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Blood, 15 October 2005, Vol. 106, No. 8, pp. 2641-2645. Prepublished online as a Blood First Edition Paper on July 5, 2005; DOI 10.1182/blood-2005-02-0733. This Article Full Text (PDF) All Versions of this Article: 2005-02-0733v1 106/8/2641    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Schwartz, S. Articles by Thiel, E. Search for Related Content PubMed PubMed Citation Articles by Schwartz, S. Articles by Thiel, E. Related Collections Related Letter in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted February 23, 2005 Accepted June 12, 2005 Improved outcome in central nervous system aspergillosis with voriconazole treatment Stefan Schwartz*, Markus Ruhnke, Patricia Ribaud, Lawrence Corey, Timothy Driscoll, Oliver A Cornely, Ulrich Schuler, Irja Lutsar, Peter Troke, and Eckhard Thiel Medizinische Klinik III, Charite Campus Benjamin Franklin, Freie Universitat, Berlin, Germany Medizinische Klinik und Poliklinik II, Charite Campus Mitte, Humboldt Universitat, Berlin, Germany Hopital Saint-Louis, Paris, France Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA, USA Divison of Hematology-Oncology, Duke University Medical Center, Durham, NC, USA Klinik I fur Innere Medizin, Klinikum der Universitat zu Koln, Koln, Germany Medizinische Klinik I, Universitatsklinikum Carl-Gustav-Carus, Dresden, Germany Institute of Microbiology, University of Tartu, Tartu, Estonia Pfizer Global Research, Sandwich, United Kingdom * Corresponding author; email: stefan.schwartz{at}charite.de. The mortality of central nervous system (CNS) aspergillosis approaches 100% requiring improved therapies. Voriconazole gives superior efficacy and survival in invasive aspergillosis compared to amphotericin B. Also, in contrast to other antifungal drugs, voriconazole penetrates well into the CNS. We evaluated, retrospectively, the outcome and survival of 81 patients, who were treated with voriconazole for definite (n=48) or probable (n=33) CNS aspergillosis. Complete and partial responses were recorded in 35% of patients and varied by the underlying disease group: hematological malignancies (54%), other underlying conditions (50%), chronic immunosuppression (45%), solid organ (36%) and hematopoietic stem cell transplantation (16%). Thirty-one percent of patients survived CNS aspergillosis for a median observation time of 390 days. Thirty-one patients underwent neurosurgical procedures, including craniotomy/abscess resection (n=14), abscess drainage (n=12), ventricular shunt (n=4), Ommaya-reservoir (n=1). Multifactorial analysis revealed that neurosurgery was associated with improved survival (p=0.02). Patients with hematopoietic stem cell transplantation had a poorer survival (p=0.02), but 7 of 32 (22%) survived for a median of 203 days. We conclude from this large cohort of patients, that voriconazole treatment together with neurosurgical management, whenever feasible, is currently the best approach to treat patients with CNS aspergillosis. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Letter in Blood Online: Improved outcome in central nervous system aspergillosis Pierre Tattevin, Yves Le Tulzo, Stefan Schwartz, Markus Ruhnke, Patricia Ribaud, Lawrence Corey, Timothy Driscoll, Oliver A. Cornely, Ulrich Schuler, Irja Lutsar, Peter Troke, and Eckhard Thiel Blood 2006 107: 3410-3412. [Full Text] [PDF] This article has been cited by other articles: L. Pagano, L. Fianchi, and M. Caira Pulmonary aspergillosis in hematologic malignancies: lights and shadows Haematologica, November 1, 2008; 93(11): 1611 - 1616. [Full Text] [PDF] P. Troke, K. Aguirrebengoa, C. Arteaga, D. Ellis, C. H. Heath, I. Lutsar, M. Rovira, Q. Nguyen, M. Slavin, S. C. A. Chen, et al. Treatment of Scedosporiosis with Voriconazole: Clinical Experience with 107 Patients Antimicrob. Agents Chemother., May 1, 2008; 52(5): 1743 - 1750. [Abstract] [Full Text] [PDF] A. Espinel-Ingroff, E. Johnson, H. Hockey, and P. Troke Activities of voriconazole, itraconazole and amphotericin B in vitro against 590 moulds from 323 patients in the voriconazole Phase III clinical studies J. Antimicrob. Chemother., March 1, 2008; 61(3): 616 - 620. [Abstract] [Full Text] [PDF] D. van de Beek, R. Patel, R. C. Daly, C. G. A. McGregor, and E. F. M. Wijdicks Central Nervous System Infections in Heart Transplant Recipients Arch Neurol, December 1, 2007; 64(12): 1715 - 1720. [Abstract] [Full Text] [PDF] M. Hummel, B. Spiess, K. Kentouche, S. Niggemann, C. Bohm, S. Reuter, M. Kiehl, H. Morz, R. Hehlmann, and D. Buchheidt Detection of Aspergillus DNA in Cerebrospinal Fluid from Patients with Cerebral Aspergillosis by a Nested PCR Assay J. Clin. Microbiol., November 1, 2006; 44(11): 3989 - 3993. [Abstract] [Full Text] [PDF] P. Leroy, A. Smismans, and T. Seute Invasive Pulmonary and Central Nervous System Aspergillosis After Near-Drowning of a Child: Case Report and Review of the Literature Pediatrics, August 1, 2006; 118(2): e509 - e513. [Abstract] [Full Text] [PDF] P. Tattevin, Y. Le Tulzo, S. Schwartz, M. Ruhnke, P. Ribaud, L. Corey, T. Driscoll, O. A. Cornely, U. Schuler, I. Lutsar, et al. Improved outcome in central nervous system aspergillosis Blood, April 15, 2006; 107(8): 3410 - 3412. [Full Text] [PDF]

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