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

Silva, Guilherme Diogo; Guedes, Bruno Fukelmann; Junqueira, Ióri Rodrigues; Gomes, Hélio Rodrigues; Vidal, José E.

doi:10.1055/s-0042-1758645

Cited by 6 publications

(2 citation statements)

References 74 publications

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“…Our study reinforces that endemic mycoses should be included in the differential diagnosis of chronic meningitis 38 . It is expected that many cases of CNS sporotrichosis may have gone undiagnosed, particularly in Brazil, where cat‐transmitted sporotrichosis is hyperendemic 39 .…”

Section: Discussionsupporting

confidence: 74%

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Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta‐analysis

de Oliveira,

Petrucci,

Taborda

et al. 2024

Mycoses

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BackgroundThe clinical features of central nervous system (CNS) sporotrichosis are derived from case reports and a limited series of cases. Our objective was to carry out a systematic review and meta‐analysis of CNS sporotrichosis.MethodsWe searched PubMed/MEDLINE, Embase, Scopus, and LILACS on 9 September 2023. Our inclusion criteria were documentation of Sporothrix and demonstrated CNS involvement. A metaproportion or metamean analysis was performed to estimate a summary proportion with 95% confidence intervals.ResultsWe included 52 cases of CNS sporotrichosis published from 1966 to 2023. Forty‐six patients were male (88%, 95% CI: 77–95), and the mean age was 39 years (95% CI: 36–43). Close contact with cats was reported in 55% of cases (95% CI: 37–72). Thirty‐two (61.5%) patients were from Brazil, 18 patients from the United State of America (34.6%). Only two Sporothrix species were reported: S. schenckii (26/41, 63%), and S. brasiliensis (15/41, 37%). The most common neurological symptom was headache. Meningitis was chronic in approximately 80% of cases. A significant majority of the patients were immunocompromised. HIV infection was the primary cause of immunosuppression (85%, 95% CI: 61–95). Overall mortality was 56% (22/39). The comparison of Kaplan–Meier survival curve showed a higher mortality with a statistically significant difference in immunosuppressed patients (p = .019).ConclusionCNS sporotrichosis represents a notable cause of chronic meningitis, especially in individuals living in the Americas with HIV infection and concurrent skin lesions.

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Section: Discussionsupporting

confidence: 74%

“…6 Our study reinforces that endemic mycoses should be included in the differential diagnosis of chronic meningitis. 38 is hyperendemic. 39 Some patients were empirically treated for tuberculous meningitis 11,17 because of overlapping clinical, CSF, and radiological findings.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta‐analysis

de Oliveira,

Petrucci,

Taborda

et al. 2024

Mycoses

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High prevalence of central nervous system cryptococcosis using a fingerprick whole-blood lateral flow assay in individuals with neurological symptoms and advanced HIV disease in a Brazilian emergency department

Oliveira,

Nakagawa,

de Oliveira

et al. 2023

Medical Mycology

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Timely diagnosis is key in managing central nervous system (CNS) cryptococcosis in people living with HIV/AIDS (PLWHA). There are few data on implementing fingerprick whole-blood cryptococcal antigen (CrAg) lateral flow assay (LFA) as the first test for diagnosing CNS cryptococcosis. We evaluated the prevalence of CNS cryptococcosis and cryptococcal antigenemia using fingerprick whole-blood in a referral emergency department (ED) in São Paulo, Brazil. This was a prospective cohort study of consecutive adult PLWHA with advanced HIV disease and neurological symptoms. Fingerprick whole-blood CrAg LFA was performed at bedside. Seventy-four individuals were enrolled (median age = 40 years; males = 62%). Prevalence of CNS cryptococcosis was 17.6% (13/74); 95% CI, 9.4 to 30.0% and prevalence of positive fingerprick whole-blood CrAg LFA was 25.7% (19/74); 95% CI, 15.5 to 40.1%. Among the six (8.1%) patients with positive fingerprick whole-blood CrAg LFA and negative CSF CrAg LFA, four (5.4%) had isolated asymptomatic cryptococcal antigenemia, one (1.3%) had symptomatic cryptococcal antigenemia, and one (1.3%) had cryptococcemia. Prevalence of CNS cryptococcosis and cryptococcal antigenemia using fingerprick whole-blood CrAg LFA were high. Point-of-care testing was important for diagnosing CNS cryptococcosis in an ED from a middle-income country.

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Identifying high-risk neurological phenotypes in adult-onset classic monogenic autoinflammatory diseases: when should neurologists consider testing?

Silva,

Mahler,

da Silva Junior

et al. 2024

BMC Neurol

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Background Monogenic autoinflammatory disorders result in a diverse range of neurological symptoms in adults, often leading to diagnostic delays. Despite the significance of early detection for effective treatment, the neurological manifestations of these disorders remain inadequately recognized. Methods We conducted a systematic review searching Pubmed, Embase and Scopus for case reports and case series related to neurological manifestations in adult-onset monogenic autoinflammatory diseases. Selection criteria focused on the four most relevant adult-onset autoinflammatory diseases—deficiency of deaminase 2 (DADA2), tumor necrosis factor receptor associated periodic fever syndrome (TRAPS), cryopyrin associated periodic fever syndrome (CAPS), and familial mediterranean fever (FMF). We extracted clinical, laboratory and radiological features to propose the most common neurological phenotypes. Results From 276 records, 28 articles were included. The median patient age was 38, with neurological symptoms appearing after a median disease duration of 5 years. Headaches, cranial nerve dysfunction, seizures, and focal neurological deficits were prevalent. Predominant phenotypes included stroke for DADA2 patients, demyelinating lesions and meningitis for FMF, and meningitis for CAPS. TRAPS had insufficient data for adequate phenotype characterization. Conclusion Neurologists should be proactive in diagnosing monogenic autoinflammatory diseases in young adults showcasing clinical and laboratory indications of inflammation, especially when symptoms align with recurrent or chronic meningitis, small vessel disease strokes, and demyelinating lesions.

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

Cited by 6 publications

References 74 publications

Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta‐analysis

Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta‐analysis

High prevalence of central nervous system cryptococcosis using a fingerprick whole-blood lateral flow assay in individuals with neurological symptoms and advanced HIV disease in a Brazilian emergency department

Identifying high-risk neurological phenotypes in adult-onset classic monogenic autoinflammatory diseases: when should neurologists consider testing?

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