Paracoccidioidomicose sistêmica com envolvimento do sistema nervoso central

Duarte, Antônio Luiz Wiener Pureza; Baruffa, Giovanni; Terra, Helena Beatriz Grassi; Renck, Décio Valente; Moura, Daniela de Queiroz; Petrucci, Cunha

doi:10.1590/s0037-86821999000400015

Cited by 12 publications

(10 citation statements)

References 7 publications

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“…The 18 reports left provided 44 cases. 1,4,16,17,23,[25][26][27][28][29][30][31][32][33][34][35][36][37] The information available were categorized and the results are in ►Table 1.…”

Section: Discussionmentioning

confidence: 99%

Neuroparacoccidioidomycosis: Case Report and Literature Review

Morais¹,

Georgeto

Haddad

et al. 2018

Arq Bras Neurocir

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Introduction Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis, and it can compromise the central nervous system (CNS) in 10-27% of all cases. Case Report A 31-year-old man presented to the Emergency Department with headache, left-sided weakness, clonus at the ankle and a positive Babinski sign. Head computed tomography (CT) and magnetic resonance imaging (MRI) scans showed a 5.1 Â 3.8 cm lobulated lesion with areas of liquefaction in the right centrum semiovale. Discussion Central nervous system PCM can mimic a brain tumor, and most cases are diagnosed by biopsy of the lesion. The treatment includes antibiotics, but some cases require surgery. Conclusion Due to high morbimortality rates, the diagnosis must be considered, and early treatment started in patients who live in rural regions endemic for PCM when a ring-enhancing mass associated with perilesional edema is observed on MRI scans.

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“…The 18 reports left provided 44 cases. 1,4,16,17,23,[25][26][27][28][29][30][31][32][33][34][35][36][37] The information available were categorized and the results are in ►Table 1.…”

Section: Discussionmentioning

confidence: 99%

Neuroparacoccidioidomycosis: Case Report and Literature Review

Morais¹,

Georgeto

Haddad

et al. 2018

Arq Bras Neurocir

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“…Hipertensão intracraniana, déficits dos nervos cranianos, déficits mot o res, distúrbios de marcha, alterações da consciência e crises convulsivas são as manifestações clínicas mais freqüentes 3,4,34,35 .…”

Section: Tabela Avaliação De Treze Pacientes Com Pcm No Snc Após Trunclassified

Paracoccidioidomicose do sistema nervoso central: análise de 13 casos

Fagundes-Pereyra

Carvalho²,

Góes

et al. 2006

Arq. Neuro-Psiquiatr.

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A paracoccidioidomicose (PCM) é infecção granulomatosa sistêmica, causada pelo fungo Paracoccidioides brasiliensis, prevalente na América Latina, particularmente no Brasil. Acomete o sistema nervoso central (SNC) em 10% dos casos. Foram estudados 13 pacientes com paracoccidioidomicose no SNC, entre 1991 e 2001, com ênfase para os aspectos clínicos, neuroradiológicos e terapêuticos. Onze pacientes eram do sexo masculino (84,6%) e dois do feminino (15,4%), com idade entre 30 e 71 anos (M= 47,1 ± 11,6 Me= 46). Os sintomas mais freqüentes foram déficits motores (53,8%), alterações cognitivas (53,8%), emagrecimento (46,1%), cefaléia (46,1%) e crises convulsivas (46,1%). O diagnóstico foi confirmado pela detecção do P. brasiliensis no SNC. Todos os pacientes apresentavam a forma granulomatosa e quatro (30,8%) tinham a forma meningoencefalítica associada. Todos foram estudados com tomografia computadorizada (TC) de crânio e um caso com ressonância magnética (RM) encefálica. Dez pacientes (76,9%) realizaram sorologia para o HIV, todos com resultados negativos. A anfotericina B foi utilizada em 12 casos (92,3%), em um deles por via intratecal. Em oito casos (61,5%) o sulfametoxazol-trimetropim foi utilizado; em dois (15,4%) a sulfadiazina e pirimetamina, e o fluconazol, cetoconazol e itraconazol, cada um deles em um paciente. Seis pacientes (46,1%) morreram e sete evoluíram satisfatoriamente. O tempo de seguimento variou de 2 a 74 meses (M=30,9). Conclui-se que as manifestações clínicas assim como os exames de imagem na PCM do SNC são inespecíficos.

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“…Recent reports indicate that itraconazole has proven successful for the long treatment (up to two years) of a case of pulmonary PCM with additional osteomielitis [31]. One report of PCM with involvement of the central nervous system was successfully treated with itraconazole [32], while a similar case was not [33]. Treatment of a multifocal case of PCM, refractive to treatment with either trimethoprimsulfamethoxazole or ketoconazole was successful with itraconazole [12], while fluconazole (a six-month treatment) was the drug of choice in three imported cases of PCM in Spanish travellers to South America [34].…”

Section: Classic Antifungal Drugs For the Treatment Of Paracoccidioidmentioning

confidence: 99%

Paracoccidioides brasiliensis, Paracoccidioidomycosis, and Antifungal Antibiotics

Visbal¹,

San-Blas²,

Murgich³

et al. 2005

CDTID

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Paracoccidioides brasiliensis is the causative agent of paracoccidioidomycosis (PCM), a human systemic, chronic and progressive mycosis. Preferred antifungals are sulfamethoxazol-trimethoprim, itraconazole, amphotericin B. Treatment is lengthy, the drugs may have undesirable side effects, and some are costly. Occasional resistant strains have been reported. Therefore, the search for more selective and efficient antifungals to treat this and other mycoses continues. Ajoene, chemically derived from garlic, behaves as an antifungal agent against P. brasiliensis and other fungi. Its antiproliferative effects in P. brasiliensis are associated with a reduction of phosphatidyl choline, a concomitant increase in its precursor phosphatidyl ethanolamine, and a large increase in unsaturated fatty acids in the pathogenic yeast phase. The sterol biosynthetic pathway has been largely studied for the search of antifungals. Azoles and allilamines act on differents steps of this pathway. However, they may interfere with similar steps in the host. Hence, the search for drugs that may act on more specific steps is ongoing. One such step focuses on the sterol C-methylations catalyzed by the enzyme (S)-adenosyl-L-methionine: Delta(24) - sterol methyl transferase (SMT). SMT inhibitors such as azasterols and derivatives (AZA1, AZA2, AZA3) have proven highly effective as antiproliferative agents against protozoa and some fungi, among them, P. brasiliensis. Their chemical synthesis and structure, and their molecular electrostatic potential are discussed in order to understand their mechanism of action, and derive rationally designed improvements on these molecules, that would favour a higher efficacy and selectivity.

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Paracoccidioidomicose sistêmica com envolvimento do sistema nervoso central

Cited by 12 publications

References 7 publications

Neuroparacoccidioidomycosis: Case Report and Literature Review

Neuroparacoccidioidomycosis: Case Report and Literature Review

Paracoccidioidomicose do sistema nervoso central: análise de 13 casos

Paracoccidioides brasiliensis, Paracoccidioidomycosis, and Antifungal Antibiotics

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