Improved outcome in central nervous system aspergillosis, using voriconazole treatment
Improved outcome in central nervous system aspergillosis, using voriconazole treatment
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DOI：
10.1182/blood-2005-02-0733
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发表时间：
2005-10-15
期刊：
影响因子：
20.3
通讯作者：
Thiel, E
中科院分区：
文献类型：
--
作者：
Schwartz, S;Ruhnke, M;Thiel, E
中枢神经系统（CNS）曲霉病的死亡率接近100%，需要改进的治疗。与两性霉素B相比，伏立康唑在侵袭性曲菌病中具有上级的疗效和生存率。此外，与其他抗真菌药物相比，伏立康唑可以很好地渗透到CNS中。我们回顾性评估了81例接受伏立康唑治疗的确诊（n = 48）或疑似（n = 33）CNS曲霉病患者的结局和生存率。在35%的患者中记录了完全和部分缓解，并根据基础疾病组而有所不同：血液恶性肿瘤（54%），其他基础疾病（50%），慢性免疫抑制（45%），实体器官移植（36%）和造血干细胞移植（16%）。31%的CNS曲霉病患者存活，中位观察时间为390天。有31例患者接受了神经外科手术，包括开颅术/脓肿切除术（n = 14）、脓肿引流术（n = 12）、脑室分流术（n = 4）和Ommaya储血器（n = 1）。多因素分析显示，神经外科手术与生存率提高相关（P = 0.02）。接受造血干细胞移植的患者生存率较低（P = 0.02），但32例患者中有7例（22%）存活中位数为203天。我们从这个大的患者队列中得出结论，伏立康唑治疗结合神经外科治疗，只要可行，是目前治疗CNS曲霉病患者的最佳方法。
The mortality of central nervous system (CNS) aspergillosis approaches 100%, requiring improved therapies. Voriconazole gives superior efficacy and survival in invasive aspergillosis, compared with amphotericin B. Also, in contrast to other antifungal drugs, voriconazole penetrates well into the CNS. We evaluated, retrospectively, the outcome and survival of 81 patients who were treated with voriconazole for definite (n = 48) or probable (n = 33) CNS aspergillosis. Complete and partial responses were recorded in 35% of patients and varied by the underlying disease group: hematologic malignancies (54%), other underlying conditions (50%), chronic immunosuppression (45%), solid organ transplantation (36%), and hematopoietic stem cell transplantation (16%). Thirty-one percent of patients survived CNS aspergillosis for a median observation time of 390 days. There were 31 patients who underwent neurosurgical procedures, including craniotomy/abscess resection (n = 14), abscess drainage (n = 12), ventricular shunt (n = 4), and Ommaya-reservoir (n = 1). Multifactorial analysis revealed that neurosurgery was associated with improved survival (P = .02). Patients who underwent hematopoietic stem cell transplantation had a poorer survival (P = .02), but 7 (22%) of 32 survived for a median of 203 days. We conclude from this large cohort of patients that voriconazole treatment together with neurosurgical management, whenever feasible, is currently the best approach to treat patients with CNS aspergillosis.