Paracoccidioidomycosis in the Central Nervous System

Paracoccidioidomycosis is a systemicmycosis caused by the Paracoccidioides brasiliensis fungus, which is endemic in Latin America. Brazil is the country with the highest number of cases. The affection of the central nervous system (CNS), a potentially fatal condition, occurs in 12% of the cases. The following forms of presentation are identified:meningeal, which is unusual;meningoencephalitic; and pseudotumoral, the latter two being more frequent. Imaging tests are essential for the diagnosis, but the histological identification of the fungus is required for confirmation of the pathology. The clinical picture depends on the neuraxial location.We present a case of amale rural worker, with expansive lesions in the CNS compatible with paracoccidioidomycosis.

Paracoccidioidomicose com comprometimento do sistema nervoso central: revisão sistemática da literatura / Paracoccidioidomycosis compromising the central nervous system: a systematic review of the literature

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 por cento 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 por cento), localizando-se nos lobos frontais e parietais. A biópsia determinou o diagnóstico em 57,2 por cento dos casos e utilizaram-se métodos de neuroimagem em 64,6 por cento deles. Houve grande associação com a forma pulmonar da doença (59,1 por cento). A mortalidade foi de 44,1 por cento e 50,1 por cento 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.

This study is the first systematic review of cases of neuroparacoccidioidomycosis available in the literature. Through searches in the MEDLINE and LILACS databases, 257 cases were found in 81 published studies, mainly after the 1970s-1980s. Approximately 93 percent of the patients were men, especially farm laborers, with a mean age of 43 years. The characteristic symptoms were motor deficits or intracranial hypertension. The chronic pseudotumoral form predominated. The mean period of evolution was 4.9 months. The lesions were mainly supratentorial (66.8 percent), located in the frontal and parietal lobes. The diagnosis was determined by biopsy in 57.2 percent of the cases and neuroimaging methods were used in 64.6 percent of them. A large proportion of the cases were associated with the pulmonary form of the disease (59.1 percent). The mortality rate was 44.1 percent, and 50.1 percent of the survivors developed sequelae, especially motor impairment. Thus, neuroparacoccidioidomycosis should be considered in the differential diagnosis for expansive and meningoencephalitic processes in the central nervous system, in order to establish early treatment and to avoid disabling sequelae.