold houseplants. In hospitals for infection prevention immunokomprometirovanny patients accommodate in individual chambers with special locks, air filters.