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Fungal Infections and Studies / Ocular Infections and Treatments · Journal article
Journal of Fungi · September 4, 2026
Early or partial results. Treat as a signal, not a conclusion.
This retrospective cohort of 8 patients with CNS-disseminated aspergillosis among hematologic malignancy patients describes a uniformly fatal phenotype (88% 12-week mortality, 0% clinical response) despite more intensive antifungal therapy, compared to 45% mortality and 35% response in matched pulmonary-only aspergillosis controls. The authors acknowledge substantial limitations due to small sample size and historical clustering, and the study does not establish whether combination therapy improved outcomes.
Retrospective cohort study with matched controls. Patients with hematologic malignancies diagnosed with invasive aspergillosis between 1993 and 2024 at a single institution. Baseline characteristics assessed included malignancy subtype, hematopoietic stem cell transplantation status, neutropenia, and antifungal prophylaxis.. Intervention: CNS-disseminated invasive aspergillosis (infection involving ≥2 non-contiguous organ systems including the CNS); various antifungal therapies administered including combination regimens in 63% of cases.. Compared with: Matched cohorts of patients with isolated invasive pulmonary aspergillosis (IPA; n derived from 1:3 matching, not stated as absolute number) and other forms of disseminated IA without CNS involvement.. n = 8. Single institution (not named); conduct limited to one centre over 31-year period..
No patients with CNS-disseminated IA achieved clinical response at end of therapy (0/8), versus 35% with IPA (p = 0.05) 12-week IA-associated mortality was 88% in CNS-disseminated IA versus 45% in IPA (p = 0.028) 12-week IA-associated mortality was 88% in CNS-disseminated IA versus 46% in other disseminated IA (p = 0.05)
12-week IA-associated mortality was 88% in CNS-disseminated IA versus 45% in IPA (p = 0.028) 12-week IA-associated mortality was 88% in CNS-disseminated IA versus 46% in other disseminated IA (p = 0.05)
CNS aspergillosis in hematologic malignancy patients carries near-universal short-term mortality with no observed clinical responses despite combination antifungal therapy, suggesting this complication represents a therapeutic failure point. Clinicians should recognize CNS involvement as a distinct, prognostically grave phenotype, though the rarity and historical clustering of cases limit generalizability and warrant confirmation in prospective or multicenter studies.
Small retrospective cohort (8 CNS cases) from a single institution over 30 years, identifying a rare phenotype with poor outcomes but explicitly cautioning that findings should be interpreted with caution due to small numbers and historical case clustering.
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CNS aspergillosis in hematologic malignancy patients carries near-universal short-term mortality with no observed clinical responses despite combination antifungal therapy, suggesting this complication represents a therapeutic failure point. Clinicians should recognize CNS involvement as a distinct, prognostically grave phenotype, though the rarity and historical clustering of cases limit generalizability and warrant confirmation in prospective or multicenter studies.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background: Disseminated invasive aspergillosis (IA) is an uncommon but devastating manifestation of disease, particularly when the central nervous system (CNS) is involved. The clinical features and outcomes of CNS dissemination, compared with isolated invasive pulmonary aspergillosis (IPA) and other disseminated forms, remain poorly characterized. Methods: Using an institutional database of 1157 cancer patients diagnosed with IA between 1993 and 2024, we identified 43 patients with disseminated IA, defined as infection involving ≥2 non-contiguous organ systems, including 8 with CNS involvement. Patients with disseminated IA were matched 1:3 to patients with IPA based on year of diagnosis. We compared clinical features, antifungal treatment, and outcomes between: (1) CNS-disseminated IA and IPA, and (2) CNS-disseminated IA and other forms of disseminated IA. Results: Baseline characteristics, including hematologic malignancy subtype, hematopoietic stem cell transplantation status, neutropenia, and antifungal prophylaxis, were similar across groups. Aspergillus fumigatus was the predominant species in all cohorts. No patients with CNS-disseminated IA achieved clinical response at end of therapy, versus 35% with IPA (p = 0.05) and 30% with other disseminated IA (p = 0.17). Twelve-week IA-associated mortality was significantly higher in CNS-disseminated IA than in IPA (88% vs. 45%, p = 0.028) and was higher than in other disseminated IA (88% vs. 46%, p = 0.05). Combination antifungal therapy was more frequently used in CNS-disseminated IA than in IPA (63% vs. 31%) and other disseminated IA (63% vs. 43%), while rates of ICU admission and mechanical ventilation were similar across groups. Conclusions: CNS involvement in disseminated IA defines a distinct, high-risk phenotype, with profoundly reduced treatment response and survival despite comparable baseline characteristics. Given the small number of CNS cases and the predominance of cases diagnosed during earlier study periods, these findings should be interpreted with caution. Although combination antifungal therapy was used more frequently in CNS-disseminated IA, no significant outcome benefit was observed, underscoring the need for improved therapeutic approaches for CNS aspergillosis in immunocompromised hosts.
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