title: Neuroparacoccidioidomycosis: analysis of 13 cases observed in an endemic area in Brazil.
abstract: The epidemiological, clinical and laboratory features of 13 cases of neuroparacoccidioidomycosis (NPCM) were analysed. All patients were men, with a mean age of 41.6 years. The lungs were involved in 11 cases (84.6%) and only two cases had mycosis limited to the central nervous system. Co-morbidity was observed in four patients (malignant neoplasm in three and diabetes mellitus in one). The most frequent neurological manifestations were paresis (eight cases), headache (five cases) and gait disturbance (four cases). Neuroimaging diagnosis showed a predominance of multiple round lesions with ring enhancement following contrast medium injection. Lesions were seen in the brain hemispheres (nine cases), thalamus (nine cases), cerebellum (four cases), brainstem (four cases) and spinal cord (four cases). Most cases responded well to therapy. Lesions with enhancement following contrast medium injection persisted in four patients for a period of 6 months to 8 years. These findings emphasize the importance of considering NPCM in the differential diagnosis of brain and spinal cord lesions in endemic areas of paracoccidioidomycosis.
authors.affiliation: Postgraduate Program in Tropical Medicine, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil. anapaniago@terra.com.br
authors.forename: Anamaria Mello Miranda
authors.initials: AM
authors.lastname: Paniago
authors.forename: Priscilla Alexandrino
authors.initials: PA
authors.lastname: de Oliveira
authors.forename: Eliana Setti Albuquerque
authors.initials: ES
authors.lastname: Aguiar
authors.forename: José Ivan Albuquerque
authors.initials: JI
authors.lastname: Aguiar
authors.forename: Rivaldo Venâncio
authors.initials: RV
authors.lastname: da Cunha
authors.forename: Lígia Maria
authors.initials: LM
authors.lastname: Leme
authors.forename: Pedro Rippel
authors.initials: PR
authors.lastname: Salgado
authors.forename: João Américo
authors.initials: JA
authors.lastname: Domingos
authors.forename: Renato Lima
authors.initials: RL
authors.lastname: Ferraz
authors.forename: Marilene Rodrigues
authors.initials: MR
authors.lastname: Chang
authors.forename: Márcio Neves
authors.initials: MN
authors.lastname: Bóia
authors.forename: Bodo
authors.initials: B
authors.lastname: Wanke
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D020314:Central Nervous System Fungal Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000382:microbiology; D006261:Headache / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010229:Paracoccidioidomycosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D010291:Paresis / Q000382:microbiology
chemical_list: D000935:Antifungal Agents