Abstract
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.
Document Type
Article
Publication Date
3-2018
Digital Object Identifier (DOI)
https://doi.org/10.1097/md.0000000000010245
Funding Information
Albert M. Anderson, MD is currently receiving funding through NIH grant K23MH095679.
Related Content
Supplemental digital content is available for this article. Supplemental table: Course of central nervous system imaging abnormalities
Repository Citation
Wheat, Joseph; Myint, Thein; Guo, Ying; Kemmer, Phebe; Hage, Chadi A.; Terry, Colin; Azar, Marwan M.; Riddell, James; Ender, Peter; Chen, Sharon; Shehab, Kareem; Cleveland, Kerry; Esguerra, Eden; Johnson, James; Wright, Patty; Douglas, Vanja; Vergidis, Pascalis; Ooi, Winnie; Baddley, John; Bamberger, David; Khairy, Raed N.; Vikram, Holenarasipur R.; Jenny-Avital, Elizabeth; Sivasubramanian, Geetha; Bowlware, Karen; Pahud, Barbara; Sarria, Juan; Tsai, Townson; Assi, Maha; and Mocherla, Satish, "Central Nervous System Histoplasmosis: Multicenter Retrospective Study on Clinical Features, Diagnostic Approach and Outcome of Treatment" (2018). Internal Medicine Faculty Publications. 161.
https://uknowledge.uky.edu/internalmedicine_facpub/161
Supplemental table: Course of central nervous system imaging abnormalities
Included in
Fungi Commons, Immune System Diseases Commons, Infectious Disease Commons, Nervous System Commons, Respiratory Tract Diseases Commons, Virus Diseases Commons, Viruses Commons
Notes/Citation Information
Published in Medicine, v. 97, issue 13, e0245, p. 1-8.
© 2018 The Authors.
This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
Due to the large number of authors, only the first 30 and the authors affiliated with the University of Kentucky are listed in the author section above. For the complete list of authors, please download this article or visit: https://doi.org/10.1097/md.0000000000010245
An erratum to this article can be found at https://doi.org/10.1097/md.0000000000010245.