Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment

Autor: David W. Allen, Chadi A. Hage, Maha A. Assi, Kareem W. Shehab, Patty Wright, Raed N Khairy, Vanja C. Douglas, Geetha Sivasubramanian, Winnie W. Ooi, Joseph Wheat, Elizabeth R. Jenny-Avital, Marwan M. Azar, Pascalis Vergidis, Ying Guo, Eden M Esguerra, Thein Myint, John W. Baddley, Sharon Chen, Phebe Brenne Kemmer, Catherine Passaretti, Satish Mocherla, David M. Bamberger, Barbara A. Pahud, Karen L. Bowlware, Vidhya Prakash, Colin Terry, Juan C. Sarria, James G. Johnson, Albert M. Anderson, James Riddell, Townson Tsai, Kerry O. Cleveland, Peter T. Ender, Shirish Huprikar, Holenarasipur R. Vikram
Rok vydání: 2018
Předmět:
Male
diagnosis
0302 clinical medicine
Blood serum
Central Nervous System Fungal Infections
antibody
Amphotericin B
Medicine
030212 general & internal medicine
Histoplasmosis
treatment
biology
Age Factors
meningitis
Brain
General Medicine
Middle Aged
Fungal antigen
Magnetic Resonance Imaging
3. Good health
histoplasma
Spinal Cord
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
outcome
Female
Erratum
Meningitis
Research Article
medicine.drug
medicine.medical_specialty
Antigens
Fungal
Itraconazole
Observational Study
03 medical and health sciences
Immunocompromised Host
antigen
Histoplasma
Internal medicine
Humans
Antibodies
Fungal
Retrospective Studies
Acquired Immunodeficiency Syndrome
business.industry
Retrospective cohort study
medicine.disease
biology.organism_classification
business
030217 neurology & neurosurgery
Zdroj: Medicine
ISSN: 1536-5964
Popis: Supplemental Digital Content is available in the text
Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment. A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment. Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment. While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.
Databáze: OpenAIRE
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