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Background:The knowledge of central nervous system (CNS) histoplasmosis is limited to case reports and series.Objectives: Our objective was to synthesise clinical, radiological and laboratory characteristics of CNS histoplasmosis to improve our understanding of this rare disease. Methods:We performed a systematic review using Pubmed/MEDLINE, Embase and LILACS databases accessed on March 2023 without publication date restrictions.Inclusion criteria comprised: (1) histopathological, microbiological, antigen or serological evidence of histoplasmosis; (2) CNS involvement based on cerebrospinal fluid pleocytosis or neuroimaging abnormalities. We classified the certainty of the diagnosis in proven (CNS microbiological and histopathological confirmation), probable (CNS serological and antigen confirmation) or possible (non-CNS evidence of histoplasmosis). Metaproportion was used to provide a summary measure with 95% confidence intervals for the clinical, radiological and laboratory characteristics. Chi-squared test was used to compare mortality between pairs of antifungal drugs. Results:We included 108 studies with 298 patients. The median age was 31 years, predominantly male, and only 23% were immunocompromised (134/276, 95%CI: 3-71), mainly due to HIV infection. The most common CNS symptom was headache (130/236, 55%, 95%CI: 49-61), with a duration predominantly of weeks or months.Radiological presentation included histoplasmoma (79/185, 34%, 95%CI: 14-61), meningitis (29/185, 14%, 95%CI: 7-25), hydrocephalus (41/185, 37%, 95%CI: 7-83) and vasculitis (18/185, 6%, 95%CI: 1-22). There were 124 proven cases, 112 probable cases and 40 possible cases. The majority of patients presented positive results in CNS pathology (90%), serology (CSF: 72%; serum: 70%) or CSF antigen (74%). Mortality was high (28%, 56/198), but lower in patients who used liposomal amphotericin B and itraconazole. Relapse occurred in 13% (23/179), particularly in HIV patients, but less frequently in patients who used itraconazole. Conclusion:Central nervous system histoplasmosis usually presents subacute-tochronic symptoms in young adults. Neuroimaging patterns included not only focal lesions but also hydrocephalus, meningitis and vasculitis. Positive results were

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Introduction Paracoccidioidomycosis is a systemic mycosis endemic to Latin America, with frequent reports of poor treatment adherence resulting in worse clinical outcomes. The present study evaluated factors related to treatment adherence in patients with paracoccidioidomycosis. Methods This cross‐sectional study included data from medical records of patients with paracoccidioidomycosis treated between 2005 and 2018 in a reference hospital in southeastern Brazil. Clinical variables, demographic characteristics, and smoking and alcohol consumption were collected and analyzed. Results Of the 198 cases included, most were adults (median age = 51 years), males (93.4%), presented chronic paracoccidioidomycosis (83.8%), reported smoking (90.4%) and alcohol consumption (84.8%), and 56.6% adhered to treatment. Treatment adherence was associated with the discontinuation of alcohol consumption (odds ratios (OR) = 5.227; 95% confidence interval (CI) = 2.697–10.129) and smoking (OR = 3.365; 95% CI = 1.781–6.358) during therapy. Conclusions Patients' continued consumption of alcohol and tobacco was associated with non‐adherence to treatment, suggesting that a joint therapeutic approach that addresses alcohol and tobacco use alongside paracoccidioidomycosis treatment may hold promise for improving adherence and patients' quality of life.

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