Autopsy and biopsy study of paracoccidioidomycosis and neuroparacoccidioidomycosis with and without HIV co‐infection

Abstract

Paracoccidioidomycosis (PCM) is a systemic mycosis prevalent among immunocompetent patients in Latin America. This study aimed to describe the frequency, demographics and clinical characteristics of central nervous system PCM (NPCM) and PCM in an endemic region, and the impact of human immunosuppression virus (HIV) co-infection. This was a retrospective study of autopsy and biopsy reports from the Medical Pathology Section of the Hospital de Clinicas, UFPR, Curitiba, Southern Brazil, between 1951 and 2014. PCM was present in 0.1% of 378,323 cases examined, with 5.7% being NPCM. Infection was prevalent in working-age men, agricultural workers and rural residents. Numbers of HIV autopsy cases increased over time, while those of PCM cases decreased. Prevalence of co-infection of HIV/PCM and HIV/NPCM was 1.6%, and 0.4%, respectively. Adrenals were affected more frequently in the NPCM group compared with the PCM group. Mortality was higher on NPCM group. The clinical course of PCM in HIV patients resembles an acute/sub-acute infection. Association of NPCM and HIV is rare, while diagnosis of NPCM is difficult, it should be considered a differential diagnosis in HIV patients who live in, or have visited, endemic areas and present with neurological symptoms.

Neuroparacoccidioidomycosis: A 13-Year Cohort Study, Rio de Janeiro, Brazil

“…NPCM prevalence among PCM cases in the literature varies depending on the methodology used for investigation and the studied area. It ranges from 3.4% to 13.9% in some retrospective cohort studies [7,8], reaching 36.0% in necropsy evaluations [9,10]. Imaging studies using computerized tomography (CT) showed a prevalence of 12.5% for NPCM among PCM patients without neurologic symptoms [11].…”

Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report

“…Pulmonary findings may be localized or may be part of a more disseminated disease. [7][8][9][10][11] A small number of patients remain subclinical. Acute lung infection rapidly spreads to the lymph nodes, liver and spleen.…”

“…Radiological findings are unspecific, and include micronodular infiltrates, foci of consolidation, cavities, fibrosis or, infrequently, calcified nodules. [7][8][9][10][11] The histopathological findings range from neutrophilic microabscesses, scattered interstitial necrotizing granulomas, and consolidative granulomatous pneumonia. Progressive pulmonary disease is more common than acute/subacute lung involvement.…”

“…The prevalence of NPDM ranges from 4% to 15% of cases of systemic PDM. 1,4,10,12,13 Manifestations of the involvement of the CNS include headache, lethargy, raised intracranial pressure, and personality changes. Neuroparacoccidioidomycosis is most commonly associated with symptoms and signs of an expansive lesion in the brain (pseudotumorous form) or to a meningitic form.…”

Geographical evaluation of Neuroparacoccidioidomycosis and Paracoccidioidomycosis in Southern Brazil

“…This study included autopsy reports between 1951 and 2014 and biopsy reports from 1954 to 2014. PCM and NPCM diagnosis criteria were described previously . PCM (systemic PCM and NPCM) was diagnosed in 381 cases, in this period; 199 cases were excluded (135 cases because CNS autopsy was not performed, in 39 the medical charts could not be located or there was no information about the city of origin, and 25 cases were from other states).…”