trimethoprim--sulfamethoxazole-drug-combination and Central-Nervous-System-Fungal-Infections

Neuroparacoccidioidomycosis is the central nervous system involvement by Paracoccidioides brasiliensis, a condition that may be underdiagnosed and has been scarcely reported. We describe a case of neuroparacoccidioidomycosis in a diabetic male with antecedent of heavy cigarette smoking and alcohol abuse. Thirty years before, he lived in the Amazon area and exerted rural activities in more recent years. The patient's main complaints were headache, visual deficit, hemiparesis, and weight loss. Imaging studies detected changes in the lungs and right adrenal gland, in addition to brain lesions. Paracoccidioides brasiliensis was found in tissue samples collected by the lung and brain biopsies. The patient is under ambulatory surveillance and in use of trimethoprim-sulfamethoxazole.

Topics: Antifungal Agents; Brain; Brain Diseases; Central Nervous System Fungal Infections; Humans; Male; Middle Aged; Paracoccidioides; Paracoccidioidomycosis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

To study prospectively the clinical features and laboratorial characteristics of 24 patients with central nervous system (CNS) involvement with paracoccidioidomycosis (PCM). PCM is an infectious disease caused by the dimorphic fungus Paracoccidioides brasiliensis, endemic in subtropical areas of Central and South America.. From 173 cases of PCM, 24 (13.9%) had CNS involvement (NPCM) and were studied prospectively from 1993 to 1997. In all the patients, the diagnosis of systemic PCM was made by the demonstration of the P. brasiliensis organisms or positive serology, DID (double immunodiffusion). In seven cases the diagnosis was made by means of a CNS biopsy. CNS clinical manifestations, neuroimaging (CT or MRI) and CSF cytochemical characteristics were reported.. The mean age was 44 years (range 25-72 years); 23 patients were male, only one was female. Neurological symptoms began before systemic symptoms in 21%; simultaneously in 33%, and after systemic symptoms in 46%. Epilepsy was the more frequent neurological presentation (44%). Twenty-three cases had parenchymatous involvement and in two of these cases there was an association with meningitis and one case had spinal cord involvement. Lesions were more frequent in the brain hemispheres (69%), in 65% there were multiple granuloma characterized by hypodense images with annular or nodular enhancing. All cases were treated with sulphamethoxazole-trimethoprin. Four patients died, while 20 patients showed a good therapeutic response.. NPCM should always be considered in the differential diagnosis of expanding lesions of the CNS and meningoencephalitis. Being alert to this diagnosis depends on knowledge of epidemiology. There was good response to sulphamethoxazole-trimethoprin treatment.

Topics: Adult; Aged; Anti-Infective Agents; Central Nervous System Fungal Infections; Cerebrospinal Fluid; Diagnosis, Differential; Female; gamma-Globulins; Glucose; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paracoccidioides; Paracoccidioidomycosis; Prospective Studies; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Central Nervous System Fungal Infections; Drug Therapy, Combination; Fluconazole; Follow-Up Studies; Homosexuality, Male; Humans; Male; Pneumonia, Pneumocystis; Spinal Puncture; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination