1
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Nambiar N, Hari GS, Uppal P. A Rare Case of Disseminated Histoplasmosis Involving the Colon and Brain. Cureus 2024; 16:e58046. [PMID: 38738006 PMCID: PMC11088366 DOI: 10.7759/cureus.58046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Histoplamsa capsulatum, the causative organism for histoplasmosis, is a dimorphic fungus seen abundantly along the river valleys of Ohio and Mississippi in the United States of America as well as in other parts of the world. The infection is primarily acquired by inhaling the fungal spores which are often found in bird and bat droppings. Histoplasmosis can have a wide range of presentations ranging from no symptoms to mild flu-like or life-threatening consequences if severe. Chronic histoplasmosis can be akin to tuberculosis with a history of weight loss or hemoptysis. In patients with weak immune systems, histoplasmosis can become disseminated, affecting different parts of the body, which can be fatal if left untreated. We present a 40-year-old male with a past medical history of alcoholic cirrhosis and portal hypertension presenting with lower GI bleed found to have rectal and colonic ulcers as well as multiple brain lesions from disseminated histoplasmosis.
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Affiliation(s)
- Nayna Nambiar
- Infectious Disease, Baylor Scott & White Medical Center, McKinney, USA
| | - Gayathri S Hari
- Infectious Disease, Baylor Scott & White Medical Center, McKinney, USA
| | - Priyanka Uppal
- Infectious Disease, Baylor Scott & White Medical Center, Mckinney, USA
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2
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Pipitò L, Medaglia AA, Trizzino M, Mancuso A, Catania B, Mancuso S, Calà C, Florena AM, Cascio A. Hemophagocytic lymphohistiocytosis secondary to histoplasmosis: A case report in a patient with AIDS and recent SARS-CoV-2 infection and minireview. Heliyon 2023; 9:e18537. [PMID: 37533984 PMCID: PMC10392081 DOI: 10.1016/j.heliyon.2023.e18537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023] Open
Abstract
Here, we describe the case of a naïve HIV late presenter female African patient with progressive disseminated histoplasmosis and a severe life-threatening clinical picture in a non-endemic area. She had not visited Africa in the past decade. She developed a reactive hemophagocytic lymphohistiocytosis and an acute psychiatric disorder. Histoplasmosis was diagnosed after two bone marrow biopsies. Therapy with liposomal amphotericin B resulted in rapid and progressive improvements in blood examinations and clinical conditions, including the disappearance of psychiatric disorders. The characteristics of our case were compared with those of all other cases of hemophagocytic syndrome secondary to histoplasmosis in HIV-positive patients reported in PubMed. In conclusion, clinicians outside endemic areas should evaluate histoplasmosis as a cause of severe clinical picture, especially in a patient with a travel history to an endemic area, even after many years, considering the possible reactivation of latent infection.
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Affiliation(s)
- Luca Pipitò
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D'Alessandro,” University of Palermo, Palermo, Italy
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
- Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
| | - Alice Annalisa Medaglia
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
- Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
| | - Marcello Trizzino
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
- Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
| | - Alessandro Mancuso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D'Alessandro,” University of Palermo, Palermo, Italy
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
- Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
| | - Bianca Catania
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D'Alessandro,” University of Palermo, Palermo, Italy
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
- Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
| | - Salvatrice Mancuso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D'Alessandro,” University of Palermo, Palermo, Italy
| | - Cinzia Calà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D'Alessandro,” University of Palermo, Palermo, Italy
- Microbiology and Virology Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D'Alessandro,” University of Palermo, Palermo, Italy
| | - Ada Maria Florena
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D'Alessandro,” University of Palermo, Palermo, Italy
- Unit of Pathology, Universital Hospital Paolo Giaccone, Palermo (PA), viale del vespro 147, Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D'Alessandro,” University of Palermo, Palermo, Italy
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
- Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
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3
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Ramírez JA, Reyes-Montes MDR, Rodríguez-Arellanes G, Pérez-Torres A, Taylor ML. Central Nervous System Histoplasmosis: An Updated Insight. Pathogens 2023; 12:pathogens12050681. [PMID: 37242351 DOI: 10.3390/pathogens12050681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/28/2023] Open
Abstract
Histoplasmosis is one of the systemic mycoses that can involve the Central Nervous System (CNS), and it is caused by the dimorphic ascomycete species of the Histoplasma capsulatum complex. Once in the CNS, this pathogen causes life-threatening injuries that are associated with clinical manifestations of meningitis, focal lesions (abscesses, histoplasmomas), and spinal cord injuries. The present review provides updated data and highlights a particular vision regarding this mycosis and its causative agent, as well as its epidemiology, clinical forms, pathogenesis, diagnosis, and therapy, focusing on the CNS.
