Blastomycosis of the central nervous system: a multicenter review of diagnosis and treatment in the modern era.
BACKGROUND
Central nervous system (CNS) involvement with Blastomyces dermatitidis is an uncommon and potentially fatal complication of blastomycosis.


METHODS
We retrospectively reviewed 22 patients with CNS blastomycosis at our institutions from 1990 through 2008 (13 proven, 5 probable, and 4 possible cases).


RESULTS
Magnetic resonance imaging was used in most patients, alone or in addition to computed tomography. CNS blastomycosis manifested as epidural abscess (1 of 22), meningitis (7 of 22), intracranial mass lesions (10 of 22), and concomitant intracranial mass lesions and meningitis (4 of 22). All patients received amphotericin B deoxycholate or a lipid formulation of amphotericin B as part of their treatment regimens. Most patients received amphotericin B followed by a prolonged course of oral azole therapy (voriconazole, fluconazole, or itraconazole). Four (18%) of 22 patients died during follow-up.


CONCLUSIONS
On the basis of these data, we recommend initial treatment with a lipid formulation of amphotericin B followed by a prolonged course of oral azole therapy, preferably voriconazole.
Bariola
J Ryan
JR
Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. BariolaJeremyR@uams.edu
Perry
Paul
P
Pappas
Peter G
PG
Proia
Laurie
L
Shealey
Wesley
W
Wright
Patty W
PW
Sizemore
James M
JM
Robinson
Matthew
M
Bradsher
Robert W
RW
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D001758:Blastomyces / Q000302:isolation & purification*; D001759:Blastomycosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006257:Head / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D014054:Tomography; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents