Aspergillosis of central nervous system in patients with leukemia and stem cell transplantation: a systematic review of case reports

Background: Aspergillosis of Central Nervous System (CNS) is a highly lethal infection in patients with leukemia and Stem Cell Transplantation (SCT). Methods: Case reports of CNS aspergillosis in patients with leukemia and SCT published between 1990 and August 2020 were gathered using a structured search through PubMed/Medline. Results: Sixty-seven cases were identified over the searches of the PubMed bibliographic database and then, 59 cases were included in the final analysis. Europe had the largest share of cases at 57.6 (34 reports), followed by Americas and Asia. Affected patients were predominantly males (58.6) and the mean age of the patients was 36.1 years, while 62.7 of the patients were under the age of 50 years. The most common leukemia types include Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), and Acute Myeloid Leukemia (AML) at 43.4, 27.4, and 23.5, respectively. Furthermore, stem cell transplantation was reported in 11 cases. The overall mortality was 33; however, the attributable mortality rate of CNS aspergillosis was 24.5. Altered mental status, hemiparesis, cranial nerve palsies, and seizures were the clearest manifestations of infection and lung involvement reported in 57 of the patients. Histopathologic examination led to the diagnosis of infection in 57 of the patients followed by culture (23.7), galactomannan assay (8.5), and molecular method (3.3). Amphotericin B and voriconazole were the most frequently used drugs for infection treatment. Good results were not obtained in one-third of the patients treated by voriconazole. Finally, neurosurgical intervention was used for 23 patients (39). Conclusion: CNS aspergillosis is a rapidly progressive infection in leukemic patients. Thus, these patients should be followed up more carefully. Furthermore, management of induction chemotherapy, use of different diagnostic methods, and use of appropriate antifungal can lead to infection control. © 2021, The Author(s)

Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series

Background: Patients with diabetes are known as an important high-risk group for cerebral mucormycosis (CM). Method: We conducted a structured search using PubMed/MEDLINE to collect both case reports and case series case (ie including at least two patients) onto CM in diabetic patient published between 2000 and March 2020. Results: Forty-five reports of individual cases and eighteen case series articles were included. India accounted for the largest share of reports with 37.7 and 38.8 of individual cases and case series, respectively. Mortality ranged from 0 to 100 in the case series. The overall mortality in the individual cases was 46.3, and 64.2 of deaths were reported in patients with ketoacidosis diabetes. Facial swelling (53.3), headache (44.4), loss of vision (35.5) and ophthalmoplegia (35.5) were the most frequently reported clinical symptoms. In all patients except 4 (91.1), CM was treated surgically; however, in many cases (42), despite the use of surgery, death occurred. Amphotericin B deoxycholate (AMB) and lipid-based AMB (LAMB) were used as the first lines of treatment for all patients; however, posaconazole, echinocandins, hyperbaric oxygen therapy (HBOT) and deferasirox were used in combination for a number of patients. Posaconazole has been shown to have positive therapeutic effect; however, posaconazole, LAMB and HBOT are not commonly used in low-income and health-challenged countries. Conclusion: Cerebral mucormycosis is a rapidly progressive infection in diabetic patients and carries immense morbidity despite early diagnosis and treatment. Low-income countries have had the highest number of reports of the disease in recent years, indicating the need to control diabetes in these countries. © 2020 Wiley-VCH Gmb

Evaluation of the effect of endoscopic partial middle-turbinectomy surgery on the quality of life of patients with chronic rhinosinusitis and nasal polyps

Background: Chronic rhinosinusitis (CRS) is a common chronic inflammatory disease. Endoscopic sinus surgery is recommended as a standard method when medical treatment fails. The effectiveness of various complementary surgical methods such as endoscopic partial middle-turbinectomy is controversial in the improvement of CRS symptoms in these patients. This study aimed to investigate the effect of endoscopic partial middle-turbinectomy on the quality of life (QOL) of patients with chronic rhinosinusitis and nasal polyps (CRSwNP) in Iran. Method: Ninety patients with CRSwNP of grades 3 and 4 were randomly assigned to either an intervention (45 patients) or control group (45 patients). In the control group, endoscopic sinus surgery without middle turbinectomy was performed and in the intervention group, endoscopic partial middle-turbinectomy was performed in addition to endoscopic sinus surgery. To evaluate the outcomes, the SNOT-22 QOL questionnaire was used, and the results were analyzed using SPSS version 24. Results: Most of the patients were male and had a mean age of 39 years. The mean SNOT-22 QOL questionnaire scores were 49.13±16.72 and 52.51±16.95 before surgery in the control and intervention groups respectively, which did not show any significant difference. In contrast, after endoscopic surgery these scores changed to 28.46±12.38 and 11.13±5.55 in the control and intervention groups, respectively< and there was a significant difference between both groups. Although there was a significant improvement in both groups, the patients in the intervention group experienced more improvement than the control group (41.4 (±16.46) vs 30.7 (±18.27), respectively Conclusion: According to this study, it appears that the use of endoscopic partial middle-turbinectomy in addition to endoscopic sinus surgery improves CRS symptoms and the QOL of patients compared with endoscopic sinus surgery alone. © 2020, International Rhinologic Society. All rights reserved