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Histoplasma capsulatum infections of the central nervous system. A clinical review
L J Wheat1, B E Batteiger, B Sathapatayavongs
1Indiana University School of Medicine, Indianapolis.
Abstract:
Central nervous system manifestations occur in 10 to 20% of patients with disseminated histoplasmosis. Additionally, histoplasmosis may be the cause of cases of chronic meningitis in patients with no other evidence for dissemination. Histoplasmosis may also cause cerebral or spinal cord mass lesions resembling neoplasms or abscesses, and encephalitis. Diagnosis of chronic meningitis or mass lesions caused by H. capsulatum may be difficult and involves careful analysis of serologic tests for antibodies, cultures and tests for HPA in body fluids. Amphotericin B remains the treatment of choice, but relapses occur in half of cases despite total courses of at least 35 mg/kg. Accordingly, careful long-term follow-up is required to identify patients with relapsing infection. Newer antifungal agents which cross the blood brain barrier are needed. A trial of amphotericin B treatment without surgical excision can be justified in patients with cerebral or spinal cord histoplasmomas, in view of the apparent success of such treatment in a few cases. Progression of clinical abnormalities or persistence of the lesion following completion of treatment would support the need for surgical excision.
Insights
Central nervous system histoplasmosis, including meningitis and mass lesions, affects 10-20% of patients. Amphotericin B is standard, but relapses necessitate long-term monitoring and new antifungals.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Disseminated histoplasmosis frequently involves the central nervous system (CNS).
- Histoplasmosis can present as chronic meningitis or focal CNS lesions mimicking tumors or abscesses.
- Diagnosis can be challenging, requiring serological tests, cultures, and Histoplasma antigen detection.
Observation:
- Central nervous system (CNS) involvement occurs in 10-20% of disseminated histoplasmosis cases.
- Histoplasmosis can cause chronic meningitis, encephalitis, and mass lesions in the brain and spinal cord.
- Diagnostic methods include serology, cultures, and antigen testing in body fluids.
Findings:
- Amphotericin B is the primary treatment, but relapses occur in approximately 50% of patients.
- Long-term follow-up is crucial for detecting relapsing infections.
- Newer antifungal agents that penetrate the blood-brain barrier are needed.
Implications:
- Amphotericin B monotherapy without surgery may be effective for cerebral or spinal cord histoplasmomas.
- Surgical intervention is indicated if clinical abnormalities progress or lesions persist post-treatment.
- Further research into novel antifungal therapies for CNS histoplasmosis is warranted.