Aspergillus fumigatus

Aspergillus species are ubiquitous, and infection is acquired by inhaling conidia. CNS aspergillosis is rare in immunocompetent individuals. Isolated aspergilloma are unusual, except in intravenous drug abusers. Individuals who are granulocytopenic and those who have received organ transplantation are at risk for brain abscesses owing to aspergillosis. CNS aspergillosis typically occurs preferentially in major vascular territories and presents as isolated or multiple ischemic infarctions or subarachnoid hemorrhage from a ruptured mycotic aneurysm.^5 The majority of patients with aspergillosis will have an unremitting fever, despite broad-spectrum antibiotics, and pulmonary infiltrates on chest radiographs. [118] The diagnosis is made

through sputum culture or lung tissue biopsy culture. CSF analysis is usually not helpful because meningitis is unusual. '115' Aspergillus is rarely, if ever, cultured from blood. Treatment should include intavenous amphotericin B (0.8 to 1.0 mg/kg/d) plus flucytosine (100 mg/kg/d in four divided doses).

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