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Isolated central nervous system histoplasmosis in immunocompetent hosts: a series of 11 cases

Pedro Schestatsky1, Marcio F Chedid, Olavo B Amaral

  • 1Department of Neurology, Hospital de Clínicas de Porto Alegre, Brazil. lonfra@hotmail.com

Scandinavian Journal of Infectious Diseases
|December 13, 2005
PubMed

Insights

Central nervous system histoplasmosis can affect immunocompetent individuals, presenting with distinct symptoms like headache and altered mental status. Immunodiffusion of cerebrospinal fluid is key for diagnosing this fungal meningitis in specific patient groups.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Mycology

Background:

  • Histoplasmosis of the central nervous system (CNS) is often linked to immunosuppression and disseminated disease.
  • Isolated CNS histoplasmosis in immunocompetent hosts is less commonly described.
  • Understanding this presentation is crucial for timely diagnosis and treatment.

Purpose of the Study:

  • To review the clinical and laboratory features of isolated CNS histoplasmosis in immunocompetent patients.
  • To differentiate this presentation from that seen in immunosuppressed individuals.
  • To identify key diagnostic markers and clinical associations.

Main Methods:

  • Retrospective case series analysis of 11 immunocompetent patients with isolated CNS histoplasmosis.
  • Review of clinical presentations, neuroimaging findings, and laboratory results.
  • Evaluation of diagnostic test efficacy, particularly cerebrospinal fluid immunodiffusion.

Main Results:

  • Patients commonly presented with headache, meningeal signs, and mental status changes.
  • Neuroimaging frequently revealed ventricular dilatation, with 8/11 patients having a ventriculoperitoneal shunt.
  • Cerebrospinal fluid (CSF) immunodiffusion was the most effective diagnostic method.

Conclusions:

  • Isolated CNS histoplasmosis in immunocompetent hosts presents differently than in immunosuppressed patients.
  • Hydrocephalus and ventriculoperitoneal shunts are significant features, potentially indicating shunt infection.
  • CSF immunodiffusion is vital for diagnosing chronic lymphocytic meningitis in endemic areas, especially with shunts.

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