Long-term outcome of neuroparacoccidioidomycosis treatment

Revista da Sociedade Brasileira de Medicina Tropical

Fabio Francesconi²  Marcus Tulius Teixeira Da Silva¹  Regina Lana Braga Costa¹  Valeska Albuquerque Francesconi²  Eleonora Carregal¹  Sinésio Talhari¹  Antonio Carlos Francesconi Do Valle¹ 

[1] ,Manaus Oncology Control Foundation Center Dermatology Department Manaus AM ,Brazil

关键词: Paracoccidioides brasiliensis;    Neuroparacoccidioidomycosis;    Treatment;    Central nervous system infection;    Paracoccidioides brasiliensis;    Neuroparacoccidioidomicose;    Tratamento;    Infecção do sistema nervoso central;   

DOI  :  10.1590/S0037-86822011000100006

来源: SciELO

【 摘 要 】

INTRODUCTION: 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.

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