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Affiliation(s)
- José Antonio Ramírez
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - María Del Rocío Reyes-Montes
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - Gabriela Rodríguez-Arellanes
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - Armando Pérez-Torres
- Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - Maria Lucia Taylor
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
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4
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Murala S, Nagarajan E, Bollu PC. Infectious Causes of Stroke. J Stroke Cerebrovasc Dis 2022; 31:106274. [PMID: 35093633 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022] Open
Abstract
Stroke is one of the primary causes of mortality and morbidity worldwide. It can be ischemic or hemorrhagic, and the former can be due to an in-situ thrombus or a distant embolus. Despite being a rare cause, stroke can also be caused in the setting of infection. Bacterial agents are the most common cause of stroke, among other infectious agents. Until the antibiotic era, rheumatic heart disease was a predisposing risk factor of infective endocarditis. VZV is the most common cause of strokes in pediatric and adult populations. Cryptococcus and Candida spp are the most common yeasts involved in CNS infections, especially in immunocompromised patients. In COVID-19 patients, ischemic strokes are more common than hemorrhagic strokes. In this review, we will discuss the most common infectious agents, with particular emphasis on COVID-19.
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Affiliation(s)
- Sireesha Murala
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States.
| | - Elanagan Nagarajan
- Department of Neurology, Erlanger Health System, University of Tennessee School of Medicine, Chattanooga, TN, United States
| | - Pradeep C Bollu
- Department of Neurology, Prisma Health, Midlands/University of South Carolina School of Medicine, Columbia, SC, United States
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5
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Khalaf SA, Patel P, Caruso CR, Parrett T, Bran A. CNS Histoplasmosis as a Gliosarcoma mimicker: The diagnostic dilemma of solitary brain lesions. IDCases 2022; 27:e01364. [PMID: 35024338 PMCID: PMC8724962 DOI: 10.1016/j.idcr.2021.e01364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Histoplasmosis is usually a benign, self-limited disease with lungs predilection. However, it might manifest as a disseminated disease in immunocompromised individuals. The involvement of the central nervous system (CNS) accounts for about 5–10% of cases with disseminated disease. Isolated histoplasmosis of the CNS is rare, and the literature shows only a few reported cases. By imaging studies, it usually presents as an isolated ring-enhancing lesion. Its spectrum of symptoms ranges from acute severe infection to progressive chronic meningitis, which delays the initial diagnosis, correct work-up and initiation of appropriate therapy. We present a case of a 57-year-old man from the Midwest of the United States who misdiagnosed with Gliosarcoma in 2019, for which he underwent appropriate management for Gliosarcoma. Presented for follow-up after new neurological symptoms; worsening in ring-enhancing brain lesions was found on magnetic resonance image MRI. After a re-examination of surgical pathological cases, histoplasmosis of the CNS was diagnosed. Failure of diagnosis CNS histoplasmosis early can lead to poor outcome and decrease chances of recovery.
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Affiliation(s)
- Suha Abu Khalaf
- University of Missouri, Division of Infectious Diseases, Columbia, MO, USA
| | - Paragkumar Patel
- University of Missouri, Division of Infectious Diseases, Columbia, MO, USA
| | - Carla R Caruso
- University of Missouri, Department of Pathology and Anatomical Sciences, Columbia, MO, USA
| | - Timothy Parrett
- University of Missouri, Department of Pathology and Anatomical Sciences, Columbia, MO, USA
| | - Andres Bran
- University of Missouri, Division of Infectious Diseases, Columbia, MO, USA
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6
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Recker MJ, Housley SB, Lipinski LJ. Indolent nonendemic central nervous system histoplasmosis presenting as an isolated intramedullary enhancing spinal cord lesion. Surg Neurol Int 2021; 12:392. [PMID: 34513158 PMCID: PMC8422457 DOI: 10.25259/sni_345_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Histoplasma capsulatum infection is largely seen in endemic regions; it results in symptomatic disease in <5% of those infected and is most often a self-limiting respiratory disease. Disseminated histoplasmosis is considered rare in the immunocompetent host. Central nervous system (CNS) dissemination can result in meningitis, encephalitis, and focal lesions in the brain and spinal cord, stroke, and hydrocephalus. An intramedullary spinal cord lesion as the only manifestation of CNS histoplasmosis has been rarely described. Case Description We present an atypical case of a 44-year-old man from a nonendemic region, on adalimumab therapy for ulcerative colitis who developed an isolated intramedullary spinal cord lesion in the setting of disseminated histoplasmosis. His course was initially indolent with vague systemic symptoms that led to consideration of several other diagnoses including sarcoidosis and lymphoma. Biopsies of several positron emission tomography positive lymph nodes revealed granulomatous inflammation, but no firm diagnosis was achieved. He was ultimately diagnosed with histoplasmosis after an acute respiratory infection in the setting of anti-tumor necrosis factor therapy. With appropriate antifungal therapy, the spinal cord lesion regressed. The previous systemic biopsies were re-reviewed, and rare fungal elements consistent with H. capsulatum were identified. A presumptive diagnosis of CNS histoplasmosis was made in the absence of direct laboratory confirmation in the setting of rapid and complete resolution on antifungal therapy. Conclusion Disseminated histoplasmosis should be considered in granulomatous disease, even if the patient resides in a nonendemic region. Furthermore, clinicians should be mindful that CNS histoplasmosis may present in an atypical fashion.
