title: Long-term outcome of neuroparacoccidioidomycosis treatment.
abstract: BACKGROUND
  Neuroparacoccidioidomycosis (NPCM) is a term used to describe the invasion of the central nervous system by the pathogenic fungus Paracoccidioides brasiliensis. NPCM has been described sporadically in some case reports and small case series, with little or no focus on treatment outcome and long-term follow-up.
  
  
  METHODS
  All patients with NPCM from January 1991 to December 2006 were analyzed and were followed until December 2009.
  
  
  RESULTS
  Fourteen (3.8%) cases of NPCM were identified out of 367 patients with paracoccidioidomycosis (PCM). A combination of oral fluconazole and sulfamethoxazole/trimethoprim (SMZ/TMP) was the regimen of choice, with no documented death due to Paracoccidioides brasiliensis infection. Residual neurological deficits were observed in 8 patients. Residual calcification was a common finding in neuroimaging follow-up.
  
  
  CONCLUSIONS
  All the patients in this study responded positively to the association of oral fluconazole and sulfamethoxazole/trimethoprim, a regimen that should be considered a treatment option in cases of NPCM. Neurological sequela was a relatively common finding. For proper management of these patients, anticonvulsant treatment and physical therapy support were also needed.
authors.affiliation: Dermatology Department, Manaus Oncology Control Foundation Center, Manaus, AM, Brazil. fabiofrancesconi@globo.com
authors.forename: Fabio
authors.initials: F
authors.lastname: Francesconi
authors.forename: Marcus Tulius Teixeira
authors.initials: MT
authors.lastname: da Silva
authors.forename: Regina Lana Braga
authors.initials: RL
authors.lastname: Costa
authors.forename: Valeska Albuquerque
authors.initials: VA
authors.lastname: Francesconi
authors.forename: Eleonora
authors.initials: E
authors.lastname: Carregal
authors.forename: Sinésio
authors.initials: S
authors.lastname: Talhari
authors.forename: Antonio Carlos Francesconi do
authors.initials: AC
authors.lastname: Valle
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D020314:Central Nervous System Fungal Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010229:Paracoccidioidomycosis / Q000188:drug therapy* / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D015725:Fluconazole