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Freitas APPO, Moll Souza RS, Falqueto A, Mendes Peçanha P. Extensive Neuroparacoccidioidomycosis Lesions with Mild Neurological Manifestations. Am J Trop Med Hyg 2021; 105:1127-1128. [PMID: 34583339 PMCID: PMC8592198 DOI: 10.4269/ajtmh.19-0694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 07/29/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- André Portilho P O Freitas
- School of Medicine, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Rodrigo S Moll Souza
- Radiology Department, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Aloisio Falqueto
- Radiology Department, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Paulo Mendes Peçanha
- Infectious Diseases Unit, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
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Neuroparacoccidioidomycosis: A 13-Year Cohort Study, Rio de Janeiro, Brazil. J Fungi (Basel) 2020; 6:jof6040303. [PMID: 33233507 PMCID: PMC7712492 DOI: 10.3390/jof6040303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022] Open
Abstract
Neuroparacoccidioidomycosis (NPCM) is a rare and severe clinical presentation of paracoccidioidomycosis (PCM). We performed a retrospective cohort study at the Evandro Chagas National Institute of Infectious Diseases (INI/Fiocruz), a reference center for PCM in the state of Rio de Janeiro, Brazil. All cases of PCM admitted to the INI/Fiocruz from January 2007 to December 2019 were reviewed. Eight (3.9%) among 207 patients met the diagnostic criteria for NPCM. The mean age was 44.6 years and the male:female ratio was 7:1. All cases presented multifocal disease, 5 (62.5%) the chronic form and 3 (37.5%) the acute/subacute form. All patients presented the pseudotumoral pattern and 6 (75.0%) had multiple lesions in the cerebral hemispheres. Seizures and motor symptoms were the most frequent clinical manifestations (50.0%, each). The treatment of choice was sulfamethoxazole/trimethoprim (SMZ-TMP) and fluconazole, in association (87.5%). Most patients responded well to the treatment. Sequela and death occurred in one (12.5%) patient, each.
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Riechelmann RS, Rodrigues LH, Avelar TM, Xander PA, da Costa GH, Cannoni LF, de Aguiar GB, Veiga JC. Isolated neuroparacoccidioidomycosis as a pseudotumoral lesion in the absence of systemic disease. Surg Neurol Int 2020; 11:151. [PMID: 32637204 PMCID: PMC7332495 DOI: 10.25259/sni_224_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Paracoccidioidomycosis (PCM) is a systemic, progressive, noncontagious, and often chronic disease caused by the fungus Paracoccidioides brasiliensis that rarely affects the central nervous system (CNS). The condition is usually treated using antifungal drugs, and some cases may require surgery. Case Description: A 55-year-old man, a smoker, without known comorbidities, was referred to the neurosurgery team with a history of a single epileptic seizure a week before hospital admission followed by progressive right- sided hemiparesis. Head computed tomography and brain magnetic resonance imaging showed an intra-axial expansive lesion affecting the left parietal lobe, associated with extensive edema and a regional compressive effect producing slight subfalcine herniation that was initially managed as an abscess. After the failure of antibiotic treatment, the patient underwent a neurosurgical procedure for excision of the lesion. Histopathological analysis revealed that it was PCM and there was no evidence of impairment of other systems due to the disease. Conclusion: PCM can be a serious, debilitating disease and is potentially fatal. Although isolated CNS involvement is rare, it must be considered, especially in endemic areas, as late diagnosis and treatment severely decreases good outcome rates.
