Imaging paracoccidioidomycosis: A pictorial review from head to toe

Júnior, Marcos Rosa; Baldon, Isabella Vargas; Amorim, André Felipe Candeas; Fonseca, Ana Paula Alves; Volpato, Richard; Lourenço, Rafael Burgomeister; Baptista, Rodrigo Melo; Mello, Raquel Rodrigues Costa; Peçanha, Paulo Mendes; Falqueto, Aloísio

doi:10.1016/j.ejrad.2018.03.026

Cited by 17 publications

(27 citation statements)

References 48 publications

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“…Liquid necrotic lesions show restricted diffusion, whereas solid necrotic lesions do not have restriction of diffusion. 15,20,33 Similar to Reis et al, 33 all our cases presented with thoracic lesions. Gasparetto et al 20 also found thoracic alterations in most patients (88%), a finding that may help in the differential diagnosis.…”

Section: Discussionsupporting

confidence: 86%

“…Nevertheless, serologic tests and imaging examinations such as CT, MR imaging, and x-rays also play an important role in the diagnosis and evaluation of the disease. 1,[5][6][7][8][9][10][11][12][13][14][15][16][17] CNS involvement is more common than it was once believed, and the disease can affect the CNS, ranging from 1% to 27.27% of cases. [18][19][20][21][22][23][24][25] Although the brain form of PCM is usually an outcome of hematogenous or lymphatic dissemination of a primary focus, it is not necessarily followed by disseminated PCM; in a few cases, it is the only location of the fungus in the body.…”

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confidence: 99%

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Paracoccidioidomycosis of the Central Nervous System: CT and MR Imaging Findings

Júnior¹,

Amorim

Baldon

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Paracoccidioidomycosis is a fungal infection mainly caused by the thermodimorphic fungus Paracoccidioides. The purpose of our study was to demonstrate the neuroimaging findings from 24 patients with CNS paracoccidioidomycosis. MATERIALS AND METHODS:We performed a retrospective analysis focusing on the radiologic characteristics of CNS paracoccidioidomycosis. The 24 selected patients underwent MR imaging and/or CT, and the diagnosis was made by the presence of typical neuroimaging features, combined with fungus isolation, a serologic test, or the presence of disseminated disease. RESULTS:Headache was the most common neurologic symptom, while the pseudotumoral form was the most common pattern. The number of lesions ranged from 1 to 11, with most localized on the frontal lobe with .2-cm lesions. CT showed mainly hypoattenuating lesions, whereas MR imaging demonstrated mainly hyposignal lesions on T1WI and T2WI. Furthermore, ring enhancement was present in most patients. The "dual rim sign" on SWI occurred in 100% of our patients with lesions of .2 cm. CONCLUSIONS:The diagnosis of CNS paracoccidioidomycosis is difficult. Nevertheless, imaging examinations can play an important role in the diagnosis and evaluation of the disease.ABBREVIATIONS: PCM ¼ paracoccidioidomycosis; CT ¼ computed tomography; MRI ¼ magnetic resonance imaging; CNS ¼ central nervous system; DSC ¼ dynamic susceptibility contrast; DCE ¼ dynamic contrast enhanced; rCBV ¼ relative cerebral blood volume; Gd ¼ gadolinium P aracoccidioidomycosis (PCM) is a fungal infection, which is endemic in Latin America and is mainly caused by the thermodimorphic fungus Paracoccidioides spp, which primarily attacks the lungs and has a potential to disseminate to other organs. 1 Recently described are 4 other species of the genus Paracoccidioides apart from P brasiliensis: P lutzii, P restrepiensis, P venezuelensis, and P Americana. 2,3 Paracoccidioides spp inhabits primarily the soil and causes autochthonous infection from southern Mexico to northern Argentina. 4-6 Most reported cases (approximately 80%) are from Brazil, and the rest are mainly from Venezuela, Colombia, and Argentina. [6][7][8][9][10][11][12][13][14] The criterion standard for the diagnosis of PCM consists of demonstrating the presence of the fungus as multiple budding cells in clinical or tissue specimens. Nevertheless, serologic tests and imaging examinations such as CT, MR imaging, and x-rays also play an important role in the diagnosis and evaluation of the disease. 1,[5][6][7][8][9][10][11][12][13][14][15][16][17] CNS involvement is more common than it was once believed, and the disease can affect the CNS, ranging from 1% to 27.27% of cases. [18][19][20][21][22][23][24][25] Although the brain form of PCM is usually an outcome of hematogenous or lymphatic dissemination of a primary focus, it is not necessarily followed by disseminated PCM; in a few cases, it is the only location of the fungus in the body. 26 Our purpose was to describe the clinical and radiologic data (CT ...

