Paracoccidioidomycosis of the Central Nervous System: CT and MR Imaging Findings

BACKGROUND AND PURPOSE

Paracoccidioidomycosis is a fungal infection mainly caused by the thermodimorphic fungus Paracoccidioides. The purpose of our study was to demonstrate the neuroimaging findings from 24 patients with CNS paracoccidioidomycosis.

MATERIALS AND METHODS

We performed a retrospective analysis focusing on the radiologic characteristics of CNS paracoccidioidomycosis. The 24 selected patients underwent MR imaging and/or CT, and the diagnosis was made by the presence of typical neuroimaging features, combined with fungus isolation, a serologic test, or the presence of disseminated disease.

RESULTS

Headache was the most common neurologic symptom, while the pseudotumoral form was the most common pattern. The number of lesions ranged from 1 to 11, with most localized on the frontal lobe with >2-cm lesions. CT showed mainly hypoattenuating lesions, whereas MR imaging demonstrated mainly hyposignal lesions on T1WI and T2WI. Furthermore, ring enhancement was present in most patients. The "dual rim sign" on SWI occurred in 100% of our patients with lesions of >2 cm.

CONCLUSIONS

The diagnosis of CNS paracoccidioidomycosis is difficult. Nevertheless, imaging examinations can play an important role in the diagnosis and evaluation of the disease.

Oral paracoccidioidomycosis in a single-center retrospective analysis from a Brazilian southeastern population

BACKGROUND

Paracoccidioidomycosis (PCM) is the most prevalent endemic systemic fungal infection in Latin America. In Brazil, it stands out as the eighth-highest cause of mortality among chronic or recurrent infections and has the highest mortality rate among systemic mycoses. Oral mucosal lesions may be the first visible physical manifestation of the disease. This study traced the epidemiological and clinical profiles of patients with oral lesions treated at the University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo.

METHODS

A retrospective cross-sectional analysis of patient medical records was performed.

RESULTS

Among the 161 patients identified with a confirmed diagnosis of PCM, 97 (60.24%) presented with oral lesions. The male:female ratio was 15:1, the mean age was 50.5 years, and the chronic form of paracoccidioidomycosis was predominant. Most of the patients had smoking habits and were rural workers. The most common oral lesions present in various anatomical sites were mulberry-like ulcers, more frequently observed in the gingiva, with regression within one to three months. Patients completed the treatment in one to two years (32.99%), and 47.42% of cases discontinued treatment.

CONCLUSIONS

In addition to the characteristics of the oral lesions, information from the clinical profiles of patients with oral PCM is a central tool for dentists for early diagnosis. Earlier diagnosis may result in fewer consequences, especially respiratory ones that may cause an inability to work and poor quality of life.

Microscopic analysis of subcutaneous reactions to endodontic sealer implants in rats

The reaction of subcutaneous tissues to Endofill, Endomethasone, Sealer 26, and AH-Plus was investigated microscopically after implantation of in rats polyethylene cannulae, obturated with gutta-percha cones and sealers, in rats. Empty polyethylene cannulae and cannulae filled with gutta-percha cones alone were used as controls. The inflammatory reactions caused by the sealers were evaluated 7, 14, and 30 days after implantation using a descriptive, histopathological analysis. Inflammatory reactions at each implant site were gauged as either absent, discreet, moderate, or intense, and scores from 0 to 3 were attributed, respectively. Microscopic analysis revealed that Endomethasone showed the best biological behavior for all postimplant periods, followed by Sealer 26 and AH Plus, which produced an irritating effect only during the initial pos-implant period. Endofill caused the severest irritation, producing an inflammatory reaction that ranged from moderate to intense over the entire experimental period. Reactions were more intense near those parts of the cannulae containing more sealer. These results reveal that the root canal sealers tested cause inflammation in rat, subcutaneous conjunctive tissue, the intensity of which may be related to the type and quantity of sealer used, and to postimplant period.