Aspergillus
Introduction:
Aspergillus is a fungus that commonly grows on decaying organic matter. In certain cases, it can cause infections in humans, particularly in immunocompromised patients. Aspergillus infections are a significant cause of morbidity and mortality, especially in patients with underlying diseases such as cancer or those undergoing transplantation. The diagnosis of Aspergillus infections is challenging, as the clinical symptoms are non-specific, and traditional diagnostic methods have limited sensitivity and specificity. In recent years, newer diagnostic tests, such as the detection of galactomannan (GM) in cerebrospinal fluid (CSF), have emerged as valuable tools in the diagnosis of Aspergillus infections.
Case presentation:
Mr. X, a 36-year-old male, was admitted to Neo Hospital in Noida, India, on April 17, 2023, under the care of Dr. Rajiv Motiani, a dedicated neuroscientist. The patient presented with a history of fever, headache, and altered sensorium for the past one week. The initial evaluation revealed a stiff neck, photophobia, and positive Kernig’s and Brudzinski’s signs. A computed tomography (CT) scan of the brain showed features suggestive of meningitis. The CSF analysis revealed an elevated protein level (85 mg/dl), low glucose (25 mg/dl), and an elevated white blood cell count (150 cells/μl) with lymphocytic predominance. Aspergillus galactomannan antigen testing of CSF was positive (2.4).
Treatment:
The patient was started on intravenous amphotericin B and voriconazole, which are antifungal medications effective against Aspergillus infections. The patient was also started on supportive therapy, including antipyretics, analgesics, and intravenous fluids. The patient’s condition gradually improved, and his sensorium improved over the next few days. The repeat CSF analysis on the 5th day showed a decrease in the white blood cell count (50 cells/μl), and the galactomannan antigen test was negative. The patient was continued on antifungal therapy for a total of 6 weeks and was discharged with advice to follow-up regularly.
Discussion:
Aspergillus infections are rare but potentially fatal infections that require prompt diagnosis and treatment. The diagnosis of Aspergillus infections is challenging, and a high index of suspicion is required, particularly in immunocompromised patients. The traditional methods of diagnosis, such as microscopy and culture, have limited sensitivity and specificity. The newer diagnostic methods, such as the detection of galactomannan antigen in blood or CSF, have emerged as valuable tools in the diagnosis of Aspergillus infections.
The treatment of Aspergillus infections involves the use of antifungal medications, such as amphotericin B and voriconazole. The choice of antifungal medication depends on the severity of the infection, the patient’s immune status, and the susceptibility of the organism to the medication. Supportive therapy, such as antipyretics, analgesics, and intravenous fluids, is also essential in the management of Aspergillus infections.
Conclusion:
Aspergillus infections are rare but potentially fatal infections that require prompt diagnosis and treatment. The diagnosis of Aspergillus infections is challenging, and a high index of suspicion is required, particularly in immunocompromised patients. The newer diagnostic methods, such as the detection of galactomannan antigen in blood or CSF, have emerged as valuable tools in the diagnosis of Aspergillus infections. The treatment of Aspergillus infections involves the use of antifungal medications, such as amphotericin B.