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Costa RDS, Hygino da Cruz Jr LC, de Souza SR, Ventura N, Corrêa DG. Insights into Magnetic Resonance Imaging Findings in Central Nervous System Paracoccidioidomycosis: A Comprehensive Review. Res Rep Trop Med 2023; 14:87-98. [PMID: 37554584 PMCID: PMC10406117 DOI: 10.2147/rrtm.s391633] [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: 04/19/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a infection caused by the thermodimorphic fungus Paracoccidioides spp. (P. lutzii and, mainly, P. brasiliensis). This infection predominantly affects rural male workers aged between 30 and 50 years old who deal with soil on daily activities. Clinically, the disease is classified as acute/subacute phase, which evolves rapidly, secondary to dissemination of the fungus through to the phagocytic-mononuclear system, leading to fever, weight loss, and anorexia, associated with hepatosplenomegaly and lymphadenopathy, which can be complicated with suppuration and fistulization; and chronic phase, which corresponds to 74% to 95% of symptomatic cases, with a common pulmonary involvement. Central nervous system involvement is almost always a characteristic of the chronic form. Inhalation is the most common route of primary infection, usually affecting the lungs, forming the primary complex. From the primary complex, hematogenic dissemination can occur to any organ, including the brain and spinal cord. Although PCM of the central nervous system diagnosis is usually based on histopathological analysis and the imaging features are not specific for PCM, computed tomography and magnetic resonance imaging can demonstrate evidences of granuloma, abscess, meningitis, or a combination of these lesions, contributing to a preoperative diagnosis, especially when considered in conjunction with epidemiology. In this article, we review the pathophysiology, clinical manifestations and imaging aspects of neuro-PCM.
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Affiliation(s)
- Rangel de Sousa Costa
- Department of Radiology, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
| | | | - Simone Rachid de Souza
- Department of Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Nina Ventura
- Department of Radiology, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
| | - Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil
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Alvarenga JALDS, Martins DE, Kanas M, Elizeche HGK, Dell'Aquila AM, Fernandes EDA, Wajchenberg M, Puertas EB. Paracoccidioidomycosis in the spine: case report and review of the literature. SAO PAULO MED J 2016; 134:263-267. [PMID: 27355801 PMCID: PMC10496604 DOI: 10.1590/1516-3180.2015.02691801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 01/18/2016] [Indexed: 11/21/2022] Open
Abstract
CONTEXT: Paracoccidioidomycosis is a systemic form of mycosis that spreads hematogenously, secondarily to reactivation of lung infection or infection at another site or to new exposure to the causative agent. Few cases of bone involvement have been reported in the literature and involvement of the spine is extremely rare. CASE REPORT: We describe a case of a 68-year-old male patient with spondylodiscitis at the levels L4-L5 caused by presence of the fungus Paracoccidioides brasiliensis, which was diagnosed through percutaneous biopsy. The patient was treated with sulfamethoxazole and trimethoprim for 36 months, with complete resolution of the symptoms. CONCLUSION: Spondylodiscitis caused by the fungus Paracoccidioides brasiliensis is uncommon. However, in patients with chronic low-back pain who live or used to live in endemic regions, this infection should be considered as a possible differential diagnosis.
