Central nervous system paracoccidioidomycosis: diagnosis and treatment.

Authors

• Jorge Elias
• Antonio Carlos dos Santos
• Carlos Gilberto Carlotti
• Benedicto Oscar Colli
• Alexandre Canheu
• Caio Matias
• Luciano Furlanetti
• Roberto Martinez
• Osvaldo Massaiti Takayanagui
• Américo Ceiki Sakamoto
• Luciano Neder Serafini
• Leila Chimelli

Publication/Presentation Date

1-1-2005

Abstract

BACKGROUND: Paracoccidioidomycosis (PCM) is a systemic mycosis caused by Paracoccidioides brasiliensis. The involvement of the central nervous system (CNS) in paracoccidioidomycosis is higher than previously thought and 2 clinical presentations have been reported, meningitis and pseudotumoral.

METHODS: Twenty medical records of patients with CNS paracoccidioidomycosis treated from 1986 to 2003 were analyzed. The follow-up ranged from 1 to 18 years (mean = 8.9 +/- 4.2).

RESULTS: Besides CNS paracoccidioidomycosis, all patients but one had the chronic systemic form and the pseudotumoral clinical presentation was the most frequent. Based on computed tomography scan findings, 4 image patterns were identified: low-density lesion with ring enhancement, lesion with calcification and ring enhancement, multiloculated low-density lesion with ring enhancement, and diffuse subarachnoid enhancement. The magnetic resonance imaging was performed in 3 patients and showed subarachnoid enhancement in 1 patient and heterogeneous lesion with ring enhancement in 2 patients. Eleven patients were submitted to medical treatment and 9 needed neurosurgical treatment; ventriculoperitoneal shunts in 4 patients, brain lesions resection in 3 patients, and partial resection of spinal cord lesions in 2 patients. Eleven patients had excellent outcome, 4 patients died, 3 are in good clinical condition with residual pulmonary dysfunction, and 1 patient was lost to follow-up.

CONCLUSIONS: The diagnosis of paracoccidioidomycosis with involvement of the CNS is difficult and clinical suspicion is a key point to achieve the correct diagnosis. Patients with early diagnosis have a favorable outcome with clinical or surgical treatment.

Volume

63 Suppl 1

First Page

13

Last Page

21

ISSN

0090-3019

Published In/Presented At

Elias, J., Jr, dos Santos, A. C., Carlotti, C. G., Jr, Colli, B. O., Canheu, A., Matias, C., Furlanetti, L., Martinez, R., Takayanagui, O. M., Sakamoto, A. C., Serafini, L. N., & Chimelli, L. (2005). Central nervous system paracoccidioidomycosis: diagnosis and treatment. Surgical neurology, 63 Suppl 1, S13–S21. https://doi.org/10.1016/j.surneu.2004.09.019

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

15629337

Department(s)

Administration and Leadership

Document Type

Article