Central Nervous System Histoplasma-Associated Post-infectious Inflammatory Response Syndrome (Histo-PIIRS)

Dean, Owen; Anjum, Seher; Hess, Bryan; Hammoud, Dima A.; Athas, Deena M.; Wheat, Joseph; Williamson, Peter R.

doi:10.1007/s10875-020-00954-9

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Post-Infectious Inflammatory Response Syndrome (PIIRS), a recognized manifestation of tuberculosis [14] and cryptococcosis [15], has been reported in a single patient with central nervous system histoplasmosis (Histo-PIIRIS) [15]. The proposed criteria for Histo-PIIRIS include worsening clinical status despite appropriate antifungal therapy; improving laboratory parameters (serology or antigen); and laboratory evidence of cerebrospinal fluid immune activation [16]. Our patient did not have antigenuria, and serology studies were not repeated.…”

Section: Discussionmentioning

confidence: 75%

Reactivation Histoplasmosis Manifested by Lymphocutaneous Fistula with Cervical Drainage of Stones

McKinsey¹,

Enriquez²

2022

PPID

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Histoplasmosis, the most common endemic fungal infection in the United States, is usually self-limiting but can cause a myriad of unusual manifestations, including lithiasis. Despite more than a century of clinical experience with the disease, controversy persists regarding the potential for latent infection with subsequent reactivation. We report a case of an apparently immunocompetent young woman who developed recurrent histoplasmosis after eight years. The presumed secondary reactivation was complicated by a lymphocutaneous fistula with the drainage of stones from her neck after the initiation of antifungal therapy. This case supports the concept of reactivation histoplasmosis. Patients with histoplasmosis are at risk for paradoxical transiently worsening local inflammation while receiving effective antifungal therapy.

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Section: Discussionmentioning

confidence: 75%

Reactivation Histoplasmosis Manifested by Lymphocutaneous Fistula with Cervical Drainage of Stones

McKinsey¹,

Enriquez²

2022

PPID

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“…We found 1159 studies and included 108 manuscripts published between 1962 and 2022, totaling 298 patients 7–10,12–115 . We excluded 38 articles that could not be retrieved.…”

Section: Resultsmentioning

confidence: 99%

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

Oliveira

Kruschewsky

Sekiguchi

et al. 2023

Mycoses

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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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“…The damaged areas in the CNS are located superficially in the meninges, in the brain tissue as focal lesions, or even as small cerebral infarcts [ 37 , 49 ]. Unusually, Histoplasma -associated post-infection inflammatory response syndrome was documented in the cerebrospinal fluid (CSF) through the determination of cytokines revealing elevated IL-6 and IL-8 levels [ 50 ].…”

Section: Histoplasmosismentioning

confidence: 99%

Central Nervous System Histoplasmosis: An Updated Insight

et al. 2023

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Histoplasmosis is one of the systemic mycoses that can involve the Central Nervous System (CNS), and it is caused by the dimorphic ascomycete species of the Histoplasma capsulatum complex. Once in the CNS, this pathogen causes life-threatening injuries that are associated with clinical manifestations of meningitis, focal lesions (abscesses, histoplasmomas), and spinal cord injuries. The present review provides updated data and highlights a particular vision regarding this mycosis and its causative agent, as well as its epidemiology, clinical forms, pathogenesis, diagnosis, and therapy, focusing on the CNS.

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Central Nervous System Histoplasma-Associated Post-infectious Inflammatory Response Syndrome (Histo-PIIRS)

Cited by 4 publications

References 28 publications

Reactivation Histoplasmosis Manifested by Lymphocutaneous Fistula with Cervical Drainage of Stones

Reactivation Histoplasmosis Manifested by Lymphocutaneous Fistula with Cervical Drainage of Stones

Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease

Central Nervous System Histoplasmosis: An Updated Insight

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