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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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Central Nervous System Infection with Histoplasma capsulatum. J Fungi (Basel) 2019; 5:jof5030070. [PMID: 31344869 PMCID: PMC6787664 DOI: 10.3390/jof5030070] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/19/2022] Open
Abstract
Histoplasmosis is an endemic fungal infection that may affect both immune compromised and non-immune compromised individuals. It is now recognized that the geographic range of this organism is larger than previously understood, placing more people at risk. Infection with Histoplasma capsulatum may occur after inhalation of conidia that are aerosolized from the filamentous form of the organism in the environment. Clinical syndromes typically associated with histoplasmosis include acute or chronic pneumonia, chronic cavitary pulmonary infection, or mediastinal fibrosis or lymphadenitis. Disseminated infection can also occur, in which multiple organ systems are affected. In up to 10% of cases, infection of the central nervous system (CNS) with histoplasmosis may occur with or without disseminated infection. In this review, we discuss challenges related to the diagnosis of CNS histoplasmosis and appropriate treatment strategies that can lead to successful outcomes.
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Stott KE, Hope W. Pharmacokinetics–pharmacodynamics of antifungal agents in the central nervous system. Expert Opin Drug Metab Toxicol 2018; 14:803-815. [DOI: 10.1080/17425255.2018.1492551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Katharine E Stott
- Antimicrobial Pharmacodynamics and Therapeutics Laboratory, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - William Hope
- Antimicrobial Pharmacodynamics and Therapeutics Laboratory, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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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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Starkey J, Moritani T, Kirby P. MRI of CNS Fungal Infections: Review of Aspergillosis to Histoplasmosis and Everything in Between. Clin Neuroradiol 2014; 24:217-30. [DOI: 10.1007/s00062-014-0305-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 03/26/2014] [Indexed: 11/28/2022]
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Loughan AR, Perna R, Hertza J. Cognitive impairment and memory loss associated with histoplasmosis: a case study. Clin Neuropsychol 2014; 28:514-24. [PMID: 24730375 DOI: 10.1080/13854046.2014.902107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Histoplasmosis is a rare disease caused by inhalation of the fungus Histoplasma capsulatum. It can spread via cerebral circulation to the central nervous system as a manifestation of a disseminated infection; particularly in patients with immune suppression, which can result in isolated ring-enhancing lesions and inflammation in the brain. Of the reported disseminated histoplasmosis cases (approximately 1 in 2000 per year), only 5-20% have evidence of central nervous system involvement. This paper reviews a single case study of a 57-year-old female diagnosed with disseminated CNS histoplasmosis. Patient's complaints included reduced short-term memory, word-finding problems, and difficulty organizing, making decisions, getting lost while driving, recalling names, retaining information while reading, and slowed processing speed. There was also a history of mild depression and anxiety. Direct testing revealed deficits in multiple cognitive domains including complex attention, processing speed, semantic fluency, visual scanning, motor speed, set-shifting, naming, nonverbal memory, and verbal memory. Neuropsychological deficits suggest cortical and subcortical brain dysfunction, including anterior, temporal, and mesial-temporal regions. This case illustrates the need for neuropsychologists to understand histoplasmosis, the related pathophysiology, and the neuropsychological impact; particularly with the potential for delayed progression.
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Abstract
PURPOSE OF REVIEW Immunosuppressive states and therapies are becoming common in clinical practice. Recent advances and trends in bacterial, fungal, viral and parasitic pulmonary infections in immunosuppressed patients are described. RECENT FINDINGS Pulmonary infections can jeopardize the prognosis of immunosuppressed patients. The number of patients infected with multidrug-resistant bacteria or opportunistic pathogens like rapid-growing environmental mycobacteria, Strongyloides stercoralis or Rhodococcus equi is increasing with the increased numbers of immunosuppressed patients due to HIV/AIDS and the potent immunosuppressive therapies used in solid-organ and haematopoietic transplantations, cancer and systemic illnesses. The slow development of more effective antibiotics underlines the necessity of preventive measures, development of rapid detection tests for pathogens and appropriate treatment regimens to avoid development of further resistance. SUMMARY Adequate prophylaxis, clinical suspicion, microbiological and molecular investigations, drug susceptibility-based antibiotic treatment and new drug development are strategies required to face up to the challenge of pulmonary infections in immunodepressed patients.
