Histoplasmose do sistema nervoso central aspectos clínicos em oito pacientes: clinical features in eight patients

Machado, L. R.; Nobrega, J. P. S.; Livramento, José Antônio; Vianna, L.S.; A-França, A. Spin

doi:10.1590/s0004-282x1993000200010

Cited by 8 publications

(5 citation statements)

References 12 publications

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“…We found 1159 studies and included 108 manuscripts published between 1962 and 2022, totaling 298 patients 7–10,12–115 . We excluded 38 articles that could not be retrieved.…”

Section: Resultsmentioning

confidence: 99%

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

Oliveira

Kruschewsky

Sekiguchi

et al. 2023

Mycoses

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Background:The knowledge of central nervous system (CNS) histoplasmosis is limited to case reports and series.Objectives: Our objective was to synthesise clinical, radiological and laboratory characteristics of CNS histoplasmosis to improve our understanding of this rare disease. Methods:We performed a systematic review using Pubmed/MEDLINE, Embase and LILACS databases accessed on March 2023 without publication date restrictions.Inclusion criteria comprised: (1) histopathological, microbiological, antigen or serological evidence of histoplasmosis; (2) CNS involvement based on cerebrospinal fluid pleocytosis or neuroimaging abnormalities. We classified the certainty of the diagnosis in proven (CNS microbiological and histopathological confirmation), probable (CNS serological and antigen confirmation) or possible (non-CNS evidence of histoplasmosis). Metaproportion was used to provide a summary measure with 95% confidence intervals for the clinical, radiological and laboratory characteristics. Chi-squared test was used to compare mortality between pairs of antifungal drugs. Results:We included 108 studies with 298 patients. The median age was 31 years, predominantly male, and only 23% were immunocompromised (134/276, 95%CI: 3-71), mainly due to HIV infection. The most common CNS symptom was headache (130/236, 55%, 95%CI: 49-61), with a duration predominantly of weeks or months.Radiological presentation included histoplasmoma (79/185, 34%, 95%CI: 14-61), meningitis (29/185, 14%, 95%CI: 7-25), hydrocephalus (41/185, 37%, 95%CI: 7-83) and vasculitis (18/185, 6%, 95%CI: 1-22). There were 124 proven cases, 112 probable cases and 40 possible cases. The majority of patients presented positive results in CNS pathology (90%), serology (CSF: 72%; serum: 70%) or CSF antigen (74%). Mortality was high (28%, 56/198), but lower in patients who used liposomal amphotericin B and itraconazole. Relapse occurred in 13% (23/179), particularly in HIV patients, but less frequently in patients who used itraconazole. Conclusion:Central nervous system histoplasmosis usually presents subacute-tochronic symptoms in young adults. Neuroimaging patterns included not only focal lesions but also hydrocephalus, meningitis and vasculitis. Positive results were

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“…We found 1159 studies and included 108 manuscripts published between 1962 and 2022, totaling 298 patients 7–10,12–115 . We excluded 38 articles that could not be retrieved.…”

Section: Resultsmentioning

confidence: 99%

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

Oliveira

Kruschewsky

Sekiguchi

et al. 2023

Mycoses

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“…A primeira paciente chegou a nós relativamente bem, confirmando a afirmação de Machado e col. 11 de ser o quadro clínico por ocasião do diagnóstico em geral relativamente benigno. Tiraboschi e col. 12 ressaltam que o acometimento do SNC, embora ocorra em 10 a 25% dos pacientes com doença disseminada, pode não ser diagnosticado caso não haja procura ativa nesse sentido.…”

Section: Discussionunclassified

Histoplasmose do sistema nervoso central como única manifestação da doença em pacientes imunocompetentes: apresentação de dois casos

Levi

Pozzi²,

Hirschheimer³

et al. 2003

Arq. Neuro-Psiquiatr.

