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Central nervous system infection caused by Pseudallescheria boydii: case report and review
J Berenguer1, J Diaz-Mediavilla, D Urra
1Servicio de Microbiología Clínica, Hospital Universitario de San Carlos, Universidad Complutense de Madrid, Spain.
Abstract:
Pseudallescheria boydii is an uncommon cause of central nervous system (CNS) infections. Of a total of 21 cases of CNS infections caused by P. boydii (one described for the first time and 20 reported previously in the English-language literature), eight occurred in immunosuppressed patients and four in patients who nearly drowned; three were trauma related and two were iatrogenic (epidural anesthesia and ventriculoperitoneal shunt, respectively); one occurred in a patient with insulin-dependent diabetes mellitus, and three, in patients without underlying disease or predisposing conditions. The clinical manifestations included brain abscesses (13 cases), spinal pachymeningitis (two cases), chronic meningitis (two cases), intraventricular device-related ventriculitis (two cases), cranial epidural abscess (one case), and acute meningitis (one case). Seven patients showed clinical evidence of extraneural involvement by P. boydii. The outcome is known for 20 patients. Of these, the diagnosis was established while the patient was alive in 18 cases, in spite of which, 15 patients died. All five survivors were managed surgically, and two received intravenous miconazole. P. boydii should be included in the differential diagnosis of CNS infections that occur in the face of immunosuppression, near drowning, and trauma. Occasionally P. boydii can cause CNS infection in the absence of underlying disease or predisposing conditions.
Insights
Pseudallescheria boydii rarely causes central nervous system infections, often in immunocompromised individuals or after near-drowning incidents. Despite diagnosis, mortality remains high, with surgery offering the only survival benefit.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Pseudallescheria boydii is an uncommon fungal pathogen.
- Central nervous system (CNS) infections are a rare but serious manifestation.
Observation:
- This study reviewed 21 cases of CNS infections caused by P. boydii.
- Infections occurred in immunocompromised patients, near-drowning victims, trauma cases, and iatrogenic situations.
- Clinical presentations included brain abscesses, meningitis, and ventriculitis.
Findings:
- P. boydii CNS infections have a high mortality rate (15 out of 20 known outcomes).
- Surgical management was associated with survival in all five reported survivors.
- Extraneural involvement was noted in seven patients.
Implications:
- P. boydii should be considered in CNS infections, especially in at-risk populations.
- Early diagnosis and surgical intervention may improve patient outcomes.
- Further research into effective treatments for P. boydii CNS infections is warranted.