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Section: Discussionsupporting

confidence: 86%

mentioning

confidence: 99%

Paracoccidioidomycosis of the Central Nervous System: CT and MR Imaging Findings

Júnior¹,

Amorim

Baldon

et al. 2019

AJNR Am J Neuroradiol

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“…The latter scintigraphic method has been shown to detect occult lesions in 21 (32%) of 65 patients with PCM. [77][78][79] In a series of 465 Brazilian patients, Peçanha et al reported 441 (91%) patients with pulmonary involvement in the chronic form of this disease. The main respiratory findings were cough, dyspnea, and sputum expectoration in 319 (66%), 219 (45%), and 210 (43%) of the patients, respectively.…”

Section: Chronic Paracoccidioidomycosis (Adult Type)mentioning

confidence: 99%

New Insights on Pulmonary Paracoccidioidomycosis

Queiroz-Telles

Peçanha-Pietrobom

Júnior

et al. 2020

Semin Respir Crit Care Med

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Paracoccidioidomycosis (PCM) is one of the most relevant systemic endemic mycoses in Latin American countries, especially in South American countries, with endemic and hyperendemic areas. The real burden of PCM may be underestimated because of a lack of compulsory case notification. Recent phylogenetic data revealed that Paracoccidioides brasiliensis comprises several cryptic species including P. brasiliensis and P. lutzii. However, the genetic biodiversity of Paracoccidioides does not affect the clinical manifestations or therapeutic response to therapy. Lung involvement is a common finding, especially in patients experiencing the chronic form of the disease, and, because of its similarities with tuberculosis, clinicians must be alert to the possibility of PCM in patients with chronic respiratory manifestations and epidemiological risk factors for this fungal disease.

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“…Na PCM, as lesões intraparenquimatosas podem ser totalmente sólidas, de padrão granulomatoso compacto, ou ter área central de necrose, semelhante a abscessos bacterianos. São encontradas lesões irregulares, com efeito de massa e realce periférico em anel após contraste em 76% delas, bem como edema perilesional em 82% 9 . Nesse estudo, as características tomográficas das lesões por PCM demonstraram hipodensidade (caso 1), captação intensa de contraste (caso 2) e halo de edema vasogênico (caso 4), como demonstra a Figura 2.…”

Section: Resultsunclassified

Doze Anos De Diagnóstico De Neuromicoses Em Unidade Oncológica: Série De Casos E Revisão Sistemática

Corrêa

Araújo

Soares

et al. 2021

RUC

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Objetivo: Elucidar o processo de diagnóstico cirúrgico de Neuromicoses e implicações prognósticas em uma unidade oncológica, entre os anos de 2009 e 2020. Métodos: Trata-se de um estudo retrospectivo em que foram analisados 129 laudosanatomopatológicos negativos para neoplasia, dos quais quatro casos concluíram etiologia fúngica, sendo três paracoccidioidomicose e um mucormicose. Uma revisão sistemática da literatura foi conduzida para referencial teórico, que levantou 77 casos para comparação. Resultados e Discussão: Os achados apresentados nesse estudo superaram a incidênciamundial documentada de neuroparacoccidioidomicose em mais de 2 vezes. Nessa série, a mucormicose do sistema nervoso central refletiu apresentação típica de doença rinocerebral, com desfecho fatal. Todos os pacientes desse estudo eram HIV negativos, mas provenientes de áreas endêmicas do Centro-Oeste e Sudeste brasileiros, além de possuírem fatores de riscopara infecções fúngicas invasivas e demonstrarem focos de acometimento extracraniano. Considerações finais: A ausência de investigação sobre o comprometimento em outros órgãos, bem como a espera por procedimento neurocirúrgico para o diagnóstico estão associadas a prejuízos à terapia adequada e tempo de hospitalização prolongada, que expõe os pacientes a maior risco de infecções nosocomiais. A subnotificação estatística supõe obstáculo importante ao avanço dos estudos em Neuromicoses, por isso é necessário investir em sistemas nacionais de vigilância e transformar as micoses endêmicas em doenças de notificação compulsória.

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Imaging paracoccidioidomycosis: A pictorial review from head to toe

Cited by 17 publications

References 48 publications

Paracoccidioidomycosis of the Central Nervous System: CT and MR Imaging Findings

Paracoccidioidomycosis of the Central Nervous System: CT and MR Imaging Findings

New Insights on Pulmonary Paracoccidioidomycosis

Doze Anos De Diagnóstico De Neuromicoses Em Unidade Oncológica: Série De Casos E Revisão Sistemática

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