Paracoccidioidomicose medular: relato de um caso

Marchiori, Edson; Freitas, Miguel Américo Lopes; Lima, Ranufo Arthur Machado

doi:10.1590/s0004-282x1989000200015

Cited by 16 publications

(11 citation statements)

References 3 publications

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“…Esses dados encontram-se de acordo com as observações de Marchiori e cols 47 , reforçando o papel da radiografia de tórax na abordagem diagnóstica desses pacientes.…”

Section: Discussionunclassified

Paracoccidioidomicose com comprometimento do sistema nervoso central: revisão sistemática da literatura

Pedroso¹,

Vilela

Pedroso

et al. 2009

Rev. Soc. Bras. Med. Trop.

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A paracoccidioidomicose (PCM), infecção sistêmica causada pelo fungo Paracoccidioides brasiliensis, é considerada a mais importante micose profunda da América Latina 48 . Pode ser considerada, ainda, um problema de saúde pública em função de seus elevados custos sociais e econômicos decorrentes não apenas Paracoccidioidomicose com comprometimento do sistema nervoso central: revisão sistemática da literatura ABSTRAcTThis study is the first systematic review of cases of neuroparacoccidioidomycosis available in the literature. Through searches in the MEDLINE and LILACS databases, 257 cases were found in 81 published studies, mainly after the 1970s-1980s. Approximately 93% of the patients were men, especially farm laborers, with a mean age of 43 years. The characteristic symptoms were motor deficits or intracranial hypertension. The chronic pseudotumoral form predominated. The mean period of evolution was 4.9 months. The lesions were mainly supratentorial (66.8%), located in the frontal and parietal lobes. The diagnosis was determined by biopsy in 57.2% of the cases and neuroimaging methods were used in 64.6% of them. A large proportion of the cases were associated with the pulmonary form of the disease (59.1%). The mortality rate was 44.1%, and 50.1% of the survivors developed sequelae, especially motor impairment. Thus, neuroparacoccidioidomycosis should be considered in the differential diagnosis for expansive and meningoencephalitic processes in the central nervous system, in order to establish early treatment and to avoid disabling sequelae. Key-words:Paracoccidioidomycosis. Fungal infection. Neuroparacoccidioidomycosis. Central nervous system. Systematic review.da doença em atividade, mas também das freqüentes seqüelas, motivo comum de incapacitação para o trabalho 15 49 . Afeta indivíduos em todas as faixas etárias a partir dos dois anos de idade, mas há marcante predomínio entre os 30 e os 50 anos de vida, período que compreende o auge da capacidade produtiva dos pacientes. A incidência é a mesma para ambos os sexos até a puberdade, entretanto, na vida adulta, torna-se mais freqüente entre os indivíduos do sexo masculino, em proporção de 11:1 22 .A doença pode manifestar-se de inúmeras maneiras e o fungo pode causar lesões em virtualmente qualquer órgão. De modo geral, os pulmões são os órgãos mais frequentemente acometidos, mas lesões cutâneas, de mucosas, linfonodais e adrenais também são comuns. Nas últimas décadas, com o surgimento de novos métodos diagnósticos, especialmente os de imagem, constatou-se que o envolvimento do sistema nervoso central (SNC) é bem mais frequente do que se admitia, ocorrendo em torno de 12,5% dos casos de PCM e chegando, em alguns estudos, até 36% dos casos 62 .

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“…Esses dados encontram-se de acordo com as observações de Marchiori e cols 47 , reforçando o papel da radiografia de tórax na abordagem diagnóstica desses pacientes.…”

Section: Discussionunclassified

Paracoccidioidomicose com comprometimento do sistema nervoso central: revisão sistemática da literatura

Pedroso¹,

Vilela

Pedroso

et al. 2009

Rev. Soc. Bras. Med. Trop.

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“…However, these findings do not allow precise differentiation with other expansive lesions, especially tuberculotic or toxoplasmotic granulomas or even some types of neoplasias. The neuroradiological characteristics of intramedullary granulomas are also nonspecific 4,5,14,18,33 . Myelography and myelotomography demonstrate an enlargement of the spinal cord with full or partial blockade of the spinal canal.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary spinal cord paracoccidioidomycosis: report of two cases

Colli

Assirati

Machado

et al. 1996

Arq. Neuro-Psiquiatr.