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Affiliation(s)
- Matthew J Recker
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States.,Department of Neurosurgery, Jacobs School of Medicine at the University at Buffalo, Buffalo New York, United States
| | - Steven B Housley
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States.,Department of Neurosurgery, Jacobs School of Medicine at the University at Buffalo, Buffalo New York, United States
| | - Lindsay J Lipinski
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States.,Department of Neurosurgery, Jacobs School of Medicine at the University at Buffalo, Buffalo New York, United States
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7
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Abstract
PURPOSE OF REVIEW Stroke continues to be a leading cause of debility in the world. Infections have been associated with stroke, but are not considered as directly causal, and so they are not often included in the traditional stroke workup and management. They are especially important in patients with stroke of undetermined etiology, and in certain patient populations, such as young patients without traditional risk factors, and immunocompromised patients. RECENT FINDINGS There has been strong evidence for infectious conditions, such as endocarditis, and pathogens, such as varicella zoster in stroke causation, and more supportive evidence is surfacing in recent years of several organisms increasing the stroke risk or being directly causal in stroke. The evidence also seems to be pointing to the role of inflammation in increasing the risk of stroke via accelerated atherosclerosis, vasculitis and vasculopathy. SUMMARY Infectious causes should be considered in the differential and work up of stroke in certain patient populations and appropriate treatments need to be initiated to minimize adverse stroke-related outcomes.
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8
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Simms A, Kobayashi T, Endelman L, Sekar P. Disseminated histoplasmosis presenting as bilateral lower extremity paresis. Int J Infect Dis 2020; 95:265-267. [PMID: 32272261 DOI: 10.1016/j.ijid.2020.03.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/16/2020] [Accepted: 03/24/2020] [Indexed: 11/20/2022] Open
Abstract
Histoplasmosis is the most common endemic mycosis in the United States and is caused by the organism Histoplasma capsulatum. Infection is often asymptomatic or self-limited, but when symptomatic it usually presents in the form of pulmonary histoplasmosis. In its most severe form, H. capsulatum can spread to extrapulmonary sites causing disseminated infection. Here we present a peculiar case of central nervous system (CNS) histoplasmosis wherein multiple focal spinal cord lesions were the only manifestation of CNS infection, causing bilateral lower extremity paresis and loss of sensation. Although uncommon, CNS histoplasmosis should be included in the differential diagnosis when a patient presents with meningitis, encephalitis, or isolated brain or spinal cord lesions in endemic areas.
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Affiliation(s)
- Andrew Simms
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Levi Endelman
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, 375 Newton Road, Iowa City, IA 52242, USA
| | - Poorani Sekar
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
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9
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de Almeida SM, Imano ECM, Vicente VA, Gomes RR, Trentin AP, Zamarchi K, Schneider GX, Pinheiro RL, da Silva NM, de Hoog GS. Primary Central Nervous System Infection by Histoplasma in an Immunocompetent Adult. Mycopathologia 2020; 185:331-338. [PMID: 31989393 DOI: 10.1007/s11046-019-00394-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/28/2019] [Indexed: 12/17/2022]
Abstract
Central nervous system (CNS) infection by Histoplasma capsulatum is a rare disease in immunocompromised individuals in endemic areas. About one quarter of cases result from hematogenous dissemination. A 23-year-old upholsterer with chronic occipital headache had developed intracranial hypertension and dizziness, incoordination with ataxic gait, and acute confusion 5 months prior to admission. Laboratory examinations and chest roentgenogram were normal. Postcontrast T1-weighted MRI of the brain revealed a multiple ring-enhancing cerebellar, brain stem and parietal lobe lesions, and meningeal contrast enhancement. Cerebrospinal fluid culture was positive for H. capsulatum species complex, which was confirmed by phylogenetic analysis. Thirteen years after the diagnosis and treatment, there was no H. capsulatum recurrence; sequels related to complications due to the ventriculoperitoneal shunt. This case shows a primary neurological presentation of cerebral histoplasmosis, without meningitis or disseminated disease in nonimmune-compromised patient. The authors propose a categorization of the diagnosis of CNS histoplasmosis. Routine diagnostics of sibling species within the H. capsulatum complex proved to be difficult.
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Affiliation(s)
- Sérgio M de Almeida
- Diagnostic Support Unit, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil
| | - Elaine C M Imano
- Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - Vania A Vicente
- Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil.
