Pre-operative Voriconazole in patients undergoing surgery for Central Nervous System fungal infections: Special Report

J Pak Med Assoc. 2019 Jan;69(1):103-107.

Abstract

Fungal infections of the central nervous system (CNS) are uncommon. Despite several advancements in diagnosis and treatment of these infections, the mortality rates remain high. The current retrospective study was planned to define the demographic and clinical features of patients with CNS fungal infections. Conducted at Aga Khan University Hospital, Karachi, and comprising CNS fungal infections operated between January 2000 and December 2015. The study analysed whether a short course of pre-operative anti-fungal therapy may improve outcomes in these patients. There were 47 cases confirmed on histopathology and/or microbiology. Outcome measures used were Glasgow coma score (GCS), Glasgow outcome score (GOS) and Karnofsky performance score (KPS). The overall 30-day mortality was 20(42.5%). Fungal infections of the CNS can occur in both immune-compromised and immune-competent patients. Early diagnosis, radical surgery, pre-operative anti-fungal therapy for at least 2 weeks, pre- and postoperative Voriconazole therapy results in more favourable outcomes.

Keywords: Central nervous system, Fungal infection, Craniotomy, Voriconazole..

MeSH terms

  • Antifungal Agents / administration & dosage
  • Central Nervous System Fungal Infections* / drug therapy
  • Central Nervous System Fungal Infections* / microbiology
  • Central Nervous System Fungal Infections* / mortality
  • Central Nervous System Fungal Infections* / surgery
  • Craniotomy* / adverse effects
  • Craniotomy* / methods
  • Early Diagnosis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / adverse effects
  • Neurosurgical Procedures / methods
  • Outcome and Process Assessment, Health Care
  • Pakistan / epidemiology
  • Preoperative Care / methods*
  • Risk Factors
  • Time Factors
  • Voriconazole / administration & dosage*

Substances

  • Antifungal Agents
  • Voriconazole