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Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, Kauffman CA. Clinical Practice Guidelines for the Management of Patients with Histoplasmosis: 2007 Update by the Infectious Diseases Society of America. Clin Infect Dis 2007; 45:807-25. [PMID: 17806045 DOI: 10.1086/521259] [Citation(s) in RCA: 799] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 06/19/2007] [Indexed: 11/04/2022] Open
Abstract
AbstractEvidence-based guidelines for the management of patients with histoplasmosis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 30:688–95). The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them. Since 2000, several new antifungal agents have become available, and clinical trials and case series have increased our understanding of the management of histoplasmosis. Advances in immunosuppressive treatment for inflammatory disorders have created new questions about the approach to prevention and treatment of histoplasmosis. New information, based on publications from the period 1999–2006, are incorporated into this guideline document. In addition, the panel added recommendations for management of histoplasmosis in children for those aspects that differ from aspects in adults.
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Affiliation(s)
- L Joseph Wheat
- MiraVista Diagnostics/MiraBella Technologies, Indianapolis, IN 46241, USA.
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Azizirad O, Clifford DB, Groger RK, Prelutsky D, Schmidt RE. Histoplasmoma: Isolated central nervous system infection with Histoplasma capsulatum in a patient with AIDS. Clin Neurol Neurosurg 2007; 109:176-81. [PMID: 16777317 DOI: 10.1016/j.clineuro.2006.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2006] [Revised: 04/20/2006] [Accepted: 04/30/2006] [Indexed: 11/22/2022]
Abstract
Histoplasma capsulatum is endemic to the Ohio and Mississippi River valleys. Exposure to H. capsulatum is very common in this region and usually follows a benign clinical course. However, immunocompromised hosts, like those with HIV/AIDS, are more susceptible to symptomatic infection, and have a greater chance of developing disseminated disease. We report an unusual case of a patient with AIDS presenting with a single ring-enhancing brain lesion and a focal neurological deficit. Workup was unrevealing, and brain biopsy was felt to represent too much risk as the lesion was located at the right tegmentum. The lesion enlarged over a period of months, and he underwent radiation therapy after the lesion caused obstructive hydrocephalus. He expired soon after completion of radiation therapy. At autopsy, the mass lesion was noted to contain organisms constant with H. capsulatum, pathologically consistent with a histoplasmoma.
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Affiliation(s)
- Omeed Azizirad
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Salvage treatment of histoplasmosis with posaconazole. J Infect 2006; 54:319-27. [PMID: 16824608 DOI: 10.1016/j.jinf.2006.05.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 05/01/2006] [Accepted: 05/12/2006] [Indexed: 11/18/2022]
Abstract
Six patients received salvage treatment with posaconazole oral suspension (800 mg/day in divided doses) for severe forms of histoplasmosis. One patient had pulmonary disease and 5 had disseminated disease. Previous antifungal therapy consisted of amphotericin B, itraconazole, fluconazole, or voriconazole. Posaconazole treatment duration for individual patients ranged from 6 weeks to 34 weeks. All patients had successful clinical outcomes with significant clinical improvements noted during the first month of therapy. Although the number of patients evaluated in this case series is small, the findings are encouraging and provide preliminary evidence that posaconazole may be a useful salvage treatment option for histoplasmosis involving a variety of infected tissues and organs.
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Wheat LJ, Musial CE, Jenny-Avital E. Diagnosis and Management of Central Nervous System Histoplasmosis. Clin Infect Dis 2005; 40:844-52. [PMID: 15736018 DOI: 10.1086/427880] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 10/22/2004] [Indexed: 11/03/2022] Open
Abstract
Two cases of Histoplasma meningitis are presented, illustrating the difficulty in diagnosis and treatment. The first case occurred in a patient with acquired immunodeficiency syndrome as a relapse of disseminated histoplasmosis and resolved after prolonged treatment and ongoing antiretroviral therapy. The second case occurred in a cardiac allograft recipient as meningitis and focal brain lesions that responded to liposomal amphotericin B, but the patient died shortly after therapy was completed. Unfortunately, there are no prospective studies addressing the diagnosis and management of patients with histoplasmosis of the central nervous system from which to provide evidence-based guidelines for care. In the absence of such data, an approach will be presented on the basis of our experience and opinions.
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Affiliation(s)
- L J Wheat
- MiraVista Diagnostics, Indianapolis, Indiana 46241, USA.
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Thompson GR, LaValle CE, Everett ED. Unusual manifestations of histoplasmosis. Diagn Microbiol Infect Dis 2004; 50:33-41. [PMID: 15380276 DOI: 10.1016/j.diagmicrobio.2004.04.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Accepted: 04/29/2004] [Indexed: 11/16/2022]
Abstract
We present 6 cases of infection with Histoplasma capsulatum that have been uncommonly or not previously reported. Our case reports include unusual manifestations of H. capsulatum presenting as meningitis, the immune reconstitution syndrome, relapsing pericarditis, and scleroconjunctivitis.
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Affiliation(s)
- George Richard Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of Missouri, Columbia, Missouri, USA
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