de Almeida S M, Queiroz-Telles F, Teive H A G, Ribeiro C E L, Werneck L C
Neurology Division, Hospital de Clínicas, Universidade Federal do Paraná, Especialidade de Neurologia, Rua General Carneiro, 181, sala 1236, Curitiba, PR 80060-900, Brazil.
J Infect. 2004 Feb;48(2):193-8. doi: 10.1016/j.jinf.2003.08.012.
To study prospectively the clinical features and laboratorial characteristics of 24 patients with central nervous system (CNS) involvement with paracoccidioidomycosis (PCM). PCM is an infectious disease caused by the dimorphic fungus Paracoccidioides brasiliensis, endemic in subtropical areas of Central and South America.
From 173 cases of PCM, 24 (13.9%) had CNS involvement (NPCM) and were studied prospectively from 1993 to 1997. In all the patients, the diagnosis of systemic PCM was made by the demonstration of the P. brasiliensis organisms or positive serology, DID (double immunodiffusion). In seven cases the diagnosis was made by means of a CNS biopsy. CNS clinical manifestations, neuroimaging (CT or MRI) and CSF cytochemical characteristics were reported.
The mean age was 44 years (range 25-72 years); 23 patients were male, only one was female. Neurological symptoms began before systemic symptoms in 21%; simultaneously in 33%, and after systemic symptoms in 46%. Epilepsy was the more frequent neurological presentation (44%). Twenty-three cases had parenchymatous involvement and in two of these cases there was an association with meningitis and one case had spinal cord involvement. Lesions were more frequent in the brain hemispheres (69%), in 65% there were multiple granuloma characterized by hypodense images with annular or nodular enhancing. All cases were treated with sulphamethoxazole-trimethoprin. Four patients died, while 20 patients showed a good therapeutic response.
NPCM should always be considered in the differential diagnosis of expanding lesions of the CNS and meningoencephalitis. Being alert to this diagnosis depends on knowledge of epidemiology. There was good response to sulphamethoxazole-trimethoprin treatment.
前瞻性研究24例伴有中枢神经系统（CNS）受累的副球孢子菌病（PCM）患者的临床特征和实验室检查特点。PCM是一种由双相真菌巴西副球孢子菌引起的传染病，在中美洲和南美洲的亚热带地区流行。
在173例PCM患者中，24例（13.9%）有CNS受累（NPCM），于1993年至1997年对其进行前瞻性研究。所有患者的系统性PCM诊断均通过巴西副球孢子菌的检出或血清学阳性（双向免疫扩散法）来确定。7例患者通过CNS活检确诊。报告了CNS临床表现、神经影像学（CT或MRI）及脑脊液细胞化学特征。
平均年龄为44岁（范围25 - 72岁）；23例为男性，仅1例为女性。21%的患者神经症状先于全身症状出现；33%同时出现；46%在全身症状之后出现。癫痫是最常见的神经表现（44%）。23例有实质受累，其中2例合并脑膜炎，1例有脊髓受累。病变在脑半球更常见（69%），65%有多个肉芽肿，表现为低密度影像伴环形或结节状强化。所有病例均接受磺胺甲恶唑 - 甲氧苄啶治疗。4例患者死亡，20例患者治疗反应良好。
在CNS扩展性病变和脑膜脑炎的鉴别诊断中应始终考虑NPCM。对该诊断保持警惕取决于对流行病学的了解。磺胺甲恶唑 - 甲氧苄啶治疗反应良好。