| | - Renata R Gomes
- Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - Ana P Trentin
- Diagnostic Support Unit, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil.,Neuroinfection Clinic, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil
| | - Kassiely Zamarchi
- Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - Gabriela X Schneider
- Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - Rosangela L Pinheiro
- Department of Mycology, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil
| | - Nickolas M da Silva
- Bioprocess Engineering and Biotechnology Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - G S de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Center of Expertise in Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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10
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Zahra K, Goldstein ED, Bohnen AM, Freeman WD. "Pseudo CNS Sarcoidosis": Histoplasmosis of Brain Mimicking Steroid Refractory Sarcoidosis. Neurohospitalist 2019; 10:150-152. [PMID: 32373283 DOI: 10.1177/1941874419887325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kaneez Zahra
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Angela M Bohnen
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - William D Freeman
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.,Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
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11
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Abdulla MC, Narayan R, Mampilly N, Kumar P. Subdural Empyema in Disseminated Histoplasmosis. Ann Indian Acad Neurol 2017; 20:414-415. [PMID: 29184348 PMCID: PMC5682749 DOI: 10.4103/aian.aian_306_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mansoor C Abdulla
- Department of General Medicine, MES Medical College, Malappuram, Kerala, India
| | - Ram Narayan
- Department of General Medicine, MES Medical College, Malappuram, Kerala, India
| | - Neena Mampilly
- Department of Pathology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Prem Kumar
- Department of Neurosurgery, MES Medical College, Malappuram, Kerala, India
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12
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McCarthy MW, Kalasauskas D, Petraitis V, Petraitiene R, Walsh TJ. Fungal Infections of the Central Nervous System in Children. J Pediatric Infect Dis Soc 2017; 6:e123-e133. [PMID: 28903523 DOI: 10.1093/jpids/pix059] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/04/2017] [Indexed: 01/03/2023]
Abstract
Although uncommon in children, fungal infections of the central nervous system can be devastating and difficult to treat. A better understanding of basic mycologic, immunologic, and pharmacologic processes has led to important advances in the diagnosis and management of these diseases, but their mortality rates remain unacceptably high. In this focused review, we examine the epidemiology and clinical features of the most common fungal pathogens of the central nervous system in children and explore recent advances in diagnosis and antifungal therapy.
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Affiliation(s)
- Matthew W McCarthy
- Division of General Internal Medicine, Weill Cornell Medicine of Cornell University, New York, New York
| | - Darius Kalasauskas
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.,Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York
| | - Vidmantas Petraitis
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York.,Institute of Infectious Disease and Pathogenic Microbiology, Prienai, Lithuania
| | - Ruta Petraitiene
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York.,Institute of Infectious Disease and Pathogenic Microbiology, Prienai, Lithuania
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York.,Departments of Pediatrics, and Microbiology & Immunology, Weill Cornell Medicine of Cornell University, New York, New York
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13
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Martínez-Girón R, Pantanowitz L. Cerebrospinal fluid cytology in nonmalignant aseptic meningeal disorders. Diagn Cytopathol 2017; 45:1020-1029. [PMID: 28816034 DOI: 10.1002/dc.23797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/21/2017] [Accepted: 08/03/2017] [Indexed: 12/16/2022]
Abstract
Cerebrospinal fluid cytology examination is a common and reliable primary and/or complementary procedure for the diagnosis of central nervous system (CNS) disorders. This review provides an update of aseptic meningeal disorders that may be encountered in cytopathology practice. The article covers the cytological findings and helpful ancillary studies needed of nonmalignant aseptic CNS disorders such as viral, bacterial, fungal and parasitic infections, and other noninfectious diseases, such as Mollaret's meningitis (recurrent benign lymphocytic meningitis), Guillain-Barré syndrome, multiple Sclerosis, subarachnoid haemorrhage, and drug-induced disorders.
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Affiliation(s)
- Rafael Martínez-Girón
- INCLÍNICA Foundation for Clinical, Pneumological and Carcinogenic Research, Calvo Sotelo, 16, Oviedo, 33007, Spain
| | - Liron Pantanowitz
- Department of Pathology, UPMC Shadyside, UPMC Cancer Pavilion Suite 201, 5150 Centre Ave, Pittsburgh, Pennsylvania, 15232
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14
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Thind GS, Patri S. Hiding in plain sight: a case of chronic disseminated histoplasmosis with central nervous system involvement. BMJ Case Rep 2017; 2017:bcr-2017-220476. [PMID: 28687695 DOI: 10.1136/bcr-2017-220476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 64-year-old man presented with gradual onset of confusion, ataxia and 25-pound weight loss over 3 months. MRI of the brain revealed two enhancing cerebellar lesions suspicious for metastases. Positron emission tomography-CT showed enhancement of cervical and axillary lymph nodes. Left axillary lymph node biopsy showed no evidence of malignancy but instead showed fungal organisms morphologically consistent with Histoplasma spp. Disseminated histoplasmosis with central nervous system involvement was suspected. Further history revealed that the patient had been having subjective fever for the past several months. He has had mild pancytopenia for about 2 years, which had not been further evaluated. Additionally, he had an oesophagogastroduodenoscopy 3 months prior to admission, which had shown granulomatous gastritis. Subsequently, the diagnosis of disseminated histoplasmosis was confirmed by serological testing and bone marrow biopsy. The patient was started on liposomal amphotericin B. Unfortunately, the patient had a catastrophic stroke and was transitioned to comfort care measures.
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15
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Abstract
This chapter provides an overview of infectious syndromes, pathogens, and diagnostic testing modalities for central nervous system infections in the immunocompromised host.
