Central Nervous System Infection with Other Endemic Mycoses: Rare Manifestation of Blastomycosis, Paracoccidioidomycosis, Talaromycosis, and Sporotrichosis

Abstract

The central nervous system (CNS) is not a major organ involved with infections caused by the endemic mycoses, with the possible exception of meningitis caused by Coccidioides species. When CNS infection does occur, the manifestations vary among the different endemic mycoses; mass-like lesions or diffuse meningeal involvement can occur, and isolated chronic meningitis, as well as widely disseminated acute infection that includes the CNS, are described. This review includes CNS infection caused by Blastomyces dermatitidis, Paracoccidioides brasiliensis, Talaromyces marneffei, and the Sporothrix species complex. The latter is not geographically restricted, in contrast to the classic endemic mycoses, but it is similar in that it is a dimorphic fungus. CNS infection with B. dermatitidis can present as isolated chronic meningitis or a space-occupying lesion usually in immunocompetent hosts, or as one manifestation of widespread disseminated infection in patients who are immunosuppressed. P. brasiliensis more frequently causes mass-like intracerebral lesions than meningitis, and most often CNS disease is part of disseminated infection found primarily in older patients with the chronic form of paracoccidioidomycosis. T. marneffei is the least likely of the endemic mycoses to cause CNS infection. Almost all reported cases have been in patients with advanced HIV infection and almost all have had widespread disseminated infection. Sporotrichosis is known to cause isolated chronic meningitis, primarily in immunocompetent individuals who do not have Sporothrix involvement of other organs. In contrast, CNS infection in patients with advanced HIV infection occurs as part of widespread disseminated infection.

Diagnostic and therapeutic approach to chronic meningitis in Brazil: a narrative review

“…and Aspergillus spp were described as causes of chronic meningitis worldwide. 5 In Brazil, Histoplasma capsulatum, 16 Sporotrix spp 17 and Paracoccidiodes spp 18 are endemic mycosis that can cause CM.…”

Talaromyces marneffei Infection: Virulence, Intracellular Lifestyle and Host Defense Mechanisms

“…Central Nervous System (CNS) infections were historically uncommon, but the incidence has gradually increased in both AIDS and non-AIDS associated talaromycosis [43,44]. Among 677 patients with HIV-associated talaromycosis in Vietnam, 21 (3%) had CNS disease [43,45]. However, the basic mechanisms of T. marneffei crossing the human blood-brain barrier is still lacking [44].…”

Current and New Perspectives in the Diagnosis of Blastomycosis and Histoplasmosis

“…Dissemination to sites other than the skin is less common, but in some patients, material for culture can be obtained from biopsy of prostate, bone, or other involved tissue or from the aspiration of synovial fluid. Patients who have central nervous system symptoms should have cerebrospinal fluid (CSF) cultured, but the yield is low [ 14 ].…”