Histoplasmosis diseminada progresiva con afectación del sistema nervioso central en un paciente inmunocompetente. Presentación de un caso y revisión de la literatura

Abstract

La histoplasmosis es una afección polifacética producida por el hongo dimorfo Histoplasma capsulatum, cuyas esporas son inhaladas y llegan al pulmón, órgano primario de infección. La forma meníngea, considerada como una de las manifestaciones más graves de esta micosis, suele presentarse en individuos con alteraciones en la inmunidad celular: pacientes con síndrome de inmunodeficiencia humana adquirida, con lupus eritematoso sistémico o con trasplante de órgano sólido, así como en lactantes, debido a su inmadurez inmunológica. La forma de presentación más usual es de resolución espontánea y se observa en individuos inmunocompetentes que se han expuesto a altas concentraciones de conidias y fragmentos miceliares del hongo. En estas personas, la afección se manifiesta por trastornos pulmonares y por la posterior diseminación a otros órganos y sistemas. Se presenta un caso de histoplasmosis del sistema nervioso central en un niño inmunocompetente. Histoplasmosis of the central nervous system in an immunocompetent patientHistoplasmosis is a multifaceted condition caused by the dimorphic fungi Histoplasma capsulatum whose infective spores are inhaled and reach the lungs, the primary organ of infection. The meningeal form, considered one of the most serious manifestations of this mycosis, is usually seen in individuals with impaired cellular immunity such as patients with acquired immunodeficiency syndrome, systemic lupus erythematous or solid organ transplantation, and infants given their immunological immaturity. The most common presentation is self-limited and occurs in immunocompetent individuals who have been exposed to high concentrations of conidia and mycelia fragments of the fungi. In those people, the condition is manifested by pulmonary disorders and late dissemination to other organs and systems. We report a case of central nervous system histoplasmosis in an immunocompetent child.

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

“…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.…”

Central Nervous System Histoplasmosis: An Updated Insight

“…In particular, CNS histoplasmosis has been considered a consequence of fungal dissemination in infected individuals who have had a decrease in their immune response associated with immunosuppressive diseases or with procedures using immunosuppressive drugs [ 26 , 34 ]. In contrast, cases of CNS histoplasmosis are sporadic in immunocompetent hosts, and it has also been reported in no disseminated histoplasmosis [ 27 , 35 , 36 ]. The fungus can reach the CNS mainly by the hematogenous route and, rarely, by traumatism or inoculation during neurosurgical procedures [ 31 , 33 ].…”

“…Liposomal amphotericin B is preferred over standard amphotericin B formulation in view of its greater CNS penetration and lower toxicity. According to clinical practice, drug administration should be followed by clinical experience and descriptive studies [ 35 , 66 ]. To avoid relapses, clinical surveillance of patients should be monitored for at least 1 year after finishing treatment [ 26 ].…”

Pulmonary dimorphic fungal infections among HIV/AIDS non‐TB patients with chronic cough in Kampala, Uganda

“…duboisii causes disease in Africa 9 . With the high rates of cell mediated immunodeficiency caused by HIV in Africa, it is logical to assume that where MTB is endemic, dimorphic fungal infections may as well be significant pathogens, 10 and this formed the basis for this study. In this study, we explored the prevalence of dimorphic fungi among HIV/AIDS patient with non‐TB chronic cough in Kampala, Uganda.…”