Paracoccidioidomycosis case series with and without central nervous system involvement

Abstract

Introduction: Paracoccidioidomycosis (PCM) is the most important systemic mycosis in South America. Central nervous system involvement is potentially fatal and can occur in 12.5% of cases. This paper aims to contribute to the literature describing eight cases of neuroparacoccidioidomycosis (NPMC) and compare their characteristics with patients without neurological involvement, to identify unique characteristics of NPCM. Methods: A cohort of 213 PCM cases was evaluated at the Infectious Diseases Clinic of the University Hospital, Federal University of Minas Gerais, Brazil, from October 1976 to August 2008. Epidemiological, clinical, laboratory, therapeutic and follow-up data were registered. Results: Eight patients presented NPCM. The observed NPCM prevalence was 3.8%. One patient presented the subacute form of PCM and the other seven presented the chronic form of the disease. The parenchymatous form of NPCM occurred in all patients. 60% of the patients who proceeded from the north/ northeast region of Minas Gerais State developed NPCM. The neurological involvement of a mother and her son was observed. NPCM patients exhibited demographical and clinical profiles similar to what is described in the literature. When NPCM cases were compared to PCM patients, there were differences in relation to origin and positive PCM family history. Conclusions: The results corroborate the clinical view that the neurological findings are extremely important in the evaluation of PCM patients. Despite the limitations of this study, the differences in relation to patient's origins and family history point to the need of further studies to determine the susceptibility factors involved in the neurological compromise.

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

“…In the current study, the predominance of NPCM in men was 13/1, and is in accordance with previous reports 7,11,20,[29][30][31] . In some studies, NPCM occurred exclusively in men 10,32 .…”

“…Soil is the main natural source for infectious airborne conidia and people living in rural areas are the main population at risk 8 . In this study, occupational activity related to soil was present in 58% of cases, in accordance with previous reports 10,20,[30][31][32]35,36 although this information could be underestimated due to lack of appropriate investigation during anamnesis. Occasional non-autochthonous cases of PCM have been reported outside Latin America 37 .…”

Neuroparacoccidioidomycosis: Case Report and Literature Review

“…Multiple parenchymal lesions accounts for 23-75% of cases and the number of lesions ranges from 1 to 10. [1][2][3]5,6,8,9,13,15,16 Leptomeningeal and/or pachymeningeal involvement represent the meningeal presentation, and it manifests by meningeal signs. Spinal cord involvement is rare and accounts for 0.6% of all cases of PCM and 4% of NPCM.…”

Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating

“…48 A cohort study with 213 consecutive PCM cases, with systematic search for SNC involvement, demonstrated a prevalence of 3.8% of specific lesions, with all cases presenting parenchymal location and other findings in accordance to the literature. 49 …”