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Published on: February 14, 2011
Central Nervous System Histoplasmosis in Acquired Immunodeficiency Syndrome
Harita Nyalakonda1, Marisol Albuerne1, Lia Patricia Suazo Hernandez1
1Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.
Background:
Involvement of the central nervous system (CNS) by Histoplasma capsulatum in AIDS is uncommon and not easily recognized.
Materials And Methods:
CNS histoplasmosis cases from our institution were identified by a retrospective chart review from 2004-2014. A thorough literature search was performed for additional cases and their characteristics were compared. Clinical findings, treatment and outcomes are discussed.
Results:
A total of 5 cases from our institution were identified. They had a clinical presentation that included classic signs of meningitis, often with evidence of disseminated involvement, and was typically severe with important neurological impairment. These cases were treated with antifungal agents, including a lipid amphotericin B formulation and azole drugs, but eventually 3 experienced nonresolution of their disease likely because of lack of adherence to therapy and died from their infection. The clinical presentation, treatment and outcome of these cases did not significantly differ from cases found in the review of the literature.
Conclusions:
Clinicians practicing in endemic areas should be aware of this rare but serious form of histoplasmosis. The recognition of 5 cases of CNS histoplasmosis in AIDS patients from a single institution suggests that histoplasmosis should be included in the differential diagnosis of the CNS complications of AIDS.
Insights
Central nervous system (CNS) histoplasmosis is a rare but severe complication in patients with acquired immunodeficiency syndrome (AIDS). Early recognition and treatment are crucial for better outcomes in this vulnerable population.
Area of Science:
- Infectious Diseases
- Neurology
- Immunology
Background:
- Central nervous system (CNS) involvement by Histoplasma capsulatum is an uncommon complication in patients with acquired immunodeficiency syndrome (AIDS).
- Diagnosis and management of CNS histoplasmosis in AIDS patients present significant challenges due to its rarity and often subtle presentation.
Observation:
- A retrospective review identified 5 cases of CNS histoplasmosis in AIDS patients from 2004-2014.
- These cases presented with classic meningitis signs, disseminated disease, and severe neurological impairment.
- Treatment with antifungal agents, including amphotericin B and azoles, was administered, but 3 patients died due to disease nonresolution, potentially linked to poor adherence.
Findings:
- Clinical presentation, treatment strategies, and outcomes in the studied cases did not significantly differ from those reported in the literature.
- Despite treatment, a high mortality rate was observed, underscoring the severity of CNS histoplasmosis in this population.
Implications:
- Clinicians in endemic areas must consider CNS histoplasmosis in the differential diagnosis of neurological complications in AIDS patients.
- Increased awareness and prompt diagnosis are essential for improving patient outcomes and managing this opportunistic infection effectively.
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