Chronic meningitis, hydrocephalus and spinal paraplegia in non-systemic histoplasmosis

Reis, Fabiano; França, Marcondes C.; Nucci, Anamarli; Queiróz, Luciano de Souza; Nascimento, Felipe Barjud Pereira do; Martinez, Alberto Rolim Muro; Nunes, Marcelo; Lucca, Karla de Oliveira

doi:10.1590/0004-282x20160068

Cited by 4 publications

(6 citation statements)

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background Chronic meningitis (CM) is characterized by neurological symptoms associated with the evidence of cerebrospinal fluid pleocytosis lasting > 4 weeks. Studies on the management of CM in Brazil are scarce. Objective To critically review the literature on CM and propose a rational approach in the Brazilian scenario. Methods Narrative literature review discussing the epidemiology, clinical evaluation, basic and advanced diagnostic testing, and empirical and targeted therapy for the most relevant causes of CM. The present review was contextualized with the local experience of the authors. In addition, we propose an algorithm for the management of CM in Brazil. Results In Brazil, tuberculosis and cryptococcosis are endemic and should always be considered in CM patients. In addition to these diseases, neurosyphilis and other endemic conditions should be included in the differential diagnosis, including neurocysticercosis, Baggio-Yoshinari syndrome, and endemic mycosis. After infectious etiologies, meningeal carcinomatosis and autoimmune diseases should be considered. Unbiased and targeted methods should be used based on availability and clinical and epidemiological data. Conclusion We propose a rational approach to CM in Brazil, considering the epidemiological scenario, systematizing the etiological investigation, and evaluating the timely use of empirical therapies.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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%

“…Meningeal patterns exhibited both pachymeningeal 22,24 and leptomeningeal enhancement, 63 particularly in the basal skull and tentorium 33,35 . Hydrocephalus was typically communicating, although there was one case with an intraventricular lesion 64 . Vasculitis more commonly presented as a small‐vessel disease, 29,33,35,63 particularly in the basal ganglia and brainstem, although cases of large‐vessel disease were also described 46,72 …”

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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“…Raquel Silveira Bello Stucchi [1] , Athanase Billis [2] and Fabiano Reis [3] [1]. Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Campinas, SP, Brasil.…”

Section: Intracranial Hemorrhage Secondary To Disseminated Histoplasmunclassified

“…The mortality rate for DH is high among severely immunocompromised patients with AIDS, and the risk factors for death are associated with blood dyscrasia, inflammatory activity, and renal and nutritional impairment 2 . Histoplasmosis should be considered in brain lesions with a granulomatous pattern 3 as well as in atypical cases with hemorrhagic lesions.…”

mentioning

confidence: 99%

Intracranial hemorrhage secondary to disseminated histoplasmosis in AIDS: an uncommon presentation

Stucchi

Billis

Reis

2021

Rev. Soc. Bras. Med. Trop.

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Chronic meningitis, hydrocephalus and spinal paraplegia in non-systemic histoplasmosis

Cited by 4 publications

References 2 publications

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

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

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

Intracranial hemorrhage secondary to disseminated histoplasmosis in AIDS: an uncommon presentation

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