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16
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Acute and Chronic Meningitis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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McCarthy MW, Walsh TJ. Molecular diagnosis of invasive mycoses of the central nervous system. Expert Rev Mol Diagn 2016; 17:129-139. [PMID: 27936983 DOI: 10.1080/14737159.2017.1271716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In September 2012, the Centers for Disease Control and Prevention (CDC) began investigating an outbreak of fungal meningitis among patients who had received contaminated preservative-free methyl prednisolone acetate injections from the New England Compounding Center in Framingham, Massachusetts. Thousands of patients were potentially exposed to tainted corticosteroids, but establishing the diagnosis of fungal meningitis during the nationwide outbreak was difficult because little was known about the natural history of the disease. Areas covered: The challenges associated with this outbreak highlighted the need for rapid and reliable methodologies to assist in the diagnosis of invasive mycoses of the central nervous system (IMCNS), which may be devastating and difficult to treat. In this paper, we review the causative agents of these potentially-lethal infections, which include cryptococcal meningitis, cerebral aspergillosis, and hematogenous Candida meningoencephalitis. Expert commentary: While microscopy, culture, and histopathologic identification of fungal pathogens remain the gold standard for diagnosis, new platforms and species-specific assays have recently emerged, including lateral flow immunoassays (LFA), matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and multiplex PCR in conjunction with magnetic resonance (MR) to potentially aid in the diagnosis of IMCNS.
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Affiliation(s)
- Matthew William McCarthy
- a Hospital Medicine , Joan and Sanford I Weill Medical College of Cornell University , New York , NY , USA
| | - Thomas J Walsh
- b Transplantation-Oncology Infectious Diseases Program , Weill Cornell Medical Center , New York , NY , USA
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Lyons JL, Zhang SX. Current laboratory approaches to diagnosis of CNS fungal infections. Future Microbiol 2016; 11:175-7. [PMID: 26849164 DOI: 10.2217/fmb.15.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jennifer L Lyons
- Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Sean X Zhang
- Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, MD, USA.,Division of Medical Microbiology, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
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Hariri OR, Minasian T, Quadri SA, Dyurgerova A, Farr S, Miulli DE, Siddiqi J. Histoplasmosis with Deep CNS Involvement: Case Presentation with Discussion and Literature Review. J Neurol Surg Rep 2015; 76:e167-72. [PMID: 26251798 PMCID: PMC4520962 DOI: 10.1055/s-0035-1554932] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/06/2015] [Indexed: 02/02/2023] Open
Abstract
Central nervous system (CNS) histoplasmosis is rare and difficult to diagnose because it is often overlooked or mistaken for other pathologies due to its nonspecific symptoms. A 32-year-old Hispanic man with advanced acquired immunodeficiency virus presented with altered mental status and reported confusion for the past 3 months. He had a Glasgow Coma Scale of 12, repetitive nonfluent speech, and a disconjugate gaze with a right gaze preference. Lung computed tomography (CT) findings indicated a pulmonary histoplasmosis infection. Magnetic resonance imaging of the brain revealed a ring-enhancing lesion in the left caudate nucleus. A CT-guided left retroperitoneal node biopsy was performed and indicated a benign inflammatory process with organisms compatible with fungal yeast. Treatment with amphotericin B followed by itraconazole was initiated in spite of negative cerebrospinal fluid (CSF) cultures and proved effective in mitigating associated CNS lesions and resolving neurologic deficits. The patient was discharged 3 weeks later in stable condition. Six weeks later, his left basal ganglia mass decreased. Early recognition of symptoms and proper steps is key in improving outcomes of CNS histoplasmosis. Aggressive medical management is possible in the treatment of intracranial deep mass lesions, and disseminated histoplasmosis with CNS involvement can be appropriately diagnosed and treated, despite negative CSF and serology studies.
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Affiliation(s)
- Omid R Hariri
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
| | - Tanya Minasian
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
| | - Syed A Quadri
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
| | - Anya Dyurgerova
- Division of Neurosurgery, Department of Surgery, Western University of Health Sciences, Pomona, California, United States
| | - Saman Farr
- Division of Neurosurgery, Department of Surgery, Western University of Health Sciences, Pomona, California, United States
| | - Dan E Miulli
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
| | - Javed Siddiqi
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
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Estrada-Bellmann I, Camara-Lemarroy CR, Flores-Cantu H, Calderon-Hernandez HJ, Villareal-Velazquez HJ. Hemichorea in a patient with HIV-associated central nervous system histoplasmosis. Int J STD AIDS 2014; 27:75-7. [PMID: 25505048 DOI: 10.1177/0956462414564608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/21/2014] [Indexed: 11/17/2022]
Abstract
Central nervous system histoplasmosis is a rare opportunistic infection with a heterogeneous clinical presentation. We describe the first case of human immunodeficiency virus-associated cerebral histoplasmosis presenting with hemichorea. The patient recovered after treatment with conventional amphotericin B and itraconazole.
