Histoplasmosis del sistema nervioso central en un paciente inmunocompetente / Histoplasmosis of the central nervous system in an immunocompetent patient

La histoplasmosis es una afección polifacética producida por el hongo dimorfo Histoplasma capsulatum , cuyas esporas son inhaladas y llegan al pulmón, órgano primario de infección. La forma meníngea, considerada como una de las manifestaciones más graves de esta micosis, suele presentarse en individuos con alteraciones en la inmunidad celular: pacientes con síndrome de inmunodeficiencia humana adquirida, con lupus eritematoso sistémico o con trasplante de órgano sólido, así como en lactantes, debido a su inmadurez inmunológica. La forma de presentación más usual es de resolución espontánea y se observa en individuos inmunocompetentes que se han expuesto a altas concentraciones de conidias y fragmentos miceliares del hongo. En estas personas, la afección se manifiesta por trastornos pulmonares y por la posterior diseminación a otros órganos y sistemas. Se presenta un caso de histoplasmosis del sistema nervioso central en un niño inmunocompetente.

Histoplasmosis is a multifaceted condition caused by the dimorphic fungi Histoplasma capsulatum whose infective spores are inhaled and reach the lungs, the primary organ of infection. The meningeal form, considered one of the most serious manifestations of this mycosis, is usually seen in individuals with impaired cellular immunity such as patients with acquired immunodeficiency syndrome, systemic lupus erythematous or solid organ transplantation, and infants given their immunological immaturity. The most common presentation is self-limited and occurs in immunocompetent individuals who have been exposed to high concentrations of conidia and mycelia fragments of the fungi. In those people, the condition is manifested by pulmonary disorders and late dissemination to other organs and systems. We report a case of central nervous system histoplasmosis in an immunocompetent child.

Chronic meningitis by histoplasmosis: report of a child with acute myeloid leukemia

Meningitis is a common evolution in progressive disseminated histoplasmosis in children, and is asymptomatic in many cases. In leukemia, the impaired of the T cells function can predispose to the disseminated form. The attributed mortality rate in this case is 20 percent-40 percent and the relapse rate is as high as 50 percent; therefore, prolonged treatment may be emphasized. We have described a child with acute myeloid leukemia (AML), that developed skin lesions and asymptomatic chronic meningitis, with a good evolution after prolonged treatment with amphotericin B deoxycholate followed by fluconazole.

Meningitis caused by Rhodotorula rubra in an human immunodeficiency virus infected patient.

Rhodotorula spp. are common saprophytes but may be responsible for systemic infections in immunocompromised patients. Meningitis caused by Rhodotorula spp. in human immunodeficiency virus (HIV) infected patients has been reported only rarely. We present a case of meningitis caused by Rhodotorula rubra in HIV infected patient. The presumptive diagnosis of cryptococcal meningitis was made on the basis of India ink preparation, Gram staining and latex agglutination test (LAT) for cryptococcal antigen. The final diagnosis was confirmed by isolation of Rhodotorula rubra from cerebrospinal fluid on culture. LAT was considered false positive. Amphotericin B and 5-fluorocytosine were administered but the patient succumbed to his illness.

An outbreak of Aspergillus meningitis following spinal anaesthesia for caesarean section in Sri Lanka: a post-tsunami effect?