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-Two cases of intramedullary paracoccidioidomycosis are reported. Paracoccidioidomycosis is a systemic disease that involves the buccopharyngeal mucosa, lungs, lymph nodes and viscera and infrequently the central nervous system. Localization in the spinal cord is rare. Case 1: a 55-year old male admitted with crural pararesis, tactile/painful hypesthesia and sphincter disturbances of 15 days duration. Cutaneous-pulmonary blastomycosis was diagnosed 17 years ago. Myelotomography showed a blockade of T3-T4 (intramedullary lesion). The lesion surgically removed was a Paracoccidioides brasiliensis granuloma. Treatment with sulfadiazine was started after the surgery. Follow-up of 15 month showed an improvement of the clinical signs. Case 2: a 57-year old male was admitted elsewhere 6 months ago and, with a radiologic diagnosis of pulmonary paracoccidioidomycosis, was treated with amphotericin B. He progressively developed paresthesia and tactile/ pain anaesthesia on the left side, sphincter disturbances and tetraparesis with bilateral extensor plantar response and clonus of the feet. Myelotomography showed a blockade of C4-C6 (intramedullary lesion). The lesion was not found during surgical exploration and the patient deteriorated and died. Post-mortem examination revealed an intramedullary tumor above the site of the mielotomy (Paracoccidioides brasiliensis granuloma). The preoperative diagnosis of intramedullary paracoccidioidomycotic granulomas is difficult because the clinical and radiologic manifestations are uncharacteristic. Clinical suspicion was possible in our cases based on the history of previous systemic disease. Contrary to intracranial localizations, paracoccidioidomycotic granulomas causing progressive spinal cord compression may require early surgery because response to clinical treatment is slow and the reversibility of neurological deficits depends on the promptness of the decompression.KEY WORDS: intramedullary paracoccidioidomycosis, granuloma intramedullar blastomycotic, spinal cord compression, surgical treatment, medical treatment. Granuloma paracoccidioidomicótico intramedular: relato de dois casosRESUMO -São relatados dois casos de granuloma blastomicótico intramedular. A paracoccidioidomicose é micose sistêmica que atinge predominantemente a mucosa bucofaríngea, pulmões, linfonodos e vísceras e infrequentemente o sistema nervoso. A localização medular é rara. Caso 1: paciente masculino, de 55 anos, admitido com parestesias, hipoestesia táctil/dolorosa, paraparesia crural e distúbios esfincterianos. Tinha diagnóstico de blastomicose cutâneo-pulmonar há 17 anos. A mielotomografia mostrou bloqueio em T3-T4 (lesão intramedular). A lesão removida cirurgicamente revelou-se um granuloma blastomiótico. Após a cirurgia foi tratado com sulfadiazina. Durante o seguimento (15 meses) apresentou melhora do quadro clínico. Caso 2: paciente masculino, de 57 anos, internado em outro hospital há 6 meses por blastomicose pulmonar e tratado com anfotericina B. Desenvolveu parestesias, hipoestesia táct...

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“…Analysis of the available data shows an increasing number of reports on NPCM, most of which correspond to neurosurgical or to anatomopathologic findings. 1,[3][4][5][6][7][8][9][10][11][12][13] The NPCM diagnosis frequently is difficult, and a clinical suspicion frequently occurs when a patient with systemic PCM has some neurologic sign or symptom. Cerebrospinal fluid (CSF) alterations and neuroradiologic methods (computed tomography scan or nuclear magnetic resonance) are useful for diagnoses but are not specific.…”

Section: Paracoccidioidomycosis (Pcm) Is a Chronic Granulomatous Infementioning

confidence: 99%

Anti-gp43 Antibodies in the Cerebrospinal Fluid of Patients With Central Nervous System Involvement by Paracoccidioidomycosis

et al. 2002

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Paracoccidioidomycosis (PCM) is a chronic granulomatous infectious disease, endemic in subtropical areas of Central and South America. The diagnosis of the central nervous system (CNS) involvement with PCM (neuroparacoccidioidomycosis [NPCM]) frequently is difficult. A definitive diagnosis usually is made by visualization or isolation of Paracoccidioides brasiliensis from CNS biopsy or necropsy material. In the present study, we determined the presence of anti-gp43 antibodies in the cerebrospinalfluid (CSF) of patients with CNS involvement in PCM by enzyme-linked immunosorbent assay (ELISA) in 9 cases of NPCM and 15 control cases. ELISA anti-gp43 was compared with double immunodiffusion (DID). ELISA anti-gp43 was positive in 8 (89%) of 9 CSF samples from patients with NPCM and negative in all CSF samples of the control group. DID was negative in all CSF samples from patients with NPCM and control samples. ELISA anti-gp43 in CSF samples is better than DID for the diagnosis of NPCM. It is a sensitive and specific diagnostic method and has high predictive values. To our knowledge, this is thefirst time ELISA anti-gp43 was applied to CSF.

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Paracoccidioidomicose medular: relato de um caso

Cited by 16 publications

References 3 publications

Paracoccidioidomicose com comprometimento do sistema nervoso central: revisão sistemática da literatura

Paracoccidioidomicose com comprometimento do sistema nervoso central: revisão sistemática da literatura

Intramedullary spinal cord paracoccidioidomycosis: report of two cases

Anti-gp43 Antibodies in the Cerebrospinal Fluid of Patients With Central Nervous System Involvement by Paracoccidioidomycosis

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