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Outcomes of persons with blastomycosis involving the central nervous system

Jonathan W Bush1, Terry Wuerz, John M Embil

  • 1Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.

Diagnostic Microbiology and Infectious Disease
|April 10, 2013
PubMed

Insights

Central nervous system (CNS) blastomycosis, a fungal infection, requires prompt diagnosis and treatment. Early recognition and appropriate therapy with amphotericin B and azoles can prevent relapse.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Blastomyces dermatitidis is a fungus that can cause life-threatening central nervous system (CNS) infections.
  • CNS blastomycosis often presents with delayed diagnosis due to nonspecific symptoms.

Purpose of the Study:

  • To present a series of patients with CNS blastomycosis.
  • To review the clinical presentation, diagnostic methods, and treatment outcomes.

Main Methods:

  • Retrospective review of 16 patients with proven or probable CNS blastomycosis.
  • Analysis of clinical symptoms, diagnostic imaging (MRI, CT scans), tissue culture results, and treatment regimens.

Main Results:

  • Median symptom duration was 90 days, with headache and focal neurologic deficits being common.
  • MRI demonstrated abnormalities in all cases, while CT scans showed abnormalities in 58%.
  • Tissue culture yielded Blastomyces dermatitidis in 71% of histology-confirmed cases.

Conclusions:

  • A high index of suspicion is crucial for diagnosing CNS blastomycosis, especially in endemic areas.
  • MRI followed by biopsy for tissue culture is recommended for diagnosis.
  • Optimal treatment involves lipid-based amphotericin B and an extended course of voriconazole to prevent relapse.

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