An outbreak of Aspergillus fumigatus meningitis occurred in 5 women following spinal anaesthesia, performed between 21 June and 17 July 2005 for caesarean section, in Colombo, Sri Lanka. The patients' median age was 27 years. Different teams in 2 maternity hospitals gave spinal anaesthesia. Mean incubation period was 11.2 days. Fever, headache and nuchal rigidity were common presentations. Remittent fever continued despite broad-spectrum intravenous antibiotics. Papilloedema, lateral rectus palsy, cerebral infarction and haemorrhage developed later. Three patients died. Cerebrospinal fluid pleocytosis with low glucose yielded negative PCR for fungi. Fungal cultures subsequently grew Aspergillus fumigatus. A post-mortem of the first patient confirmed Aspergillus meningitis, followed by treatment with amphotericin B and voriconazole, that saved the lives of others. Visual and hearing impairment in one and complete recovery in the other were observed a year after treatment. Examination of unused plastic syringes, needles, cannulae, and ampoules of anaesthetic agents confirmed that 43 syringes from three different manufactures were contaminated with Aspergillus fumigatus. The stores for drugs and devices of the Ministry of Health were examined and found to be full of tsunami donations, while regular procurements of the Ministry were kept in a poorly maintained humid warehouse. Inadequate space for tsunami donations was identified as the most plausible explanation for sub-optimal storage. Withdrawal and incineration of all unused syringes controlled the outbreak. The survival of those aggressively treated for Aspergillus meningitis suggests in hindsight that the availability of diagnostic tests and specific treatment, and early recognition of the outbreak could have saved the lives of victims who died. Early life-threatening side-effects and permanent long term sequelae of antifungal medication stress the need to be cautious with empirical treatment in immuno-competent low-risk individuals.

Tumoral form of aspergillosis in central nervous system (cerebral aspergilloma): case report

Aspergilose do sistema nervoso central é uma infecção rara, acometendo principalmente pacientes imunossuprimidos. Clinicamente pode se apresentar sob várias formas: meningite, aneurisma micótico, infartos cerebrais e como lesão tumoral (aspergiloma). Os autores apresentam o caso de um paciente diabético com aspergiloma cerebral.

Chronic Aspergillus sp. meningitis successfully treated with fluconazole: case report

We a case of chronic Aspergillu sp. Meningitis in a healthy 43-year-old woman successfully treated with fluconazole given orally (300 ms/day). The diagnosis was made by detection of anti-aspergillus antibodies and positive culture to Aspergillus sp, in the cerebrospinal fluid.

Coccidioides immitis: Infección primaria del sistema nervioso central. Informe de un caso y revisión de la literatura / Case report and literature review of primary coccidioidal meningitis

Se presenta un caso de meningitis primaria (sin afección pulmonar, ósea o dérmica) por el hongo Coccidioides immitis en un hombre de 27 años de edad que acudió por un síndrome de cráneo hipertensivo de un mes de evolución atendido en nuestra institución. El paciente provenía del norte de California y era previamente sano, sin antecedentes para sospechar inmunodeficiencia. La punción lumbar mostró glucosa 22 mg/dL, proteínas totales 62 mg/dL, leucocitos 110 células/mm3 97 por ciento polimorfonucleares, 3 por ciento mononucleares. La tomografía axial computada de cráneo evidenció dilatación ventricular bilateral. Se hizo el diagnóstico de meningitis por coccidioides immitis mediante la detección de anticuerpos (IgM 6.8 mg/dL e IgG 4.9 mg/dL; normal < 2 mg/dL) y cultivo de líquido cerebroespinal. La radiografía de tórax no mostró alteración alguna. La detección de anticuerpos contra el virus de la inmunodeficiencia humana fue negativa. Se colocó una válvula de derivación ventrículo-peritoneal y se manejó con anfotericina B intravenosa e intratecal a través de un reservorio de Ommaya. A pesar de este tratamiento, el paciente se deterioró neurológicamente y falleció dos semanas después de su egreso en su lugar de origen

El fluconazol en la coccidioidomicosis meníngea / Fluconazole in coccidioidal meningitis

Se analiza la experiencia en 10 vírgenes (5 niños y 5 adultos) con coccidioidomicosis meníngea tratados con fluconazol oral. En todos el diagnóstico fue confirmado por la presencia del hongo en líquido cefalorraquídeo. Los pacientes recibieron tratamiento inicial a dosis de 6 mg/kg/día en niños y 400 mg/día en adultos. Todos respondieron favorablemente y en cinco casos el tratamiento fue retirado al obtener mejoría, pero se reactivó la enfermedad en cuatro de ellos. Todos mejoraron al reinstaurar con fluconazol. Se corroboró la utilidad del fluconazol en el tratamiento de la coccidioidomicosisi meníngea