Central nervous system aspergillosis in children: a systematic review of reported cases

Objective: Central nervous system (CNS) aspergillosis is a life-threatening disease that has had a published mortality of >80%. Little is known about this serious Infection in the pediatric population. We conducted this study to analyze characteristics of CNS aspergillosis in infants and children.

Methods: The English literature was reviewed and all CNS aspergillosis cases in patients younger than 18 years of age were analyzed.

Results: Ninety cases were recorded up to June 2005. The median age of the patients was 9 years, ranging from 18 days to 18 years (15.6% younger than 1 year). CNS aspergillosis most commonly presented as brain abscess(es), either single or multiple. While prematurity was the predominant underlying condition among infants, leukemia was the most frequent underlying disease in children. Aspergillus fumigatus was isolated from 75.5% of the cases. The overall mortality in published cases was 65.4%. In multivariate analysis, surgical treatment was independently associated with survival.

Conclusion: CNS aspergillosis in infants and children predominantly presents as brain abscess(es) and has significantly better outcome compared to published adult data. The findings of this systematic review could assist future investigations for improved outcome of this life-threatening Infection in pediatric patients.