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Affiliation(s)
- Ricardo Salemi Riechelmann
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Leonardo Henrique Rodrigues
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Tiago Marques Avelar
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Paulo Adolfo Xander
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Guilherme Henrique da Costa
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Luiz Fernando Cannoni
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Guilherme Brasileiro de Aguiar
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Jose Carlos Veiga
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
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de Almeida SM, Roza TH, Salvador GLO, Izycki LF, Locatelli G, Santos ID, Aragão A, Torres LFB, de Noronha LH. Autopsy and biopsy study of paracoccidioidomycosis and neuroparacoccidioidomycosis with and without HIV co-infection. Mycoses 2018; 61:237-244. [PMID: 29274088 DOI: 10.1111/myc.12737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/13/2017] [Accepted: 12/16/2017] [Indexed: 11/29/2022]
Abstract
Paracoccidioidomycosis (PCM) is a systemic mycosis prevalent among immunocompetent patients in Latin America. This study aimed to describe the frequency, demographics and clinical characteristics of central nervous system PCM (NPCM) and PCM in an endemic region, and the impact of human immunosuppression virus (HIV) co-infection. This was a retrospective study of autopsy and biopsy reports from the Medical Pathology Section of the Hospital de Clinicas, UFPR, Curitiba, Southern Brazil, between 1951 and 2014. PCM was present in 0.1% of 378,323 cases examined, with 5.7% being NPCM. Infection was prevalent in working-age men, agricultural workers and rural residents. Numbers of HIV autopsy cases increased over time, while those of PCM cases decreased. Prevalence of co-infection of HIV/PCM and HIV/NPCM was 1.6%, and 0.4%, respectively. Adrenals were affected more frequently in the NPCM group compared with the PCM group. Mortality was higher on NPCM group. The clinical course of PCM in HIV patients resembles an acute/sub-acute infection. Association of NPCM and HIV is rare, while diagnosis of NPCM is difficult, it should be considered a differential diagnosis in HIV patients who live in, or have visited, endemic areas and present with neurological symptoms.
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Affiliation(s)
- Sergio Monteiro de Almeida
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil.,Virology Laboratory, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Thiago Henrique Roza
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Gabriel L O Salvador
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Luís Felipe Izycki
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Giuliana Locatelli
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Isaias Dos Santos
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Afonso Aragão
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Luis Fernando Bleggi Torres
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Lucia Helena de Noronha
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil.,Laboratório de Patologia Experimental, Escola de Medicina- Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Ortiz S, Wiesner S, Cataño JC. An immunocompetent 49-year-old man with a disseminated infection. Eur J Intern Med 2016; 34:e5-e6. [PMID: 27118205 DOI: 10.1016/j.ejim.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/07/2016] [Accepted: 04/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S Ortiz
- CES University Medical School, Medellin, Colombia
| | - S Wiesner
- CES University Medical School, Medellin, Colombia
| | - J C Cataño
- Internal Medicine and Infectious Diseases Section, University of Antioquia Medical School, Medellin, Colombia.
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Shi M, Mody CH. Fungal Infection in the Brain: What We Learned from Intravital Imaging. Front Immunol 2016; 7:292. [PMID: 27532000 PMCID: PMC4969284 DOI: 10.3389/fimmu.2016.00292] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
Approximately 1.2 billion people suffer from fungal diseases worldwide. Arguably, the most serious manifestation occurs when pathogenic fungi infect the brain, often causing fatal meningoencephalitis. For most fungi, infection occurs via the vascular route. The organism must first be arrested in the brain microvasculature and transmigrate into the brain parenchyma across the blood–brain barrier. As a result, host immune cells are recruited into the brain to contain the fungi. However, it remains poorly understood how fungi traffic to, and migrate into the brain and how immune cells interact with invading fungi in the brain. A new era of intravital fluorescence microscopy has begun to provide insights. We are able to employ this powerful approach to study dynamic interactions of disseminating fungi with brain endothelial cells as well as resident and recruited immune cells during the brain infection. In this review, with a focus on Cryptococcus neoformans, we will provide an overview of the application of intravital imaging in fungal infections in the brain, discuss recent findings and speculate on possible future research directions.
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Affiliation(s)
- Meiqing Shi
- Division of Immunology, Virginia-Maryland Regional College of Veterinary Medicine, University of Maryland , College Park, MD , USA
| | - Christopher H Mody
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada; Department of Internal Medicine, University of Calgary, Calgary, AB, Canada
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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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Central nervous system paracoccidioidomycosis in an AIDS patient: case report. Mycopathologia 2014; 177:137-41. [PMID: 24464241 DOI: 10.1007/s11046-014-9729-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 01/13/2014] [Indexed: 01/06/2023]
Abstract
Up to now, over 200 patients with paracoccidioidomycosis (PCM) associated to HIV infection have already been reported; however, the central nervous system involvement in this coinfection was rarely reported. This paper presents a 35-year-old Brazilian male AIDS patient who developed pulmonary PCM successfully treated with itraconazole. At the antiretroviral therapy starting, he had 32 CD4(+) T cells baseline count and high viral load levels. After 9 months, he presented severe fungal meningoencephalitis diagnosed by sublenticular enhanced nodular lesion at computerized tomography and magnetic resonance brain imaging and a positive Paracoccidiodes brasiliensis smear and culture from cerebrospinal fluid. At the time, a sixfold increase in CD4(+) T cell count and undetectable viral load level were evidenced. The patient received amphotericin B during 1 year presenting slow but progressive clinical improvement, and he is currently asymptomatic and without neurological disabilities. To our knowledge, this is the second case report of a patient with neuroparacoccidioidomycosis associated to HIV infection.
