| Central nervous system paracoccidioidomycosis: diagnosis and treatment. | |
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MedLine Citation:
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PMID: 15629337 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Paracoccidioidomycosis (PCM) is a systemic mycosis caused by Paracoccidioides brasiliensis. The involvement of the central nervous system (CNS) in paracoccidioidomycosis is higher than previously thought and 2 clinical presentations have been reported, meningitis and pseudotumoral. METHODS: Twenty medical records of patients with CNS paracoccidioidomycosis treated from 1986 to 2003 were analyzed. The follow-up ranged from 1 to 18 years (mean = 8.9 +/- 4.2). RESULTS: Besides CNS paracoccidioidomycosis, all patients but one had the chronic systemic form and the pseudotumoral clinical presentation was the most frequent. Based on computed tomography scan findings, 4 image patterns were identified: low-density lesion with ring enhancement, lesion with calcification and ring enhancement, multiloculated low-density lesion with ring enhancement, and diffuse subarachnoid enhancement. The magnetic resonance imaging was performed in 3 patients and showed subarachnoid enhancement in 1 patient and heterogeneous lesion with ring enhancement in 2 patients. Eleven patients were submitted to medical treatment and 9 needed neurosurgical treatment; ventriculoperitoneal shunts in 4 patients, brain lesions resection in 3 patients, and partial resection of spinal cord lesions in 2 patients. Eleven patients had excellent outcome, 4 patients died, 3 are in good clinical condition with residual pulmonary dysfunction, and 1 patient was lost to follow-up. CONCLUSIONS: The diagnosis of paracoccidioidomycosis with involvement of the CNS is difficult and clinical suspicion is a key point to achieve the correct diagnosis. Patients with early diagnosis have a favorable outcome with clinical or surgical treatment. |
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Authors:
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Jorge Elias; Antonio Carlos dos Santos; Carlos Gilberto Carlotti; Benedicto Oscar Colli; Alexandre Canheu; Caio Matias; Luciano Furlanetti; Roberto Martinez; Osvaldo Massaiti Takayanagui; Américo Ceiki Sakamoto; Luciano Neder Serafini; Leila Chimelli |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Surgical neurology Volume: 63 Suppl 1 ISSN: 0090-3019 ISO Abbreviation: Surg Neurol Publication Date: 2005 |
Date Detail:
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Created Date: 2005-01-04 Completed Date: 2005-03-08 Revised Date: 2009-11-19 |
Medline Journal Info:
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Nlm Unique ID: 0367070 Medline TA: Surg Neurol Country: United States |
Other Details:
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Languages: eng Pagination: S13-21; discussion S21 Citation Subset: IM |
Affiliation:
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Division of Imaging, Department of Internal Medicine, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, 14048-900 Ribeirão Preto, SP, Brazil. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Antifungal Agents / therapeutic use Brain / microbiology*, pathology*, radiography Brain Neoplasms / diagnosis Calcinosis / microbiology, pathology, radiography Central Nervous System Fungal Infections / diagnosis*, mortality, therapy* Diagnosis, Differential Female Follow-Up Studies Humans Hydrocephalus / microbiology, pathology, radiography Magnetic Resonance Imaging Male Meningitis, Fungal / microbiology, pathology, radiography Middle Aged Neurosurgical Procedures / statistics & numerical data Paracoccidioidomycosis / diagnosis*, mortality, therapy* Retrospective Studies Tomography, X-Ray Computed Treatment Outcome Ventriculoperitoneal Shunt / statistics & numerical data |
| Chemical | |
Reg. No./Substance:
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0/Antifungal Agents |
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