Neuroparacoccidioidomycosis: Case reports and review

Plá, María-del-Pilar; Hartung, C.; Mendoza, Pedro; Stukanoff, Antonio; Moreno, María-Jesús

doi:10.1007/bf01102913

Cited by 29 publications

(5 citation statements)

References 11 publications

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“…The prevalence of NPCM varies widely in the literature, from 1.0% to 27.3%, and is higher in autopsy studies (17)(18)(19) . In the present study, the prevalence was 4.3%.…”

Section: Discussionmentioning

confidence: 99%

“…There have been various studies of the systemic and CNS changes in patients with PCM ( 2 , 10 - 12 , 14 - 19 , 24 , 25 , 28 - 30 ) . However, to our knowledge, this is the first conventional imaging study analyzing the behavior of NPCM lesions after treatment, as well as the largest imaging follow-up study of patients with NPCM.…”

Section: Discussionmentioning

confidence: 99%

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“Star of Bethlehem sign” in the analysis of the evolution of brain lesions during and after treatment for neuroparacoccidioidomycosis

Santana,

Peçanha,

Falqueto

et al. 2023

Radiol Bras

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Objective: To describe the clinical and radiological evolution of lesions during and after treatment in patients diagnosed with neuroparacoccidioidomycosis (NPCM). Materials and Methods: This was a retrospective study of the medical records, computed tomography scans, and magnetic resonance imaging (MRI) scans of patients with NPCM treated between September 2013 and January 2022. Results: Of 36 cases of NPCM, eight were included in the study. One patient presented only with pachymeningeal and skull involvement, and seven presented with pseudotumors in the brain. Collectively, the eight patients presented with 52 lesions, of which 46 (88.5%) were supratentorial. There were 32 lesions with a diameter ≤ 1.2 cm, of which 27 (84.4%) disappeared during the treatment. In three cases, there were lesions > 1.2 cm that showed a characteristic pattern of evolution on MRI: an eccentric gadolinium contrast-enhanced nodule, with a subsequent decreased in the size and degree of contrast enhancement of the lesions. Conclusion: In NPCM, supratentorial lesions seem to predominate. Lesions ≤ 1.2 cm tend to disappear completely during treatment. Lesions > 1.2 cm tend to present with a similar pattern, designated the “Star of Bethlehem sign”, throughout treatment.

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“…The prevalence of NPCM varies widely in the literature, from 1.0% to 27.3%, and is higher in autopsy studies (17)(18)(19) . In the present study, the prevalence was 4.3%.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“Star of Bethlehem sign” in the analysis of the evolution of brain lesions during and after treatment for neuroparacoccidioidomycosis

Santana,

Peçanha,

Falqueto

et al. 2023

Radiol Bras

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“…The most common symptoms of neurological involvement are intracranial hypertension, cranial nerve deficits, motor deficits, gait disturbances, altered consciousness, hemiparesis, headache, ataxia, and seizures. [101116] Differential diagnosis should include neoplasms (particularly malignant gliomas and metastatic tumors), tuberculosis, bacterial and parasitic abscesses, neurocysticercosis, and infections such as histoplasmosis and cryptococcosis. [10]…”

Section: Discussionmentioning

confidence: 99%

“…[421] Less frequently, in about 10% of cases, PCM affects the central nervous system (CNS), with a mortality rate of 53%. [1016] Its clinical course remains unclear and the diagnosis can be elusive. Radiographic images may provide nonspecific findings that can be suggestive of neoplasia.…”

Section: Introductionmentioning

confidence: 99%

Paracoccidioidomycosis simulating brain tumor

Isolan¹,

Vieira²,

Hehn³

et al. 2014

Surg Neurol Int

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Background:Paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by Paracoccidioides brasiliensis. Involvement of the central nervous system (CNS) occurs in about 10% of cases.Case Description:A 57-year-old white man presented with the complaint of headache and an episode of focal seizure 1 month earlier. Magnetic resonance imaging (MRI) revealed a ring-enhancing lesion in the right parietal lobe with peri-lesional vasogenic edema suggestive of a primary neoplasm. The patient underwent craniotomy and the intraoperative finding was a yellowish, hard lesion with thick content and yellow inside. Anatomo-pathological findings were pathognomonic of PCM: large, thick-walled, spherical yeast cells with multiple peripheral buds. The patient tested negative for human immunodeficiency virus (HIV). Encephalitis and meningitis were ruled out by cerebrospinal fluid analysis. Culture confirmed the diagnosis of PCM and the patient was treated with amphotericin B. The patient responded well to treatment with resolution of the headache and clinical improvement, despite a bitemporal hemianopia. He was clinically stable and then discharged in good general condition.Conclusions:Radiographic findings of PCM with CNS involvement may suggest neoplasia, making diagnosis difficult. In endemic areas, the diagnosis of PCM should be promptly considered when a ring-enhancing mass associated with peri-lesional edema is observed on MRI.

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“…Acredita-se que a porta de entrada do microrganismo seja através da inalação dos conídios, levando à uma infecção pulmonar primária cuja forma pode ser desde assintomática, a aguda, sub-aguda ou crônica. Pode ocorrer disseminação para outros órgãos e sistemas, notadamente a mucosa oral, as glândulas adrenais, o sistema retículo endotelial, a pele, o trato genital e raramente o Sistema Nervoso Central 5,6,7,8,9 .…”

Section: Introductionunclassified

Exame direto no diagnóstico de Paracoccidioides brasiliensis realizados nos Laboratórios Regionais do Instituto Adolfo Lutz, São Paulo, Brasil

Moreira,

Silva,

Meira

et al. 2006

Rev Inst Adolfo Lutz

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Paracoccidioidomicose (PCM) é uma doença sistêmica causada pelo fungo dimórfico Paracoccidioides brasiliensis. Apresenta-se como infecção pulmonar primária assintomática, aguda, sub-aguda ou crônica. Para ratificar a importância do exame direto, de baixo custo e complexidade, no diagnóstico da PCM, foi realizado um levantamento de amostras clínicas nos Laboratórios Regionais do IAL (LR-IAL) e Laboratório I Araçatuba - DIR VI, no período de janeiro de 1996 a dezembro de 2002. Foram analisadas 3807 amostras de origem pulmonar e 25 amostras extrapulmonares, preparadas de acordo com suas peculiaridades. Detectou-se significativa quantidade de solicitações de exames com informações incompletas quanto aos dados do paciente. Foi demonstrada positividade em 4% das amostras pulmonares (predominando no adulto do sexo masculino) assim como em amostras extrapulmonares (88%). A diferença na demanda natural das solicitações para este diagnóstico, entre os Regionais, pode estar relacionada com endemicidade da região, busca e/ou suspeita da doença e encaminhamento das amostras para os Laboratórios de Referência da Rede Pública. Após 98 anos da descrição pioneira por Adolfo Lutz, a doença ainda é foco de preocupação para a Saúde Pública.

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Neuroparacoccidioidomycosis: Case reports and review

Cited by 29 publications

References 11 publications

“Star of Bethlehem sign” in the analysis of the evolution of brain lesions during and after treatment for neuroparacoccidioidomycosis

“Star of Bethlehem sign” in the analysis of the evolution of brain lesions during and after treatment for neuroparacoccidioidomycosis

Paracoccidioidomycosis simulating brain tumor

Exame direto no diagnóstico de Paracoccidioides brasiliensis realizados nos Laboratórios Regionais do Instituto Adolfo Lutz, São Paulo, Brasil

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