Neuroparacoccidioidomycosis: analysis of 13 cases observed in an endemic area in Brazil.
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.
Paniago
Anamaria Mello Miranda
AM
Postgraduate Program in Tropical Medicine, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil. anapaniago@terra.com.br
de Oliveira
Priscilla Alexandrino
PA
Aguiar
Eliana Setti Albuquerque
ES
Aguiar
José Ivan Albuquerque
JI
da Cunha
Rivaldo Venâncio
RV
Leme
Lígia Maria
LM
Salgado
Pedro Rippel
PR
Domingos
João Américo
JA
Ferraz
Renato Lima
RL
Chang
Marilene Rodrigues
MR
Bóia
Márcio Neves
MN
Wanke
Bodo
B
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
D000935:Antifungal Agents