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Traffic of Leukocytes and Cytokine Up-regulation in the Central Nervous System in a Murine Model of Neuroparacoccidioidomycosis. Mycopathologia 2013; 176:191-9. [DOI: 10.1007/s11046-013-9679-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/08/2013] [Indexed: 02/06/2023]
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Pedroso VSP, Lyon AC, Araújo SA, Veloso JMR, Pedroso ERP, Teixeira AL. Paracoccidioidomycosis case series with and without central nervous system involvement. Rev Soc Bras Med Trop 2013; 45:586-90. [PMID: 23152341 DOI: 10.1590/s0037-86822012000500009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/22/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Paracoccidioidomycosis (PCM) is the most important systemic mycosis in South America. Central nervous system involvement is potentially fatal and can occur in 12.5% of cases. This paper aims to contribute to the literature describing eight cases of neuroparacoccidioidomycosis (NPMC) and compare their characteristics with patients without neurological involvement, to identify unique characteristics of NPCM. METHODS A cohort of 213 PCM cases was evaluated at the Infectious Diseases Clinic of the University Hospital, Federal University of Minas Gerais, Brazil, from October 1976 to August 2008. Epidemiological, clinical, laboratory, therapeutic and follow-up data were registered. RESULTS Eight patients presented NPCM. The observed NPCM prevalence was 3.8%. One patient presented the subacute form of PCM and the other seven presented the chronic form of the disease. The parenchymatous form of NPCM occurred in all patients. 60% of the patients who proceeded from the north/ northeast region of Minas Gerais State developed NPCM. The neurological involvement of a mother and her son was observed. NPCM patients exhibited demographical and clinical profiles similar to what is described in the literature. When NPCM cases were compared to PCM patients, there were differences in relation to origin and positive PCM family history. CONCLUSIONS The results corroborate the clinical view that the neurological findings are extremely important in the evaluation of PCM patients. Despite the limitations of this study, the differences in relation to patient's origins and family history point to the need of further studies to determine the susceptibility factors involved in the neurological compromise.
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Affiliation(s)
- Vinicius Sousa Pietra Pedroso
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Reis F, Collier PP, Souza TF, Lopes GP, Bronzatto E, Silva Junior NA, Pereira RM, Appenzeller S. Neuroparacoccidioidomycosis (NPCM): magnetic resonance imaging (MRI) findings. Mycopathologia 2012; 175:181-6. [PMID: 23229616 DOI: 10.1007/s11046-012-9607-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/23/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the magnetic resonance imaging (MRI) patterns of the central nervous system (CNS) involvement by neuroparacoccidioidomycosis (NPCM). METHODS Between January 1999 and March 2011, a review of MRI data analysis from 8 cases of NPCM was performed. The following MRI characteristics were examined by an experienced neuroradiologist: topography of lesions, aspects on T1- and T2-weighted images (WI), contrast enhancement, diffusion and spectroscopy. RESULTS All patients had evidence of paracoccidioidomycosis infection outside the nervous system. Regarding CNS involvement, five patients had only supratentorial lesions; three had infra- and supratentorial ones. Meningeal extension occurred in three patients. The lesions were predominantly hyperintense on T1WI. At T2WI, a hypointense component was present in five cases as well as a perilesional abnormal white matter. A ring-enhancement pattern was seen in five cases. Spectroscopy was performed in three patients and showed an increased lipid peak in all of them. In one case, there was also an increased choline peak. CONCLUSION NPCM is rare, and MRI may help its differentiation from other inflammatory lesions. However, the presence of active infection outside CNS and some imaging characteristics should point to this diagnosis.
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Affiliation(s)
- Fabiano Reis
- Departamento de Radiologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Rua Tessália Vieira de Camargo, 126 CP: 6111, 13083-887, Cidade Universitária Zeferino Vaz Campinas, SP, Brazil.
