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Central nervous system histoplasmosis.

Michael Saccente1

  • 1Michael Saccente, MD Department of Medicine and Division of Infectious Diseases, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 639, Little Rock, AR 72205, USA. SaccenteMichael@uams.edu.

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Central nervous system (CNS) histoplasmosis affects 5-10% of patients with disseminated disease. Early diagnosis and aggressive antifungal treatment are crucial for managing this serious fungal infection.

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Progressive disseminated histoplasmosis can involve the central nervous system (CNS) in 5-10% of patients.
  • Risk factors include impaired cellular immunity, though not all affected individuals are immunocompromised.
  • CNS histoplasmosis presents with diverse syndromes like meningitis, focal lesions, stroke, or encephalitis.

Purpose of the Study:

  • To review the clinical presentation, diagnosis, and treatment of central nervous system histoplasmosis.
  • To emphasize the importance of considering CNS histoplasmosis in endemic areas, even with absent extraneural signs.

Main Methods:

  • Review of clinical syndromes associated with CNS histoplasmosis.
  • Discussion of diagnostic methods including fungal culture and antigen detection.
  • Summary of current treatment recommendations based on expert opinion.

Main Results:

  • Central nervous system (CNS) histoplasmosis manifests as meningitis, focal lesions, stroke, or encephalitis.
  • Diagnosis relies on culture of Histoplasma capsulatum or antigen detection in CSF, blood, or urine.
  • Aggressive, prolonged antifungal therapy is essential.

Conclusions:

  • CNS histoplasmosis requires a high index of suspicion, particularly in endemic regions.
  • Early diagnosis and treatment with liposomal amphotericin B followed by itraconazole are recommended.
  • Further prospective trials are needed to establish definitive treatment guidelines.