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[Central nervous system histoplasmosis].

Masashi Hamada1, Shoji Tsuji

  • 1Department of Neurology, Division of Neuroscience, Graduated School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.

Brain and Nerve = Shinkei Kenkyu No Shinpo
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PubMed
Summary

Central nervous system (CNS) histoplasmosis, a fungal infection, is increasingly diagnosed in non-endemic areas. Early diagnosis and treatment with antifungals like fluconazole are crucial for managing this challenging condition.

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Central nervous system (CNS) histoplasmosis is an endemic mycosis in parts of America and Africa.
  • Its incidence is rising in non-endemic regions, posing diagnostic challenges.
  • Delayed diagnosis can lead to poor outcomes and complications like hydrocephalus.

Observation:

  • Diagnosis in non-endemic areas is difficult, with antigen or serological tests potentially yielding false positives.
  • Cerebrospinal fluid (CSF) cultures have low sensitivity, necessitating repeated testing with large volumes.
  • Liposomal amphotericin B is common initial therapy, but treatment failure and relapse rates are high.

Findings:

  • A case of chronic meningitis initially negative for other causes over 10 years was diagnosed as CNS histoplasmosis.
  • Fluconazole treatment led to gradual symptom improvement.
  • Long-term follow-up (2 years, 9 months) showed no recurrence of meningitis or hydrocephalus, indicating successful treatment.

Implications:

  • CNS histoplasmosis should be considered in the differential diagnosis of chronic meningitis, even in immunocompetent individuals in non-endemic areas.
  • Fluconazole can be an effective treatment option for CNS histoplasmosis.
  • Careful long-term management and monitoring are essential for patients with CNS histoplasmosis to prevent relapse.