Paracoccidioidomycosis compromising the central nervous system: a systematic review of the literature

• Published in: Revista da Sociedade Brasileira de Medicina Tropical 2009-11, Vol.42 (6), p.691
• Main Authors: Pedroso, Vinicius Sousa Pietra, Vilela, Márcia de Carvalho, Pedroso, Enio Roberto Pietra, Teixeira, Antônio Lúcio
• Format: Article
• Language: eng ; por
• Subjects: Adolescent; Adult; Aged; Central nervous system; Central Nervous System Fungal Infections - complications; Central Nervous System Fungal Infections - diagnosis; Central Nervous System Fungal Infections - therapy; Child; Female; Humans; Hypertension; Male; Middle Aged; Paracoccidioidomycosis - complications; Paracoccidioidomycosis - diagnosis; Paracoccidioidomycosis - therapy; Young Adult
• ISSN: 0037-8682; 1678-9849
• DOI: 10.1590/S0037-86822009000600016

This study is the first systematic review of cases of neuroparacoccidioidomycosis available in the literature. Through searches in the MEDLINE and LILACS databases, 257 cases were found in 81 published studies, mainly after the 1970s-1980s. Approximately 93% of the patients were men, especially farm laborers, with a mean age of 43 years. The characteristic symptoms were motor deficits or intracranial hypertension. The chronic pseudotumoral form predominated. The mean period of evolution was 4.9 months. The lesions were mainly supratentorial (66.8%), located in the frontal and parietal lobes. The diagnosis was determined by biopsy in 57.2% of the cases and neuroimaging methods were used in 64.6% of them. A large proportion of the cases were associated with the pulmonary form of the disease (59.1%). The mortality rate was 44.1%, and 50.1% of the survivors developed sequelae, especially motor impairment. Thus, neuroparacoccidioidomycosis should be considered in the differential diagnosis for expansive and meningoencephalitic processes in the central nervous system, in order to establish early treatment and to avoid disabling sequelae.