Document Detail


Central nervous system paracoccidioidomycosis: diagnosis and treatment.
MedLine Citation:
PMID:  15629337     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article    
Journal Detail:
Title:  Surgical neurology     Volume:  63 Suppl 1     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2005  
Date Detail:
Created Date:  2005-01-04     Completed Date:  2005-03-08     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S13-21; discussion S21     Citation Subset:  IM    
Affiliation:
Division of Imaging, Department of Internal Medicine, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, 14048-900 Ribeirão Preto, SP, Brazil.
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MeSH Terms
Descriptor/Qualifier:
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:
0/Antifungal Agents

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