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Affiliation(s)
| | - Délio Eulálio Martins
- MD, PhD. Attending Physician, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Michel Kanas
- MD. Spine Resident, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Hugo Gustavo Kunzle Elizeche
- MD. Spine Fellow, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Adriana Macêdo Dell'Aquila
- MD, PhD. Infectious Disease Specialist, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Eloy De Avila Fernandes
- MD, PhD. Affiliated Professor, Department of Imaging Diagnostics, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Marcelo Wajchenberg
- MD, PhD. Affiliated Professor, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Eduardo Barros Puertas
- MD, PhD. Full Professor, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
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Pedroso VSP, Vilela MDC, Pedroso ERP, Teixeira AL. Paracoccidioidomicose com comprometimento do sistema nervoso central: revisão sistemática da literatura. Rev Soc Bras Med Trop 2009; 42:691-7. [DOI: 10.1590/s0037-86822009000600016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 10/08/2009] [Indexed: 11/21/2022] Open
Abstract
Este trabalho é o primeiro a realizar uma revisão sistemática dos casos de neuroparacoccidioidomicose disponíveis na literatura. Foram encontrados 257 casos em 81 trabalhos pesquisados pelo MEDLINE e LILACS, com maior número de publicações após as décadas de 1970-1980. Aproximadamente, 93% dos pacientes eram homens, principalmente lavradores, com idade média de 43 anos. O quadro caracterizou-se por sintomatologia motora ou de hipertensão intracraniana. A forma crônica pseudotumoral predominou. O período médio de evolução foi de 4,9 meses. As lesões foram principalmente supratentoriais (66,8%), localizando-se nos lobos frontais e parietais. A biópsia determinou o diagnóstico em 57,2% dos casos e utilizaram-se métodos de neuroimagem em 64,6% deles. Houve grande associação com a forma pulmonar da doença (59,1%). A mortalidade foi de 44,1% e 50,1% dos sobreviventes evoluíram com sequelas, principalmente motoras. Assim, deve-se considerar a neuroparacoccidioidomicose no diagnóstico diferencial dos processos expansivos e meningoencefalíticos do sistema nervoso central para se estabelecer tratamento precoce e evitar seqüelas incapacitantes.
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Leal Filho MB, Borges G, da Silva RG, de Almeida Xavier Aguiar A, de Almeida BR, da Cunha E Silva Vieira MA, Pinheiro LMR. Paracoccidioidomicose em hemisfério cerebral e tronco encefálico: relato de caso. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:686-9. [PMID: 17119820 DOI: 10.1590/s0004-282x2006000400033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 05/03/2006] [Indexed: 11/21/2022]
Abstract
Relata-se sobre um homem de 36 anos com passagem quatro anos antes pela selva amazônica. Admitido após seis meses do aparecimento progressivo de tetraparesia, ataxia de marcha, disfagia, disartria, dispnéia e soluço. A ressonância magnética revelou lesão parietoccipital à direita e no bulbo, sendo esta última maior. Investigações para tuberculose e síndrome da imunodeficiência adquirida tiveram resultados negativos. Foi submetido a microcirurgia da lesão do bulbo. O estudo anatomopatológico revelou paracoccidioidomicose. Recebeu tratamento com anfotericina B até 2100 mg, e sulfametoxazol-trimetoprim por três meses, e fisioterapia. Voltou às atividades após seis meses do término do tratamento. Comenta-se sobre a participação do sistema imunológico e das citocinas (interleucinas).
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de Almeida SM, Queiroz-Telles F, Teive HAG, Ribeiro CEL, Werneck LC. Central nervous system paracoccidioidomycosis: clinical features and laboratorial findings. J Infect 2004; 48:193-8. [PMID: 14720496 DOI: 10.1016/j.jinf.2003.08.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study prospectively the clinical features and laboratorial characteristics of 24 patients with central nervous system (CNS) involvement with paracoccidioidomycosis (PCM). PCM is an infectious disease caused by the dimorphic fungus Paracoccidioides brasiliensis, endemic in subtropical areas of Central and South America. METHODS From 173 cases of PCM, 24 (13.9%) had CNS involvement (NPCM) and were studied prospectively from 1993 to 1997. In all the patients, the diagnosis of systemic PCM was made by the demonstration of the P. brasiliensis organisms or positive serology, DID (double immunodiffusion). In seven cases the diagnosis was made by means of a CNS biopsy. CNS clinical manifestations, neuroimaging (CT or MRI) and CSF cytochemical characteristics were reported. RESULTS The mean age was 44 years (range 25-72 years); 23 patients were male, only one was female. Neurological symptoms began before systemic symptoms in 21%; simultaneously in 33%, and after systemic symptoms in 46%. Epilepsy was the more frequent neurological presentation (44%). Twenty-three cases had parenchymatous involvement and in two of these cases there was an association with meningitis and one case had spinal cord involvement. Lesions were more frequent in the brain hemispheres (69%), in 65% there were multiple granuloma characterized by hypodense images with annular or nodular enhancing. All cases were treated with sulphamethoxazole-trimethoprin. Four patients died, while 20 patients showed a good therapeutic response. CONCLUSION NPCM should always be considered in the differential diagnosis of expanding lesions of the CNS and meningoencephalitis. Being alert to this diagnosis depends on knowledge of epidemiology. There was good response to sulphamethoxazole-trimethoprin treatment.
