Central nervous system histoplasmosis

Wheat, Joseph; Myint, Thein; Guo, Ying; Kemmer, Phebe; Hage, Chadi A.; Terry, Colin; Azar, Marwan M.; Riddell, James; Ender, Peter T.; Chen, Sharon; Shehab, Kareem W.; Cleveland, Kerry O.; Esguerra, Eden M; Johnson, James G.; Wright, Patty W.; Douglas, Vanja C.; Vergidis, Pascalis; Ooi, Winnie W.; Baddley, John W.; Bamberger, David M.; Khairy, Raed N; Vikram, Holenarasipur R.; Jenny-Avital, Elizabeth R.; Sivasubramanian, Geetha; Bowlware, Karen L.; Pahud, Barbara; Sarria, Juan C.; Tsai, Townson; Assi, Maha; Mocherla, Satish; Prakash, Vidhya; Allen, David M.; Passaretti, Catherine; Huprikar, Shirish; Anderson, Albert M.

doi:10.1097/md.0000000000010245

Cited by 77 publications

(86 citation statements)

References 32 publications

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“…Central nervous system (CNS) involvement occurs in 5-10% of individuals with disseminated histoplasmosis [30]. In our experience, 20% of cases presented signs and symptoms associated with the CNS, notably headache and confusion, similar to previous studies [5,21].…”

Section: Clinical Findingssupporting

confidence: 88%

“…In the case of meningeal involvement, a progressive meningeal syndrome over several weeks should raise the physician's suspicion. CSF examinations are not very informative, revealing nonspecific abnormalities with direct examination and fungal culture that are rarely positive [30,31]. In these cases, the demonstration of Histoplasma capsulatum in blood, urine, bone marrow, or other samples is crucial.…”

Section: Clinical Findingsmentioning

confidence: 99%

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The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

Couppié¹,

Herceg²,

Bourne-Watrin³

et al. 2019

JoF

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Histoplasmosis is a common but neglected AIDS-defining condition in endemic areas for Histoplasma capsulatum. At the advanced stage of HIV infection, the broad spectrum of clinical features may mimic other frequent opportunistic infections such as tuberculosis and makes it difficult for clinicians to diagnose histoplasmosis in a timely manner. Diagnosis of histoplasmosis is difficult and relies on a high index of clinical suspicion along with access to medical mycology facilities with the capacity to implement conventional diagnostic methods (direct examination and culture) in a biosafety level 3 laboratory as well as indirect diagnostic methods (molecular biology, antibody, and antigen detection tools in tissue and body fluids). Time to initiation of effective antifungals has an impact on the patient’s prognosis. The initiation of empirical antifungal treatment should be considered in endemic areas for Histoplasma capsulatum and HIV. Here, we report on 30 years of experience in managing HIV-associated histoplasmosis based on a synthesis of clinical findings in French Guiana with considerations regarding the difficulties in determining its differential diagnosis with other opportunistic infections.

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Section: Clinical Findingssupporting

confidence: 88%

Section: Clinical Findingsmentioning

confidence: 99%

The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

Couppié¹,

Herceg²,

Bourne-Watrin³

et al. 2019

JoF

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“…Identifying the histoplasma in the brain either by stereotactic or open biopsy remains gold standard for diagnosis of CNS histoplasma [1]. Patients with CNS histoplasmosis can present with chronic meningitis, encephalitis, hydrocephalus, parenchymal lesions involving the brain and spinal cord resulting in stroke, seizures, confusion, memory impairment [1,2]. Due to rarity of the CNS histoplasmosis and due to lack of randomized or comparative trials definitive treatment for CNS histoplasmosis in immunocompetent persons remains unclear.…”

Section: Discussionmentioning

confidence: 99%

A Case of Histoplasmosis with Central Nervous System Relapse after Itraconazole Therapy Needs Further Research

Peddi¹,

Challa²,

Meegada³

et al. 2020

Cureus

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Central nervous system (CNS) histoplasmosis occurs in 5-20% of all cases and is most commonly seen in immunosuppressed patients who have acquired immunodeficiency syndrome (AIDS) or have received organ transplant. The prevalence of histoplasmosis in patients greater than 65 years old between the years of 1999-2008 in the state of Texas was about 2-3 cases per 100,000 patients year. Since 1990 with the discovery of Triazoles, itraconazole (ICZ) has become the standard initial and suppressive therapy in patients with mild-moderate histoplasmosis without CNS involvement. However, poor penetration of ICZ into the brain, in vitro fluconazole resistance and lack of controlled-trials pose challenge in the treatment of cerebral histoplasmosis.

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“…The prevalence of primary Sjögren syndrome with central nervous system involvement varies widely from 10 to 67.5% ( 6 , 11 ), as currently, the prevalence rate of this condition cannot be reliably estimated. Upon reviewing the literature on Sjögren syndrome with central nervous system involvement from 1960 to 2014, we found nine cases of stroke ( 12 – 15 ) and two cases of transient ischemic attacks ( 16 , 17 ). However, none of the above cases involved recurrent strokes.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Cerebral Infarctions in Primary Sjögren Syndrome: A Case Report and Literature Review

Meng

Cui

et al. 2018

Front. Neurol.

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Recurrent cerebral infarctions are extremely rare in patients with primary Sjögren syndrome. We report a 66-year-old woman who was admitted to our hospital due to acute cerebral infarction with exacerbation of dysphagia and right-sided hemiplegia as the main symptoms. In the past 3 months, she had developed cerebral infarction twice, even though she had no risk factors for atherosclerosis. She was eventually diagnosed with primary Sjögren syndrome based on a long history of dryness of the eyes and mouth, positive anti-Ro(SSA) antibodies, and the findings of a labial salivary gland biopsy. The response to pulse methylprednisolone therapy after recurrent cerebral infarctions was poor. Thus we consider primary Sjögren syndrome patients with central nervous system involvement should be treated as soon as possible.

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Central nervous system histoplasmosis

Abstract: Supplemental Digital Content is available in the text

Cited by 77 publications

References 32 publications

The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

A Case of Histoplasmosis with Central Nervous System Relapse after Itraconazole Therapy Needs Further Research

Recurrent Cerebral Infarctions in Primary Sjögren Syndrome: A Case Report and Literature Review

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