Monosporium apiospermum meningoencephalitis: a clinico-pathological case.

Abstract

Twenty nine cases of central nervous system infection due to Monosporium apiospermum have been reported. Six of them occurred after an aspiration pneumonia following a near drowning. The case of a 53 year old man is reported: M apiospermum was isolated from cerebrospinal fluid, sputum, urine and from the mud of the ditch where the patient had fallen. Though the treatment used recommended doses of intravenous, intrathecal and intraventricular amphotericin B, it was ineffective and the patient died 97 days after the near drowning. Necropsy showed that the ventricular infectious process was more prominent distant from the antifungal ventricular source. frontal headache and mild neck stiffness appeared while the remaining neurological examination was normal. CSF was clear with normal pressure and contained 280 leukocytes/mm3 (76% polymorphonuclear), 180 mg/dl proteins and 29 mg/dl glucose; CSF cultures were sterile. Brain CT scan revealed a left cerebellar lesion suggesting an abscess. Staphylococcus dermatitis was isolated from the blood cultures and catheter, and the patient was .treated with rifampicin (1800 mg IV daily), vancomycin (1500 mg IV daily) and ornidazole (1 g IV daily). Hydrocortisone (50 mg) and chloramphenicol (50 mg) were administered intrathecally every three days.The temperature fell to 37°C within three days but the patient remained confused. Thrombocytopaenia (75,000 platelets/mm3) was seen between day 47-50, and on the fifty first day, transient macular rashes appeared on

True Fungal Mycotic Aneurysm of the Basilar Artery: A Clinical and Surgical Dilemma

“…The prior case described a patient who experienced a near drowning and developed a fatal mycotic aneurysm with an associated brain abscess [20]. Near drowning appears to be the single most common risk factor in the reported cases of CNS infection from Scedosporium , occurring in approximately 20% of the cases [20, 21, 22, 23, 24, 25]. Our patient did not suffer a near drowning, but a history of fresh water exposure was not taken.…”

“…Intrathecal dosing is common in the treatment of fungal CNS infection, particularly for amphotericin B, as it limits systemic toxicity. Intrathecal amphotericin B was described in a case of S. apiospermum meningitis, but the patient died despite aggressive treatment [21]. …”

Infections Caused byScedosporiumspp

“…Several authors, however, have suggested that the hypoxic state following submersion or the use of corticosteroids for treatment of aspiration pneumonia may compromise host immune responses, facilitating the penetration and spreading of the organism (108,109,283). The mode of fungal invasion in submersion victims is not always obvious.…”

“…Infectious lesions in organs other than the CNS have been reported in 13 of the 21 cases, including in the lung (7 of 21, usually manifested as bronchopneumonia) (78,109,110,179,216,283,448), kidney (3 of 21) (108,110,283), eye (3 of 21, manifested as endophthalmitis or chorioretinitis) (110,283,473), musculoskeletal system (2 of 21, manifested as knee joint synovitis, femoral and tibial osteomyelitis, or spondylodiscitis) (110,144), heart (2 of 21) (108, 110), liver (283), skin (erythematous lesions with purplish-black necrotic centers in arms and abdomen) (110), and thyroid gland (110).…”

“…The diagnosis of P. boydii infection in near-drowning victims was delayed, as the fungus was isolated from respiratory secretions in only 6 of 21 cases (78,109,110,216,283,448) and from cerebrospinal fluid (CSF) obtained by lumbar puncture in only 3 patients (109,131,225). In the majority of cases the organism was isolated from material obtained by aspiration or surgical drainage of brain abscesses.…”