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Affiliation(s)
- S M de Almeida
- Neurology Division, Hospital de Clínicas, Universidade Federal do Paraná, Especialidade de Neurologia, Rua General Carneiro, 181, sala 1236, Curitiba, PR 80060-900, Brazil.
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Gasparetto EL, Liu CB, de Carvalho Neto A, Rogacheski E. Central nervous system paracoccidioidomycosis: imaging findings in 17 cases. J Comput Assist Tomogr 2003; 27:12-7. [PMID: 12544236 DOI: 10.1097/00004728-200301000-00003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To quantify the imaging findings of 17 patients with central nervous system (CNS) paracoccidioidomycosis. METHOD Retrospective analysis of the clinical data, films, and laboratory findings of 17 patients with CNS paracoccidioidomycosis. The clinical data were obtained by medical records review. Plain chest films, cranial computed tomography scans (CT), and serum and liquor analysis were evaluated. RESULTS All the patients were male, with a mean age of 46.5 years. Headache and hemiparesis were the most frequent symptoms. The head CT scans revealed two or more granulomas in 53% of the cases, frequently confined to the parietal lobes (35%) and cerebellar hemispheres (35%). The lesions were hypodense (53%) and irregular (76%) and showed ring-like contrast enhancement (94%). Perilesional edema was seen in 82% of the patients, and hydrocephalus was seen in 41%. CONCLUSION Although CNS paracoccidioidomycosis might represent a suspicious lesion pattern on CT scan examination, correlation of the CT scan findings, clinical data, plain chest films, and laboratory results is necessary to define the diagnosis of this uncommon entity.
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Affiliation(s)
- Emerson L Gasparetto
- Section of Diagnostic Radiology, Hospital de Clínicas, University of Paraná, Curitiba, PR, Brazil.
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de Almeida SM, Queiroz-Telles F, Doi EM, Ono M, Werneck LC. Anti-gp43 antibodies in the cerebrospinal fluid of patients with central nervous system involvement by paracoccidioidomycosis. Am J Clin Pathol 2002; 118:864-8. [PMID: 12472279 DOI: 10.1309/h2lu-ux28-7qhn-v5h3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is a chronic granulomatous infectious disease, endemic in subtropical areas of Central and South America. The diagnosis of the central nervous system (CNS) involvement with PCM (neuroparacoccidioidomycosis [NPCM]) frequently is difficult. A definitive diagnosis usually is made by visualization or isolation of Paracoccidioides brasiliensis from CNS biopsy or necropsy material. In the present study, we determined the presence of anti-gp43 antibodies in the cerebrospinalfluid (CSF) of patients with CNS involvement in PCM by enzyme-linked immunosorbent assay (ELISA) in 9 cases of NPCM and 15 control cases. ELISA anti-gp43 was compared with double immunodiffusion (DID). ELISA anti-gp43 was positive in 8 (89%) of 9 CSF samples from patients with NPCM and negative in all CSF samples of the control group. DID was negative in all CSF samples from patients with NPCM and control samples. ELISA anti-gp43 in CSF samples is better than DID for the diagnosis of NPCM. It is a sensitive and specific diagnostic method and has high predictive values. To our knowledge, this is thefirst time ELISA anti-gp43 was applied to CSF.
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do Valle AC, Skacel M, Costa RL, Ribeiro CT, Montagna NA, da Cruz LC. A case report of intraspinal paracoccidioidomycosis. Rev Inst Med Trop Sao Paulo 1998; 40:203-7. [PMID: 9830738 DOI: 10.1590/s0036-46651998000300014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The authors report a case of paraplegia caused by a lumbar intraspinal paracoccidioidomycosis (PCM) granuloma. Clinical neurological diagnosis of a compressive spinal cord lesion was confirmed by spinal magnetic resonance imaging (MRI). Patient was submitted to surgery with total excision of the lesion. Histopathological analysis confirmed the diagnosis of PCM. Patient is on sulfamethoxazole/trimethoprim combined with fluconazole and is experiencing positive neurological recovery.
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Affiliation(s)
- A C do Valle
- Hospital Evandro Chagas, IOC-FIOCRUZ, Rio de Janeiro, RJ, Brasil
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