epiglucan and Central-Nervous-System-Fungal-Infections

We report a case of Fonsecaea monophora cerebral phaeohyphomycosis successfully treated with surgical excision and voriconazole monotherapy in a patient receiving maintenance immunosuppression therapy for 8 years after cadaveric renal transplantation. She presented with a severe frontal headache in the absence of any constitutional or neurologic symptoms. Brain magnetic resonance imaging showed an irregular 3.1 x 3.4 cm ring-enhancing lesion in her left frontal lobe. The patient underwent craniotomy and resection of her mass, with intraoperative spillage of some of her abscess contents into her lateral ventricle. Histopathology of her resected mass showed necrotic fragments of brain parenchyma with granulomatous inflammation and numerous pigmented fungal forms. A mold, recovered from cultures inoculated with portions of her brain resection specimen, was later definitively identified as Fonsecaea monophora. Initial serum (1-->3) beta-D-glucan (BG) levels exceeded 500 pg/ml. The patient received voriconazole, which she tolerated well, without recurrent headaches or abscess formation noted on serial brain imaging. Her BG declined to <31 pg/ml one year following her abscess resection. She discontinued antifungal therapy after an 18-month treatment course, and has remained free of any clinical or radiographic evidence of recurrent abscess formation three years later.

Topics: Antifungal Agents; Ascomycota; beta-Glucans; Central Nervous System Fungal Infections; Female; Frontal Lobe; Histocytochemistry; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Magnetic Resonance Imaging; Microscopy; Middle Aged; Pyrimidines; Radiography; Treatment Outcome; Triazoles; Voriconazole

The diagnostic usefulness of beta-D-glucan values and the efficacy of flconazole (FLCZ) were investigated in 20 patients with deep-seated mycosis treated in our neurosurgical department from Oct 1, 1997 to May 31, 1998. The diagnosis of deep-seated mycosis was carried out using mycological and serological methods. When the serological beta-D-glucan value was above 10 pg/ml, the patient was considered to have deep-seated mycosis. In 13 patients (65%), the definite diagnosis of deep-seated mycosis was established by culture. In 7 patients, diagnosis based on serological examination alone was false positive or false negative. FLCZ 200 or 400 mg per day was administered for 10 days. Three patients were administered 200 mg/day FLCZ for another 10 days. No side effect of FLCZ was noticed among these patients. Three of 13 patients (23%) in whom fungi were isolated became fungi negative after FLCZ administration. The mean beta-D-glucan values before and after the administration of FLCZ were 36.37 mg/ml and 13.75 mg/ml, respectively. The beta-D-glucan values before and after the administration of FLCZ were significantly correlated with statistics (Student's t-test; p < 0.001). It was concluded that FLCZ was useful, and that beta-D-glucan values generally reflected the therapeutic effect of FLCZ. In contrast to the mycological culture tests that provided only a low detection rate, beta-D-glucan values were useful not only as a diagnostic means but also as a means to evaluate the efficacy of FLCZ treatment.

Topics: Adult; Aged; Aged, 80 and over; Antifungal Agents; beta-Glucans; Biomarkers; Central Nervous System Fungal Infections; Fluconazole; Glucans; Humans; Middle Aged

Primary fungal infection of the central nervous system (CNS) is rare but often associated with severe prognosis. Diagnosis is complicated since cerebrospinal fluid (CSF) samples obtained from lumbar puncture usually remain sterile. Testing for fungal antigens in CSF could be a complementary diagnostic tool. We conducted such measurements in CSF from patients with CNS fungal infection and now discuss the usefulness of ventricular puncture. Mannan and (1→3)ß-D-glucan (BDG) testing were retrospectively performed in CSF samples from three patients with proven chronic CNS fungal infection (excluding Cryptococcus), and subsequently compared to 16 controls. Results from lumbar punctures and those from cerebral ventricles were confronted. BDG detection was positive in all the CSF samples (from lumbar and/or ventricular puncture) from the three confirmed cases. In case of Candida infection, mannan antigen measurement was positive in 75% of the CSF samples. In the control group, all antigen detections were negative (n = 15), except for one false positive. Faced with suspected chronic CNS fungal infection, measurement of BDG levels appears to be a complementary diagnostic tool to circumvent the limitations of mycological cultures from lumbar punctures. In the event of negative results, more invasive procedures should be considered, such as ventricular puncture.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Antigens, Fungal; beta-Glucans; Biomarkers; Central Nervous System Fungal Infections; Cerebrospinal Fluid; Chronic Disease; Diagnostic Tests, Routine; Female; Healthy Volunteers; Humans; Male; Mannans; Middle Aged; Retrospective Studies; Treatment Outcome; Triazoles

Fungal infections of the central nervous system (FICNS) are important causes of morbidity and mortality among immunocompromised pediatric patients. Standard diagnostic modalities lack the sensitivity for detecting and therapeutically monitoring these life-threatening diseases. Current molecular methods remain investigational. (1→3)-β-d-glucan (BDG) is a cell wall component found in several fungal pathogens, including Candida and Aspergillus spp. Detecting BDG in cerebrospinal fluid (CSF) may be an important approach for detecting and therapeutically monitoring FICNS. To date, there has been no study that has investigated the effectiveness of CSF BDG as a diagnostic and therapeutic marker of FICNS in children.. Serial BDG levels were measured in serum and CSF samples obtained from pediatric patients (aged 0-18 years) with a diagnosis of probable or proven Candida or Aspergillus CNS infection.. Nine cases of FICNS were identified in patients aged 1 month to 18 years. Two patients were infected with an Aspergillus species, and 7 patients were infected with a Candida species. All the patients at baseline had detectable BDG in their CSF. Among 7 patients who completed therapy for an FICNS, all elevated CSF BDG levels decreased to <31 pg/mL. At the time of this writing, 1 patient was still receiving therapy and continued to have elevated BDG levels. One patient died from overwhelming disseminated candidiasis. The lengths of therapy for these 9 children ranged from 2 weeks to 28 months.. The BDG assay is useful in diagnosing and therapeutically monitoring Candida and Aspergillus CNS infections in pediatric patients.

Topics: Aspergillosis; beta-Glucans; Biomarkers; Candida; Candidiasis; Central Nervous System Fungal Infections; Child; Humans; Nervous System; Proteoglycans

(1-3)-β-d-Glucan (BDG) from cerebrospinal fluid (CSF) is a promising marker for diagnostic and prognostic aid of central nervous system (CNS) fungal infection, but its relationship to serum values has not been studied. Herein, we detected BDG from CSF at levels 2-fold lower than those in serum in patients without evidence of fungal disease but 25-fold higher than those in in serum in noncryptococcal CNS fungal infections. CSF BDG may be a useful biomarker in the evaluation of fungal CNS disease.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; beta-Glucans; Biomarkers; Central Nervous System Fungal Infections; Female; Humans; Male; Middle Aged; Proteoglycans; Young Adult

Topics: Adult; beta-Glucans; Biomarkers; Central Nervous System Fungal Infections; Female; Humans; Male; Middle Aged