Isolated central nervous system histoplasmosis in immunocompetent hosts: A series of 11 cases

Abstract

Histoplasmosis of the central nervous system occurs in a significant percentage of patients with Histoplasma capsulatum infection, but has usually been described in association with immunosuppression and/or disseminated histoplasmosis. We aim to review the clinical and laboratory features of isolated histoplasmosis of the central nervous system in the immunocompetent host by presenting a series of 11 cases with this condition. Most of these patients presented with headache, meningeal irritation signs and mental status changes, comprising a somewhat different picture from that described in immunosuppressed patients. Moreover, almost all patients had signs of ventricular dilatation in neuroimaging studies, and 8 of the 11 patients had a ventriculoperitoneal shunt at the time of diagnosis, suggesting hydrocephalus to be an important feature of this condition and/or the possibility of shunt infection by the fungus. Immunodiffusion analysis of the cerebrospinal fluid appeared to be the most efficient way to reach the diagnosis and should be considered in immunocompetent patients with chronic lymphocytic meningitis, especially in those who have ventricular shunt or live in endemic areas of Histoplasma capsulatum.

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

“…En la literatura científica mundial existen pocos reportes de histoplasmosis del sistema nervioso central en personas inmunocompetentes, y tan solo un pequeño porcentaje de los casos corresponde a pacientes pediátricos (17)(18)(19)(20)(21)(22)(23).…”

“…Los síntomas pueden ser muy variados y, como sucedió en este caso, suele haber un retraso de varias semanas o meses en el diagnóstico; por ello, los médicos en regiones endémicas siempre deben contemplar y sospechar la presencia de histoplasmosis como un diagnóstico diferencial en pacientes con sintomatología insidiosa del sistema nervioso central y en aquellos con hidrocefalia obstructiva cuyo origen sea difícil de establecer (17)(18)(19)(20)(21)(22)(23). Por su localización geográfica y por presentar las condiciones ambientales óptimas para el hongo (temperatura, composición del suelo, humedad, etc.…”

Histoplasmosis Brain Abscesses in an Immunocompetent Adult

“…Imaging findings include hydrocephalus, histoplasmoma, vasculitis with infarctions and leptomeningeal enhancement 9 . In one case series of isolated CNS histoplasmosis, 90% of patients had hydrocephalus and two patients had focal enhancement on T1 imaging 10 . This case series of 11 patients included two children age three and 15 years.…”

Central nervous system histoplasmosis in an immunocompetent patient

“…CNS histoplasmosis in immunocompetent hosts is extremely rare in the United Kingdom [5] and most of the cases reported in the literature are from outside Europe [1,2,4]. Hydrocephalus is a common clinical feature in these patients.…”