{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:52:21Z","timestamp":1791942741486,"version":"4.3.4"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,1,22]],"date-time":"2019-01-22T00:00:00Z","timestamp":1548115200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2019,3]]},"abstract":"Summary<\/jats:title>Invasive fungal infections (IFI<\/jats:styled-content>) of the Central Nervous System (IFI<\/jats:styled-content>\u2010CNS<\/jats:styled-content>) and Paranasal Sinuses (IFI<\/jats:styled-content>\u2010PS<\/jats:styled-content>) are rare, life\u2010threatening infections in haematologic patients, and their management remains a challenge despite the availability of new diagnostic techniques and novel antifungal agents. In addition, analyses of large cohorts of patients focusing on these rare IFI<\/jats:styled-content> are still lacking. Between January 2010 and December 2016, 89 consecutive cases of Proven (53) or Probable (36) IFI<\/jats:styled-content>\u2010CNS<\/jats:styled-content> (71\/89) and IFI<\/jats:styled-content>\u2010PS<\/jats:styled-content> (18\/89) were collected in 34 haematological centres. The median age was 40\u00a0years (range 5\u201079); acute leukaemia was the most common underlying disease (69%) and 29% of cases received a previous allogeneic stem cell transplant. Aspergillus spp<\/jats:italic>. were the most common pathogens (69%), followed by mucormycetes (22%), Cryptococcus spp<\/jats:italic>. (4%) and Fusarium spp<\/jats:italic>. (2%). The lung was the primary focus of fungal infection (48% of cases). The nervous system biopsy was performed in 10% of IFI<\/jats:styled-content>\u2010CNS<\/jats:styled-content>, and a sinus biopsy was performed in 56% of IFI<\/jats:styled-content>\u2010PS<\/jats:styled-content> (P<\/jats:italic>\u00a0=\u00a00.03). The Galactomannan test on cerebrospinal fluid has been performed in 42% of IFI<\/jats:styled-content>\u2010CNS<\/jats:styled-content> (30\/71), and it was positive in 67%. Eighty\u2010four pts received a first\u2010line antifungal therapy with Amphotericine B in 58% of cases, Voriconazole in 31% and both in 11%. Moreover, 58% of patients received 2 or more lines of therapy and 38% were treated with a combination of 2 or more antifungal drugs. The median duration of antifungal therapy was 60\u00a0days (range 5\u2010835). A surgical intervention was performed in 26% of cases but only 10% of IFI<\/jats:styled-content>\u2010CNS<\/jats:styled-content> underwent neurosurgical intervention. The overall response rate to antifungal therapy (complete or partial response) was 57%, and 1\u2010year overall survival was 32% without significant differences between IFI<\/jats:styled-content>\u2010CNS<\/jats:styled-content> and IFI<\/jats:styled-content>\u2010PS<\/jats:styled-content>. The overall mortality was 69% but the IFI<\/jats:styled-content> attributable mortality was 33%. Mortality of IFI<\/jats:styled-content>\u2010CNS<\/jats:styled-content>\/PS<\/jats:styled-content> remains high but, compared to previous historical data, it seems to be reduced probably due to the availability of newer antifungal drugs. The results arising from this large contemporary cohort of cases may allow a more effective diagnostic and therapeutic management of these very rare IFI<\/jats:styled-content> complications in haematologic patients.<\/jats:p>","DOI":"10.1111\/myc.12884","type":"journal-article","created":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T11:30:15Z","timestamp":1545219015000},"page":"252-260","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":73,"title":["Fungal infections of the central nervous system and paranasal sinuses in onco\u2010haematologic patients. Epidemiological study reporting the diagnostic\u2010therapeutic approach and outcome in 89 cases"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4436-1310","authenticated-orcid":false,"given":"A.","family":"Candoni","sequence":"first","affiliation":[{"name":"Clinica Ematologica ASUI Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Klimko","sequence":"additional","affiliation":[{"name":"Metchnikov North\u2010Western State Medical University St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Busca","sequence":"additional","affiliation":[{"name":"S.C. Ematologia AO Citt\u00e0 della Salute e della Scienza Torino Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Di Blasi","sequence":"additional","affiliation":[{"name":"Istituto di Ematologia Polo Onco\u2010Ematologico Fondazione Policlinico A. 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