title: Central nervous system histoplasmosis in an immunocompetent pediatric patient.
abstract: Neurohistoplasmosis is a rare disease, most prevalent in immunosuppressed patients, secondary to disseminated disease with a high mortality rate when diagnosis and treatment are delayed. We report a previously healthy 12 year old girl, from a bat infested region of Tucuman Province, Argentine Republic, who developed meningoencephalitis due to Histoplasma capsulatum. Eighteen months prior to admission the patient started with headaches and intermittent fever. The images of the central nervous system showed meningoencephalitis suggestive of tuberculosis. She received antibiotics and tuberculostatic medications without improvement. Liposomal amphotericin B was administered for six weeks. The patient's clinical status improved remarkably. Finally the culture of cerebral spinal fluid was positive for micelial form of Histoplasma capsulatum. The difficulties surrounding the diagnosis and treatment of neurohistoplasmosis in immunocompetent patients are discussed in this manuscript, as it also intends to alert to the presence of a strain of Histoplasma capsulatum with affinity for the central nervous system.
authors.affiliation: Servicio de Clínica Pediátrica, Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina. ignacio.esteban@hospitalitaliano.org.ar.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Esteban
authors.affiliation: Servicio de Terapia Intensiva Pediátrica, Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Minces
authors.affiliation: Servicio de Infectología Pediátrica, Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Analía M
authors.initials: AM
authors.lastname: De Cristofano
authors.affiliation: Unidad Micologia, Hospital de Infecciosas Francisco J. Muñiz.|Microbiología y Parasitología, Facultad de Medicina, Universidad de Buenos Aires. Ciudad Autónoma de Buenos Aires. Argentina.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Negroni
mesh_terms: D002648:Child; D005260:Female; D006660:Histoplasmosis; D006801:Humans; D007121:Immunocompetence; D008590:Meningoencephalitis / Q000382:microbiology*
keywords: Central nervous system; Histoplasmosis; Immunocompetence; Pediatrics; Tucumán