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Affiliation(s)
- Ingrid Estrada-Bellmann
- Servicio de Neurologia, Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, México
| | - Carlos R Camara-Lemarroy
- Servicio de Neurologia, Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, México
| | - Hazael Flores-Cantu
- Servicio de Neurologia, Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, México
| | - Hector J Calderon-Hernandez
- Servicio de Neurologia, Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, México
| | - Hector J Villareal-Velazquez
- Servicio de Neurologia, Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, México
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Deodhar D, Frenzen F, Rupali P, David D, Promila M, Ramya I, Seshadri MS. Disseminated histoplasmosis: a comparative study of the clinical features and outcome among immunocompromised and immunocompetent patients. NATIONAL MEDICAL JOURNAL OF INDIA 2014; 8:86-91. [PMID: 24758444 DOI: 10.1177/1941874417725969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Disseminated histoplasmosis is a chronic granulomatous disease caused by the dimorphic fungus, Histoplasma capsulatum. Clinical presentation can vary from the acute pulmonary to the chronic disseminated form. In India, disseminated histoplasmosis often presents with pyrexia of unknown origin with a presentation similar to 'disseminated tuberculosis' involving the adrenal glands and bone marrow. Due to rarity of the disease, data are lacking regarding its clinical presentation and outcome among immunocompromised and immunocompetent patients. METHODS During January 2000 to December 2010, we identified 37 patients of disseminated histoplasmosis and attempted to characterize the differences between immuno- compromised and immunocompetent patients. Demographic characteristics, clinical presentation, risk factors, laboratory findings, diagnostic yield, treatment received and prognosis were noted and compared between the two groups. RESULTS Eleven of 37 patients with disseminated histo- plasmosis were immunocompromised and 26 were immuno- competent. Comparison of their clinical features showed a higher frequency of skin lesions in the immunocompromised compared to the immunocompetent group (54.5% v. 11.5%). Pancytopenia and anaemia were more common among the immunocompromised (81.8%) compared to the immunocompetent (46.2%) group. In the immuno- compromised patients, the diagnosis was made most often by bone marrow aspirate and culture (72.7%) compared to the immunocompromised group where the diagnosis was most often obtained by adrenal gland biopsy and fungal cultures (57.7%). The cure rate was significantly higher in the immunocompetent group (73% v. 45%). CONCLUSION The clinical presentation and outcome of patients with disseminated histoplasmosis differs among immunocompromised and immunocompetent patients.
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Affiliation(s)
- D Deodhar
- Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India - Department of Infectious Diseases and Medicine Unit 1
| | - F Frenzen
- Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India - Department of Medicine Unit 1
| | - P Rupali
- Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India - Department of Infectious Diseases and Medicine Unit 1
| | - D David
- Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India - Department of General Medicine
| | - M Promila
- Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India - Department of Microbiology
| | - I Ramya
- Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India - Department of General Medicine
| | - M S Seshadri
- Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India - Department of Endocrinology
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Andrade AI, Donato M, Previgliano C, Hardjasudarma M. Histoplasmosis brain abscesses in an immunocompetent adult. A case report and literature review. Neuroradiol J 2014; 27:334-8. [PMID: 24976201 DOI: 10.15274/nrj-2014-10038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 11/12/2022] Open
Abstract
We describe the case of a 62-year-old man, who presented with a new onset of focal seizures of his right leg. There were no other clinical symptoms, and laboratory results were normal. Brain magnetic resonance imaging revealed multiple lesions, two supratentorial lesions were ring-enhancing. The brain biopsy tissue showed Histoplasma capsulatum abscesses. He improved on treatment with Amphotericin B. This case is reported since cerebral ring-enhancing lesions are rarely associated with histoplasmosis, which is also rare in an immunocompetent individual. We review the literature and discuss the radiologic and pathologic findings of this case compared with previous reports.
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Affiliation(s)
- Ana Ines Andrade
- Department of Radiology, CIMED; La Plata, Buenos Aires, Argentina -
| | - Maren Donato
- Department of Radiology, CIMED; La Plata, Buenos Aires, Argentina
| | - Carlos Previgliano
- Department of Radiology, Louisiana State University Health Sciences center; Shreveport, LA, USA
| | - Mardjohan Hardjasudarma
- Department of Radiology, Louisiana State University Health Sciences center; Shreveport, LA, USA
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Abstract
Most infectious pathogens have anecdotal evidence to support a link with stroke, but certain pathogens have more robust associations, in which causation is probable. Few dedicated prospective studies of stroke in the setting of infection have been done. The use of head imaging, a clinical standard of diagnostic care, to confirm stroke and stroke type is not universal. Data for stroke are scarce in locations where infections are probably most common, making it difficult to reach conclusions on how populations differ in terms of risk of infectious stroke. The treatment of infections and stroke, when concomitant, is based on almost no evidence and requires dedicated efforts to understand variations that might exist. We highlight the present knowledge and emphasise the need for stronger evidence to assist in the diagnosis, treatment, and secondary prevention of stroke in patients in whom an infectious cause for stroke is probable.
