title: Blastomycosis of the central nervous system: a multicenter review of diagnosis and treatment in the modern era.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. BariolaJeremyR@uams.edu
authors.forename: J Ryan
authors.initials: JR
authors.lastname: Bariola
authors.forename: Paul
authors.initials: P
authors.lastname: Perry
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
authors.forename: Laurie
authors.initials: L
authors.lastname: Proia
authors.forename: Wesley
authors.initials: W
authors.lastname: Shealey
authors.forename: Patty W
authors.initials: PW
authors.lastname: Wright
authors.forename: James M
authors.initials: JM
authors.lastname: Sizemore
authors.forename: Matthew
authors.initials: M
authors.lastname: Robinson
authors.forename: Robert W
authors.initials: RW
authors.lastname: Bradsher
mesh_terms: 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
chemical_list: D000935:Antifungal Agents