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Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and
Joseph Wheat1, Thein Myint, Ying Guo
1Mira Vista Diagnostics University of Kentucky School of Medicine, Lexington, Kentucky Emory University Rollins School of Public Health Indiana University School of Medicine Indiana University Health, Indianapolis, Indiana Yale University School of Medicine, New Haven, Connecticut University of Michigan Health System, Ann Arbor, Michigan St. Luke's University Hospital and Health Network, Bethlehem Stanford University School of Medicine, Stanford University of Arizona College of Medicine, Tucson University of Tennessee Health Sciences Center, Memphis Mercy Hospital, Joplin Vanderbilt University School of Medicine, Nashville, Tennessee University of California at San Francisco School of Medicine, San Francisco University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Lahey Hospital and Medical Center, Burlington, Massachusetts University of Alabama- Birmingham, Birmingham, Alabama University of Missouri-Kansas City, Kansas City Sparks Center for Infectious Diseases, Fort Smith, Arkansas Mayo Clinic, Phoenix, Arizona Jacobi Medical Center, Bronx Metro Infectious Diseases, Chicago University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma Children's Mercy Hospital, Kansas City, Missouri University of Texas Medical Branch, Galveston Kaiser Permanente, Los Angeles, California Infectious Disease Consultants, Wichita, Kansas Premier Physicians, Midland, Texas Southern Illinois University School of Medicine, Springfield, Illinois Courage Fund, National University of Singapore, Singapore Carolinas Medical Center, Charlotte, North Carolina Icahn School of Medicine at Mount Sinai, New York, New York Emory University School of Medicine, Atlanta, Georgia.
Abstract:
Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment.While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.
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