Clinical and laboratory features of sinus-originated intracranial aspergillosis and rhino-orbito-cerebral mucormycosis： a comparative analysis
10.19845/j.cnki.zfysjjbzz.2024.0021
- VernacularTitle:窦源性颅内曲霉菌病与鼻-眶-脑毛霉菌病的临床及实验室检查特点比较
- Author:
Yushu JIANG
1
,
2
,
3
,
4
;
Wei LI
1
,
2
,
3
,
4
Author Information
1. Department of Neurology，The People'
2. s Hospital of Zhengzhou University &
3. Henan Provincial People'
4. s Hospital，Zhengzhou 450003，China
- Publication Type:Journal Article
- Keywords:
Central nervous system;
Fungal infection;
Aspergillus;
Mucormycosis
- MeSH:
Aspergillus;
Mucormycosis
- From:
Journal of Apoplexy and Nervous Diseases
2024;41(2):108-115
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the clinical features and auxiliary examination results of sinus-originated intracranial aspergillosis（ICA）and rhino-orbito-cerebral mucormycosis（ROCM）. Methods A retrospective analysis was performed for the clinical data of seven patients with sinus-originated ICA and six patients with ROCM who were diagnosed and treated in our hospital from January 2018 to January 2023. Results The pathogenic factor of CNS fungal infection was observed in all patients with ROCM and 57.1% of the patients with sinus-originated ICA. Compared with the patients with sinus-originated ICA，the patients with ROCM were more likely to develop ocular symptoms and signs such as exophthalmos，periorbital swelling，and intraocular inflammation，as well as non-ocular symptoms and signs including fever，facial swelling，and facial nerve palsy. Compared with the patients with sinus-originated ICA，the patients with ROCM had significantly greater increases in blood glucose，erythrocyte sedimentation rate，C-reactive protein，and procalcitonin. Cranial magnetic resonance imaging showed that sinus-originated ICA often affected the paranasal sinuses，orbital apices，retro-orbital regions，and cavernous sinuses，while the patients with ROCM were more likely to have sinusitis，bone destruction，and mucormycosis invading cerebral vessels. As for treatment，50% of the patients with ROCM and 42.9% of the patients with sinus-originated ICA received antifungal therapy alone，while 50% of the patients with ROCM and 57.1% of the patients with sinus-originated ICA received a combination of medication and surgery. By follow-up to September 2023，50% of the patients with ROCM and 28.6% of the patients with sinus-originated ICA had no response to treatment and died. Conclusion Both sinus-originated ICA and ROCM have rapid progression，and ROCM survivors with diabetes are more likely to experience disabilities. Timely diagnosis and initiation of antifungal therapy，correction of underlying predisposing factors，and active surgical debridement are essential for the treatment of CNS fungal infections.