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Benard G, Campos AF, Netto LC, Gonçalves LG, Machado LR, Mimicos EV, França FOS, Gryschek RCB. Treatment of severe forms of paracoccidioidomycosis: is there a role for corticosteroids? Med Mycol 2012; 50:641-8. [PMID: 22309459 DOI: 10.3109/13693786.2011.654135] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite their immunosuppressive effects, corticosteroids have long been used as adjunct therapy (aCST) in the treatment of infectious diseases. The rationale is that in certain infections it is necessary to decrease the exacerbated host's inflammatory response, which can otherwise result in tissue damage and organ dysfunction. In fact, a major concern in treating paracoccidioidomycosis (PCM) is the host's intense inflammatory response to Paracoccidioides brasiliensis, which can be further intensified by antifungal therapy. Depending on its localization, this immunological phenomenon may be life threatening or result in permanent sequels, as is the case for some patients with cerebral or laryngeal involvement. However, the literature on aCST in paracoccidioidomycosis treatment is scarce and as a result we present our recent experience in the management of four patients with severe PCM manifestations, i.e., cerebral paracoccidioidal granuloma, laryngeal stenosis, compressive abdominal mass, and exacerbated inflammatory response with tissue destruction. In addition to the antifungal therapy, these patients required aCST, which probably promoted their clinical improvement and/or prevented serious complications. We suggest that aCST: (a) can potentially help in the management of selected cases of severe forms of PCM, particularly when there is a risk of acute complications, and (b) that it can be used safely provided that the risk-benefit ratio is carefully weighed. Well-controlled, prospective studies of aCST in the treatment of severe cases of paracoccidioidomycosis are needed to better define its role in the management of PCM.
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Affiliation(s)
- Gil Benard
- Dermatology Division of the Hospital das Clínicas, University of São Paulo Medical School and Laboratory of Medical Mycology, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil.
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Francesconi F, da Silva MTT, Costa RLB, Francesconi VA, Carregal E, Talhari S, Valle ACFD. Long-term outcome of neuroparacoccidioidomycosis treatment. Rev Soc Bras Med Trop 2011; 44:22-5. [PMID: 21340402 DOI: 10.1590/s0037-86822011000100006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 10/06/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Neuroparacoccidioidomycosis (NPCM) is a term used to describe the invasion of the central nervous system by the pathogenic fungus Paracoccidioides brasiliensis. NPCM has been described sporadically in some case reports and small case series, with little or no focus on treatment outcome and long-term follow-up. METHODS All patients with NPCM from January 1991 to December 2006 were analyzed and were followed until December 2009. RESULTS Fourteen (3.8%) cases of NPCM were identified out of 367 patients with paracoccidioidomycosis (PCM). A combination of oral fluconazole and sulfamethoxazole/trimethoprim (SMZ/TMP) was the regimen of choice, with no documented death due to Paracoccidioides brasiliensis infection. Residual neurological deficits were observed in 8 patients. Residual calcification was a common finding in neuroimaging follow-up. CONCLUSIONS All the patients in this study responded positively to the association of oral fluconazole and sulfamethoxazole/trimethoprim, a regimen that should be considered a treatment option in cases of NPCM. Neurological sequela was a relatively common finding. For proper management of these patients, anticonvulsant treatment and physical therapy support were also needed.
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Affiliation(s)
- Fabio Francesconi
- Dermatology Department, Manaus Oncology Control Foundation Center, Manaus, AM, Brazil.
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Eosinophilia in returning travellers and migrants from the tropics: UK recommendations for investigation and initial management. J Infect 2010; 60:1-20. [DOI: 10.1016/j.jinf.2009.11.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 11/11/2009] [Accepted: 11/13/2009] [Indexed: 11/18/2022]
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Pedroso VSP, Vilela MDC, Santos PC, Cisalpino PS, Arantes RME, Rachid MA, Teixeira AL. Development of a Murine Model of Neuroparacoccidioidomycosis. ACTA ACUST UNITED AC 2010. [DOI: 10.4303/jnp/n100402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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dos Santos VM, Xavier RM, Cortes JA, Osterne EMC, de Worisch Ferreira Lopes M. Pseudotumoral Neuroparacoccidioidomycosis: One Case Report. Mycopathologia 2008; 166:155-8. [DOI: 10.1007/s11046-008-9115-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 03/17/2008] [Indexed: 10/22/2022]
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