Paracoccidioidomicose do sistema nervoso central: análise de 13 casos

Fagundes-Pereyra, Walter José; Carvalho, Gervásio Teles Cardoso de; Góes, Alfredo de Miranda; Silva, Francisco das Chagas Lima e; Sousa, Atos Alves de

doi:10.1590/s0004-282x2006000200018

Cited by 30 publications

(31 citation statements)

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“…Interestingly, the majority (75%) of the cases reported in this work were diagnosed after 1990, especially after the year 2000, and the adjusted prevalence to this period is raised to 7.7%. This is in accordance with the growing trend of NPCM diagnosing in the last decades, which could be due to the expansion of modern neuroimaging methods 4,11,16 .…”

Section: Discussionsupporting

confidence: 86%

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Paracoccidioidomycosis case series with and without central nervous system involvement

Pedroso

Lyon

Araújo

et al. 2012

Rev. Soc. Bras. Med. Trop.

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Introduction: Paracoccidioidomycosis (PCM) is the most important systemic mycosis in South America. Central nervous system involvement is potentially fatal and can occur in 12.5% of cases. This paper aims to contribute to the literature describing eight cases of neuroparacoccidioidomycosis (NPMC) and compare their characteristics with patients without neurological involvement, to identify unique characteristics of NPCM. Methods: A cohort of 213 PCM cases was evaluated at the Infectious Diseases Clinic of the University Hospital, Federal University of Minas Gerais, Brazil, from October 1976 to August 2008. Epidemiological, clinical, laboratory, therapeutic and follow-up data were registered. Results: Eight patients presented NPCM. The observed NPCM prevalence was 3.8%. One patient presented the subacute form of PCM and the other seven presented the chronic form of the disease. The parenchymatous form of NPCM occurred in all patients. 60% of the patients who proceeded from the north/ northeast region of Minas Gerais State developed NPCM. The neurological involvement of a mother and her son was observed. NPCM patients exhibited demographical and clinical profiles similar to what is described in the literature. When NPCM cases were compared to PCM patients, there were differences in relation to origin and positive PCM family history. Conclusions: The results corroborate the clinical view that the neurological findings are extremely important in the evaluation of PCM patients. Despite the limitations of this study, the differences in relation to patient's origins and family history point to the need of further studies to determine the susceptibility factors involved in the neurological compromise.

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Section: Discussionsupporting

confidence: 86%

“…Nevertheless, in some cases, the primary infection develops, leading to a symptomatic pulmonary disease or spreading to other sites by hematological and/or lymphatic routes, affecting virtually any organ 3,4 . In general, the most affected sites are the lungs, the skin, mucous membranes, lymph nodes and adrenal glands.…”

Section: Introductionmentioning

confidence: 99%

Paracoccidioidomycosis case series with and without central nervous system involvement

Pedroso

Lyon

Araújo

et al. 2012

Rev. Soc. Bras. Med. Trop.

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“…Em trabalho publicado por Hutzer e cols 36 , 40 pacientes com PCM e com exame clínico, neurológico e de líquor normais foram submetidos a TC do encéfalo encontrando-se 12,5% de positividade para o acometimento do SNC. Desses pacientes, 60% apresentaram, em épocas diferentes da observada, sintomas neurológicos; fato importante ao se considerar que a taxa de mortalidade da NPCM chega a 53% 22 , tendo sido observada uma taxa de mortalidade de 44,1% no presente estudo. A análise dos dados confirma a tendência de aumento do volume de relatos de casos de NPCM ao longo do tempo, principalmente após as décadas de 1970-1980, fato que talvez seja explicado pela evolução dos métodos diagnósticos citados, especialmente os de neuroimagem.…”

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“…O surgimento de crises convulsivas, sinais e sintomas cerebelares, como dismetria ou distúrbios de marcha, e transtornos mentais como alterações da cognição ou da memória, também foram relativamente comuns. Em três diferentes estudos realizados por Almeida e cols 2 , Elias Jr e cols 21 e Fagundes-Pereyra 22 , os autores observaram as principais alterações clínicas em 24, 20 e 13 casos de NPCM, respectivamente. As principais manifestações relatadas nos três estudos foram crises epilépticas, déficits motores, sinais cerebelares e cefaléia.…”

Section: Discussionunclassified

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Paracoccidioidomicose com comprometimento do sistema nervoso central: revisão sistemática da literatura

Pedroso¹,

Vilela

Pedroso

et al. 2009

Rev. Soc. Bras. Med. Trop.

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A paracoccidioidomicose (PCM), infecção sistêmica causada pelo fungo Paracoccidioides brasiliensis, é considerada a mais importante micose profunda da América Latina 48 . Pode ser considerada, ainda, um problema de saúde pública em função de seus elevados custos sociais e econômicos decorrentes não apenas Paracoccidioidomicose com comprometimento do sistema nervoso central: revisão sistemática da literatura ABSTRAcTThis study is the first systematic review of cases of neuroparacoccidioidomycosis available in the literature. Through searches in the MEDLINE and LILACS databases, 257 cases were found in 81 published studies, mainly after the 1970s-1980s. Approximately 93% of the patients were men, especially farm laborers, with a mean age of 43 years. The characteristic symptoms were motor deficits or intracranial hypertension. The chronic pseudotumoral form predominated. The mean period of evolution was 4.9 months. The lesions were mainly supratentorial (66.8%), located in the frontal and parietal lobes. The diagnosis was determined by biopsy in 57.2% of the cases and neuroimaging methods were used in 64.6% of them. A large proportion of the cases were associated with the pulmonary form of the disease (59.1%). The mortality rate was 44.1%, and 50.1% of the survivors developed sequelae, especially motor impairment. Thus, neuroparacoccidioidomycosis should be considered in the differential diagnosis for expansive and meningoencephalitic processes in the central nervous system, in order to establish early treatment and to avoid disabling sequelae. Key-words:Paracoccidioidomycosis. Fungal infection. Neuroparacoccidioidomycosis. Central nervous system. Systematic review.da doença em atividade, mas também das freqüentes seqüelas, motivo comum de incapacitação para o trabalho 15 49 . Afeta indivíduos em todas as faixas etárias a partir dos dois anos de idade, mas há marcante predomínio entre os 30 e os 50 anos de vida, período que compreende o auge da capacidade produtiva dos pacientes. A incidência é a mesma para ambos os sexos até a puberdade, entretanto, na vida adulta, torna-se mais freqüente entre os indivíduos do sexo masculino, em proporção de 11:1 22 .A doença pode manifestar-se de inúmeras maneiras e o fungo pode causar lesões em virtualmente qualquer órgão. De modo geral, os pulmões são os órgãos mais frequentemente acometidos, mas lesões cutâneas, de mucosas, linfonodais e adrenais também são comuns. Nas últimas décadas, com o surgimento de novos métodos diagnósticos, especialmente os de imagem, constatou-se que o envolvimento do sistema nervoso central (SNC) é bem mais frequente do que se admitia, ocorrendo em torno de 12,5% dos casos de PCM e chegando, em alguns estudos, até 36% dos casos 62 .

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