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RESUMO -Apresentamos dois casos de histoplasmose em que o acometimento do sistema nervoso central foi a única manifestação clínica da doença. Revisão da literatura permitiu confirmar a raridade dessa forma de patologia, em particular em crianças, sendo o segundo caso aqui apresentado o de mais baixa idade na literatura nacional. São feitos comentários sobre a variedade das apresentações clínicas e os principais diagnósticos diferenciais da doença. São discutidos os resultados laboratoriais, tanto em relação às alterações liquóricas quanto aos resultados sorológicos. Finalmente, é analisada a terapêutica dessa forma de infecção fúngica tanto em relação aos medicamentos utilizáveis quanto à duração prolongada aconselhável para o tratamento específico.PALAVRAS-CHAVE: histoplasmose cerebral, meningite crônica, terapêutica antifúngica. C C C C Central nervous system involvement by histoplasmosis as the unique manifestation of this disease in entral nervous system involvement by histoplasmosis as the unique manifestation of this disease in entral nervous system involvement by histoplasmosis as the unique manifestation of this disease in entral nervous system involvement by histoplasmosis as the unique manifestation of this disease in entral nervous system involvement by histoplasmosis as the unique manifestation of this disease in immunocompetent patients: presentation of two cases immunocompetent patients: presentation of two cases immunocompetent patients: presentation of two cases immunocompetent patients: presentation of two cases immunocompetent patients: presentation of two cases ABSTRACT -We present two patients with central nervous system involvement as the unique clinical manifestation of histoplasmosis. A clinical review confirmed the infrequency of this form of the disease, overall in childhood, being one of these cases the youngest in Brazilian reports. Comments about the diversity of clinical presentation and main differential diagnosis are presented. We analyze the serologic and cerebrospinal fluid results and, finally, discuss the drugs and duration of treatment.KEY WORDS: cerebral histoplasmosis, chronic meningitis, antifungal therapy. A infecção pelo Histoplasma capsulatum é relativamente comum em nosso meio. Lacaz e col.1 , empregando o teste cutâneo da histoplasmina, verificaram positividade de 16,0% no Rio de Janeiro, 19,0% em São Paulo, 19,2% em Goiás e 27,5% no Pará. A maioria dessas infecções, no entanto, é oligo ou assintomática, sendo os casos com manifestação clí-nica franca uma pequena minoria (menos que 5% nas exposições de baixo nível, porém mais comum após exposições mais intensas 2 ). As formas mais frequentemente descritas da histoplasmose são basicamente de dois tipos: 1.Doença progressiva grave, em geral disseminada, em indivíduos com comprometimento da imunidade. Nos anos mais recentes a maioria desses casos foi descrita em pacientes com a síndrome da imunodeficiência adquirida 3 , havendo também relatos em pacientes com lupus eritematoso 4,5 e com a síndrome da linfopenia CD 4 idiop...

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“…The signs and symptoms presented by patients with CNS histoplasmosis include fever, headaches, lethargy, altered mental status, weakness, hydrocephalus, and focal neurological deficits that resemble cerebrovascular accidents [ 26 , 38 ]. CNS histoplasmosis patients can develop subacute or chronic lymphocytic meningitis (the most common), diffuse encephalitis, cerebral embolism, and spinal cord injuries [ 32 , 39 , 40 , 41 ]. In patients with cerebrospinal meningitis, the basilar meninges are the most severely affected area ( Figure 2 ), and fluid pleocytosis can be observed [ 39 , 40 , 41 , 42 ].…”

Section: Histoplasmosismentioning

confidence: 99%

Section: Histoplasmosismentioning

confidence: 99%

“…CNS histoplasmosis patients can develop subacute or chronic lymphocytic meningitis (the most common), diffuse encephalitis, cerebral embolism, and spinal cord injuries [32,[39][40][41]. In patients with cerebrospinal meningitis, the basilar meninges are the most severely affected area (Figure 2), and fluid pleocytosis can be observed [39][40][41][42]. In general, focal lesions associated with parenchymal masses in the brain or spinal cord (abscesses, histoplasmomas) in the course of CNS histoplasmosis are unusual [43,44].…”

Section: Clinical Formsmentioning

confidence: 99%

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Central Nervous System Histoplasmosis: An Updated Insight

et al. 2023

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Histoplasmosis is one of the systemic mycoses that can involve the Central Nervous System (CNS), and it is caused by the dimorphic ascomycete species of the Histoplasma capsulatum complex. Once in the CNS, this pathogen causes life-threatening injuries that are associated with clinical manifestations of meningitis, focal lesions (abscesses, histoplasmomas), and spinal cord injuries. The present review provides updated data and highlights a particular vision regarding this mycosis and its causative agent, as well as its epidemiology, clinical forms, pathogenesis, diagnosis, and therapy, focusing on the CNS.

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Histoplasmose do sistema nervoso central aspectos clínicos em oito pacientes: clinical features in eight patients

Cited by 8 publications

References 12 publications

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

Histoplasmose do sistema nervoso central como única manifestação da doença em pacientes imunocompetentes: apresentação de dois casos

Central Nervous System Histoplasmosis: An Updated Insight

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