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Pseudallescheria boydii infection of the central nervous system
P Kershaw1, R Freeman, D Templeton
1Department of Neurology, Boston City Hospital, MA.
Abstract:
Pseudallescheria boydii is a rare cause of central nervous system infection characteristically presenting as a neutrophilic meningitis or multiple brain abscesses. Factors predisposing to central nervous system infection with this fungus include immunosuppression and near drowning. The organism is infrequently cultured from fluid obtained by lumbar puncture, delaying clinical recognition and appropriate antifungal therapy. All untreated patients with P boydii infection of the central nervous system died. We describe a patient who developed a persistent neutrophilic meningitis with focal neurologic deficits due to P boydii 6 months after a freshwater aspiration pneumonia. We also review the characteristic clinical and pathologic features of previously reported cases and emphasize the importance of early detection and treatment in the management of this frequently intractable disease.
Insights
Pseudallescheria boydii rarely causes central nervous system infections like meningitis or brain abscesses. Early diagnosis and treatment are crucial as all untreated patients died.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Pseudallescheria boydii is an uncommon fungal pathogen.
- Central nervous system (CNS) infections are rare but severe complications.
Observation:
- CNS infections typically manifest as neutrophilic meningitis or brain abscesses.
- Risk factors include immunosuppression and near-drowning incidents.
- Diagnosis is often delayed due to infrequent fungal culture from cerebrospinal fluid.
Findings:
- This study details a case of persistent neutrophilic meningitis caused by P. boydii.
- The patient developed symptoms 6 months post-freshwater aspiration pneumonia.
- All documented cases of untreated CNS P. boydii infection were fatal.
Implications:
- Early detection and prompt antifungal therapy are critical for managing P. boydii CNS infections.
- Increased awareness of this pathogen is needed for timely clinical recognition.
- Effective treatment strategies are essential for improving outcomes in this intractable disease.