Central nervous system paracoccidioidomycosis: diagnosis and treatment

Surg Neurol. 2005;63 Suppl 1:S13-21; discussion S21. doi: 10.1016/j.surneu.2004.09.019.

Abstract

Background: Paracoccidioidomycosis (PCM) is a systemic mycosis caused by Paracoccidioides brasiliensis. The involvement of the central nervous system (CNS) in paracoccidioidomycosis is higher than previously thought and 2 clinical presentations have been reported, meningitis and pseudotumoral.

Methods: Twenty medical records of patients with CNS paracoccidioidomycosis treated from 1986 to 2003 were analyzed. The follow-up ranged from 1 to 18 years (mean = 8.9 +/- 4.2).

Results: Besides CNS paracoccidioidomycosis, all patients but one had the chronic systemic form and the pseudotumoral clinical presentation was the most frequent. Based on computed tomography scan findings, 4 image patterns were identified: low-density lesion with ring enhancement, lesion with calcification and ring enhancement, multiloculated low-density lesion with ring enhancement, and diffuse subarachnoid enhancement. The magnetic resonance imaging was performed in 3 patients and showed subarachnoid enhancement in 1 patient and heterogeneous lesion with ring enhancement in 2 patients. Eleven patients were submitted to medical treatment and 9 needed neurosurgical treatment; ventriculoperitoneal shunts in 4 patients, brain lesions resection in 3 patients, and partial resection of spinal cord lesions in 2 patients. Eleven patients had excellent outcome, 4 patients died, 3 are in good clinical condition with residual pulmonary dysfunction, and 1 patient was lost to follow-up.

Conclusions: The diagnosis of paracoccidioidomycosis with involvement of the CNS is difficult and clinical suspicion is a key point to achieve the correct diagnosis. Patients with early diagnosis have a favorable outcome with clinical or surgical treatment.

MeSH terms

  • Adult
  • Aged
  • Antifungal Agents / therapeutic use
  • Brain / diagnostic imaging
  • Brain / microbiology*
  • Brain / pathology*
  • Brain Neoplasms / diagnosis
  • Calcinosis / diagnostic imaging
  • Calcinosis / microbiology
  • Calcinosis / pathology
  • Central Nervous System Fungal Infections / diagnosis*
  • Central Nervous System Fungal Infections / mortality
  • Central Nervous System Fungal Infections / therapy*
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Humans
  • Hydrocephalus / diagnostic imaging
  • Hydrocephalus / microbiology
  • Hydrocephalus / pathology
  • Magnetic Resonance Imaging
  • Male
  • Meningitis, Fungal / diagnostic imaging
  • Meningitis, Fungal / microbiology
  • Meningitis, Fungal / pathology
  • Middle Aged
  • Neurosurgical Procedures / statistics & numerical data
  • Paracoccidioidomycosis / diagnosis*
  • Paracoccidioidomycosis / mortality
  • Paracoccidioidomycosis / therapy*
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ventriculoperitoneal Shunt / statistics & numerical data

Substances

  • Antifungal Agents