Long-term outcome of neuroparacoccidioidomycosis treatment

Francesconi, Fábio; Silva, Marcus Tulius T.; Costa, Regina Lana Braga; Francesconi, Valeska Albuquerque; Carregal, Eleonora; Talhari, Sinésio; Valle, Antônio Carlos Francesconi do

doi:10.1590/s0037-86822011000100006

Cited by 27 publications

(58 citation statements)

References 14 publications

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“…Cotrimoxazole can also be used in contraindications of itraconazole, or in cases of suspected therapeutic failure or concomitant tuberculosis treatment. According to a few published cases, cotrimoxazole is the treatment of choice for patients with neuroparacoccidioidomycosis 52,97 . …”

Section: Cotrimoxazole (Sulfamethoxazole/trimethoprim)mentioning

confidence: 99%

Brazilian guidelines for the clinical management of paracoccidioidomycosis

Shikanai-Yasuda

Mendes

Colombo

et al. 2017

Rev. Soc. Bras. Med. Trop.

289

514

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Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis (P. brasiliensis) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii (P. lutzii), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients' sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.

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Section: Cotrimoxazole (Sulfamethoxazole/trimethoprim)mentioning

confidence: 99%

Brazilian guidelines for the clinical management of paracoccidioidomycosis

Shikanai-Yasuda

Mendes

Colombo

et al. 2017

Rev. Soc. Bras. Med. Trop.

289

514

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“…However, it is very close to the 3.8% prevalence reported by a recent case series report 11 . Beyond that, it must be noted that NCPM prevalence is extremely variable in the literature, ranging from 0% to 36% [12][13][14][15] . Interestingly, the majority (75%) of the cases reported in this work were diagnosed after 1990, especially after the year 2000, and the adjusted prevalence to this period is raised to 7.7%.…”

Section: Discussionmentioning

confidence: 99%

Paracoccidioidomycosis case series with and without central nervous system involvement

Pedroso

Lyon

Araújo

et al. 2012

Rev. Soc. Bras. Med. Trop.

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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.

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“…[10] The prevalence of CNS involvement ranges from 3.4 to 13.9% of cases,[5311] with rates also ranging from 9.9 to 27.3% of cases in some reports. [2691418] In PCM with CNS involvement, the disease can present as meningitis, meningoencephalitis, meningoradiculitis, and as a pseudo-tumoral form.…”

Section: Discussionmentioning

confidence: 99%

“…[2691418] In PCM with CNS involvement, the disease can present as meningitis, meningoencephalitis, meningoradiculitis, and as a pseudo-tumoral form. [1117] In 66.8% of cases, the fungus affects the supratentorial region, especially the frontal and parietal lobes. [15]…”

Section: Discussionmentioning

confidence: 99%

“…The most common symptoms of neurological involvement are intracranial hypertension, cranial nerve deficits, motor deficits, gait disturbances, altered consciousness, hemiparesis, headache, ataxia, and seizures. [101116] Differential diagnosis should include neoplasms (particularly malignant gliomas and metastatic tumors), tuberculosis, bacterial and parasitic abscesses, neurocysticercosis, and infections such as histoplasmosis and cryptococcosis. [10]…”

Section: Discussionmentioning

confidence: 99%

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Paracoccidioidomycosis simulating brain tumor

Isolan¹,

Vieira²,

Hehn³

et al. 2014

Surg Neurol Int

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Background:Paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by Paracoccidioides brasiliensis. Involvement of the central nervous system (CNS) occurs in about 10% of cases.Case Description:A 57-year-old white man presented with the complaint of headache and an episode of focal seizure 1 month earlier. Magnetic resonance imaging (MRI) revealed a ring-enhancing lesion in the right parietal lobe with peri-lesional vasogenic edema suggestive of a primary neoplasm. The patient underwent craniotomy and the intraoperative finding was a yellowish, hard lesion with thick content and yellow inside. Anatomo-pathological findings were pathognomonic of PCM: large, thick-walled, spherical yeast cells with multiple peripheral buds. The patient tested negative for human immunodeficiency virus (HIV). Encephalitis and meningitis were ruled out by cerebrospinal fluid analysis. Culture confirmed the diagnosis of PCM and the patient was treated with amphotericin B. The patient responded well to treatment with resolution of the headache and clinical improvement, despite a bitemporal hemianopia. He was clinically stable and then discharged in good general condition.Conclusions:Radiographic findings of PCM with CNS involvement may suggest neoplasia, making diagnosis difficult. In endemic areas, the diagnosis of PCM should be promptly considered when a ring-enhancing mass associated with peri-lesional edema is observed on MRI.

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Long-term outcome of neuroparacoccidioidomycosis treatment

Cited by 27 publications

References 14 publications

Brazilian guidelines for the clinical management of paracoccidioidomycosis

Brazilian guidelines for the clinical management of paracoccidioidomycosis

Paracoccidioidomycosis case series with and without central nervous system involvement

Paracoccidioidomycosis simulating brain tumor

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