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Progressive disseminated histoplasmosis in the HIV population in Europe in the HAART era. Case report and literature review. Infection 2014; 42:611-20. [PMID: 24627267 DOI: 10.1007/s15010-014-0611-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 02/28/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In highly endemic areas, up to 20 % of human immunodeficiency virus (HIV)-infected persons will develop progressive disseminated histoplasmosis (PDH). Europe is not endemic to histoplasmosis, and the disease is mainly found in immigrants often co-infected with HIV. METHODS We present a case of a patient with HIV and PDH highlighting the possible diagnostic difficulties that may arise in a non-endemic area and review the literature of histoplasmosis in the context of HIV infection with special focus on Europe. DISCUSSION When cellular immunity wanes (usually at CD4 T-lymphocyte counts <150 cells/μL) histoplasma infection, acquired earlier, can reactivate and disseminate. PDH is an acquired immune deficiency syndrome(AIDS)-defining disease and a life-threatening infection, with a clinical spectrum ranging from an acute, fatal course with lung infiltrates and respiratory failure, shock, coagulopathy and multi-organ failure, to a more subacute disease with focal organ involvement, pancytopenia and hepatosplenomegaly. Mortality rates remain high for untreated patients, but early diagnosis, proper antifungal treatment and early initiation of antiretroviral therapy have improved the prognosis. CONCLUSION European infectious diseases physicians, microbiologists and pathologists must be aware of histoplasmosis, particularly when facing HIV-infected immigrants from endemic areas. This is increasingly important due to migration and travel activities from these areas.
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Reginato A, Giannuzzi P, Ricciardi M, De Simone A, Sanguinetti M, Porcellato I, Mandara MT. Extradural spinal cord lesion in a dog: first case study of canine neurological histoplasmosis in Italy. Vet Microbiol 2014; 170:451-5. [PMID: 24646600 DOI: 10.1016/j.vetmic.2014.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/11/2014] [Accepted: 02/14/2014] [Indexed: 11/26/2022]
Abstract
A 7-year-old intact male mixed dog was presented with a history of acute and progressive paraparesis. Abnormal clinical signs consisted of non-ambulatory paraparesis, hind limbs hypertonia and severe thoracolumbar pain. Magnetic resonance imaging demonstrated an isointense in T1 and T2 WI epidural lesion, with good contrast enhancement, extending from T-10 to T-13. Laminectomy was carried out to remove the epidural mass. Histological examination revealed a pyogranulomatous lesion characterized by numerous macrophages containing yeast-like Grocott and PAS-positive bodies. Immunohistochemistry and PCR performed on formalin-fixed paraffin-embedded tissue confirmed Histoplasma capsulatum as the causative agent. H. capsulatum has a worldwide distribution in temperate and subtropical climates but its presence as an autochthonous fungus in Europe is now recognized. To the authors' knowledge this is the first report of canine histoplasmosis in Italy with lesion confined to the central nervous system.
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Affiliation(s)
- A Reginato
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy.
| | - P Giannuzzi
- Pingry Veterinary Hospital, Via Medaglie d'oro, 70126 Bari, Italy
| | - M Ricciardi
- Pingry Veterinary Hospital, Via Medaglie d'oro, 70126 Bari, Italy
| | - A De Simone
- Pingry Veterinary Hospital, Via Medaglie d'oro, 70126 Bari, Italy
| | - M Sanguinetti
- Institute of Microbiology, Catholic University of Sacred Heart, L. go F. Vito 1, 00168 Rome, Italy
| | - I Porcellato
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy
| | - M T Mandara
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy
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Veeravagu A, Ludwig C, Camara-Quintana JQ, Jiang B, Lad N, Shuer L. Fungal infection of a ventriculoperitoneal shunt: histoplasmosis diagnosis and treatment. World Neurosurg 2012; 80:222.e5-13. [PMID: 23247021 DOI: 10.1016/j.wneu.2012.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 09/12/2012] [Accepted: 12/11/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND Histoplasmosis is a fungal disease caused by Histoplasma capsulatum, commonly found in the Americas, and Histoplasma duboisii, located in Africa. In the United States, H. capsulatum is prevalent in the Ohio and Mississippi river valleys. In rare circumstances, central nervous system (CNS) histoplasmosis infection can be caused by shunt placement. We present a case report of a 45-year-old woman in whom CNS histoplasmosis developed after having a ventriculoperitoneal (VP) shunt placed for communicating hydrocephalus. A review of the literature on fungal infections after CNS shunt placement as well as treatment options for this subset of patients was undertaken. METHODS The PubMed database current to 1958 was filtered and limited to English-language articles. Fifty-eight articles were selected for review based on evidence of information regarding the fungal organism responsible for shunt infection, symptoms, treatment, and/or outcomes. Also included in this review is our case study. RESULTS A thorough analysis of the PubMed database revealed 58 reported cases of CNS shunt-related fungal infections in the English-language medical literature as well as 7 therapeutic agents used to treat patients in whom postshunt fungal infections developed. CONCLUSIONS We describe the steps in diagnosis of histoplasmosis after shunt placement, provide an effective therapeutic regimen, and review the present understanding of CNS fungal infections. The medical literature was surveyed to compare and analyze various CNS fungal infections that can arise from shunt placement as well as treatments rendered.
