title: Central nervous system pseudallescheriasis after near-drowning.
abstract: BACKGROUND
  Clinical characteristics of central nervous system (CNS) pseudallescheriasis after near-drowning have not been systematically analyzed.
  
  
  METHODS
  Review of cases reported in the English-language literature.
  
  
  RESULTS
  Sixteen patients were identified. The average period between the near-drowning episode and onset of clinical manifestations was 37 days. Common manifestations included fever, altered mental status, headache, seizures, and hemiparesis. All patients developed brain abscesses; however, imaging studies were normal at presentation in 6 patients. Cerebrospinal fluid neutrophilic pleocytosis, elevated protein, and decreased glucose were commonly observed. Most patients were treated with surgical resection and systemic amphotericin B or miconazole. Voriconazole was used in 2 patients. Twelve patients (75%) died. The average time between the near-drowning episode and death was 12 weeks. Four survivors received prompt treatment.
  
  
  CONCLUSIONS
  CNS pseudallescheriasis after near-drowning is highly lethal. Early diagnosis and aggressive medical and surgical interventions may improve survival.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA.
authors.forename: Kessarin
authors.initials: K
authors.lastname: Panichpisal
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent
authors.forename: Juan C
authors.initials: JC
authors.lastname: Sarria
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001921:Brain / Q000382:microbiology / Q000473:pathology; D001922:Brain Abscess / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002494:Central Nervous System Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D015701:Near Drowning / Q000150:complications*; D011541:Pseudallescheria / Q000302:isolation & purification*; D015996:Survival Rate
chemical_list: D000935:Antifungal Agents