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Affiliation(s)
- Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
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Rangel-Castilla L, Hwang SW, White AC, Zhang YJ. Neuroendoscopic diagnosis of central nervous system histoplasmosis with basilar arachnoiditis. World Neurosurg 2011; 77:399.E9-13. [PMID: 22120362 DOI: 10.1016/j.wneu.2011.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/08/2011] [Accepted: 06/03/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Histoplasmosis of the central nervous system (CNS) is seen in 10% to 20% of patients with disseminated histoplasmosis and/or in association with immunocompromised patients. Meningitis, arachnoiditis, and hydrocephalus are the most common clinical manifestations of CNS histoplasmosis. Patients with CNS histoplasmosis present similarly to other infectious etiologies, and confirmatory diagnosis is important in the management of these patients. However, diagnosis of CNS histoplasmosis can be difficult, and sometimes performing a parenchymal biopsy is necessary to confirm the diagnosis. METHODS AND RESULTS We describe the case of a 41-year-old man with HIV/AIDS who presented with the signs, symptoms, and radiologic evidence of basal meningitis and hydrocephalus. Cerebrospinal fluid (CSF) analysis from multiple lumbar punctures was negative. The patient underwent a neuroendoscopic procedure with diagnostic and therapeutic goals. Internal CSF diversion (endoscopic third ventriculostomy) and biopsy of the floor of the third ventricle and subarachnoid space were performed; surgical biopsies identified noncaseating granulomas, and ventricular CSF was positive for Histoplasmosis antibodies. The patient was treated with liposomal amphotericin B and itraconazole. The patient had resolution of his symptoms immediately after surgery, and 1-month follow-up computed tomography of the head demonstrated resolution of the hydrocephalus. At the last follow-up 12 months postoperatively, the patient has not required insertion of a ventriculoperitoneal shunt. CONCLUSION Clinicians should maintain a high index of suspicion for fungal basal meningitis in patients with AIDS and hydrocephalus. With nondiagnostic lumbar CSF sampling, neuroendoscopy can be considered as an alternative for diagnosis and treatment of basal meningitis and hydrocephalus.
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de Broucker T, Martinez-Almoyna L. Diagnostic des méningites chroniques. Rev Med Interne 2011; 32:159-72. [DOI: 10.1016/j.revmed.2010.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 03/26/2010] [Accepted: 04/10/2010] [Indexed: 12/26/2022]
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Abstract
Infectious and inflammatory processes of the intracranial compartment often result in acute clinical presentations. The possible causes are legion. Clues to the diagnosis involve clinical presentation, laboratory analysis, and neuroimaging. This article reviews some of the salient factors in understanding intracranial infection/ inflammation, including pathophysiology and neuroimaging protocols/findings, and provides some examples and a few "pearls and pitfalls."
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Abstract
The endemic mycoses are a diverse group of diseases caused by thermally dimorphic fungi. While they share many characteristics, each has unique aspects with regards to their clinical course, diagnosis and management. Diagnosis may be difficult and delayed owing to the varied manifestations and wide differential diagnosis. Historically, treatment has been with amphotericin B, which has been limited by its significant toxicity. The advent of the azole class of medications has allowed for safer alternatives to amphotericin B. The azoles have become the mainstay of treatment for many, if not most, forms of these diseases. Guidelines have been released for the management of each of the North American endemic mycoses; however, many questions remain as to the best strategies for the diagnosis and management of various manifestations of these diseases.
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Affiliation(s)
- Keyur S Vyas
- Division of Infectious Diseases, University of Arkansas for Medical Sciences, 4301 W Markham, Mail Slot #639, Little Rock, AR 72205, USA.
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Fungal infections of the nervous system: Current perspective and controversies in management. Int J Surg 2010; 8:591-601. [DOI: 10.1016/j.ijsu.2010.07.293] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 06/06/2010] [Accepted: 07/21/2010] [Indexed: 01/23/2023]
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Acute and chronic meningitis. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00018-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Mariani MM, Kielian T. Microglia in infectious diseases of the central nervous system. J Neuroimmune Pharmacol 2009; 4:448-61. [PMID: 19728102 DOI: 10.1007/s11481-009-9170-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 08/11/2009] [Indexed: 02/06/2023]
Abstract
Microglia are the resident macrophage population in the central nervous system (CNS) parenchyma and, as such, are poised to provide a first line of defense against invading pathogens. Microglia are endowed with a vast repertoire of pattern recognition receptors that include such family members as Toll-like receptors and phagocytic receptors, which collectively function to sense and eliminate microbes invading the CNS parenchyma. In addition, microglial activation elicits a broad range of pro-inflammatory cytokines and chemokines that are involved in the recruitment and subsequent activation of peripheral immune cells infiltrating the infected CNS. Studies from several laboratories have demonstrated the ability of microglia to sense and respond to a wide variety of pathogens capable of colonizing the CNS including bacterial, viral, and fungal species. This review will highlight the role of microglia in microbial recognition and the resultant antipathogen response that ensues in an attempt to clear these infections. Implications as to whether microglial activation is uniformly beneficial to the CNS or in some circumstances may exacerbate pathology will also be discussed.
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Affiliation(s)
- Monica M Mariani
- Department of Pathology and Microbiology, University of Nebraska Medical Center, 985900 Nebraska Medical Center, Omaha, NE 68198-5900, USA
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